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Comorbidities in Patients With End-Stage Knee OA: Prevalence and Effect on Physical Function

  • Won Bin Kim
    Affiliations
    Department of Rehabilitation Medicine, Jeju National University School of Medicine, Regional Rheumatoid and Degenerative Arthritis Center, Jeju National University Hospital, Jeju, Republic of Korea
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  • Bo Ryun Kim
    Correspondence
    Corresponding author Bo Ryun Kim, MD, PhD, Department of Rehabilitation Medicine, Jeju National University, School of Medicine, Regional Rheumatoid and Degenerative Arthritis Center, Jeju National University Hospital, Aran 13 gil 15, Jeju 63241, Republic of Korea.
    Affiliations
    Department of Rehabilitation Medicine, Jeju National University School of Medicine, Regional Rheumatoid and Degenerative Arthritis Center, Jeju National University Hospital, Jeju, Republic of Korea
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  • Sang Rim Kim
    Affiliations
    Department of Orthopaedic Surgery, Jeju National University School of Medicine, Regional Rheumatoid and Degenerative Arthritis Center, Jeju, Republic of Korea
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  • Eun Young Han
    Affiliations
    Department of Rehabilitation Medicine, Jeju National University School of Medicine, Regional Rheumatoid and Degenerative Arthritis Center, Jeju National University Hospital, Jeju, Republic of Korea
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  • Kwang Woo Nam
    Affiliations
    Department of Orthopaedic Surgery, Jeju National University School of Medicine, Regional Rheumatoid and Degenerative Arthritis Center, Jeju, Republic of Korea
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  • So Young Lee
    Affiliations
    Department of Rehabilitation Medicine, Jeju National University School of Medicine, Regional Rheumatoid and Degenerative Arthritis Center, Jeju National University Hospital, Jeju, Republic of Korea
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  • Suh Min Ji
    Affiliations
    Department of Rehabilitation Medicine, Jeju National University School of Medicine, Regional Rheumatoid and Degenerative Arthritis Center, Jeju National University Hospital, Jeju, Republic of Korea
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  • Jong Hyun Kim
    Affiliations
    Department of Rehabilitation Medicine, Jeju National University School of Medicine, Regional Rheumatoid and Degenerative Arthritis Center, Jeju National University Hospital, Jeju, Republic of Korea
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      Abstract

      Objective

      To investigate the prevalence of comorbidities and their effect on physical function, quality of life (QOL), and pain, in patients with end-stage knee osteoarthritis (OA).

      Design

      A cross-sectional study.

      Setting

      A rehabilitation facility at university hospital.

      Participants

      Patients (N=577; 503 women and 74 men) diagnosed with end-stage knee OA between October 2013 and June 2018.

      Intervention

      Not applicable.

      Main Outcome Measures

      Comorbidities were as follows: osteoporosis, presarcopenia, degenerative spine disease, diabetes, and hypertension. All patients completed the following performance-based physical function tests: stair-climbing test (SCT), 6-minute walk test (6MWT), timed Up and Go (TUG) test, and gait analysis. Self-reported physical function and pain were measured using Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) and a visual analog scale (VAS), respectively, and self-reported QOL was measured using EuroQoL 5 dimensions (EQ-5D) questionnaire.

      Results

      Univariate analyses revealed that patients with osteoporosis had significantly higher scores in SCT ascent, SCT descent, TUG, WOMAC pain tests, and lower scores in 6MWT, gait speed, and cadence tests than those without osteoporosis. Patients with presarcopenia recorded higher scores in SCT ascent, TUG, EQ-5D, and lower scores in 6MWT and gait speed tests than those without presarcopenia. Patients with degenerative spine disease showed higher scores in WOMAC pain and lower scores in gait speeds than those without degenerative spine disease. Patients with diabetes showed higher scores in SCT ascent than those without diabetes, and patients with hypertension showed lower scores in 6MWT than those without hypertension. After adjusting age, sex, and body mass index, SCT descent retained significant association with osteoporosis, SCT ascent showed independent association with presarcopenia and diabetes, and WOMAC pain revealed significant association with degenerative spine disease.

      Conclusion

      The results confirm associations between comorbidities, performance-based and self-reported physical functions, and QOL in patients with end-stage knee OA.

      Keywords

      List of abbreviations:

      6MWT (6-minute walk test), BMI (body mass index), CI (confidence interval), EQ-5D (EuroQoL 5 dimensions), OA (osteoarthritis), OR (odds ratio), QOL (quality of life), SCT (stair-climbing test), TKA (total knee arthroplasty), TUG (timed Up and Go), VAS (visual analog scale), WOMAC (Western Ontario McMaster Universities Osteoarthritis Index)
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