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Is Self-Reported Improvement in Osteoarthritis Pain and Disability Reflected in Objective Measures?
SINDHU R. JOHNSON, ALISON ARCHIBALD, AILEEN M. DAVIS, ELIZABETH BADLEY, JAMES G. WRIGHT, and GILLIAN A. HAWKER ABSTRACT. Objective. To determine if self-reported improvements in pain and function correlate with improvement in objective measures of disease in osteoarthritis (OA). Methods. Individuals with disabling hip/knee OA were assessed 7 years apart by questionnaire [sociodemographics, body mass index, and Western Ontario and McMaster University Osteoarthritis Index (WOMAC) scores] and physical [range of motion (ROM), disease activity based on joint stress pain, erythema, warmth, effusion] and radiographic examination of the hips and knees (Kellgren-Lawrence grade). Changes over time were expressed as improved, unchanged, or worse based on a priori criteria. Results. Of 69 eligible patients, 43 (64%) with a mean age of 76.3 years participated; 77% were female. For WOMAC scores, 25% and 19% reported improved pain and function, respectively. For joint ROM, disease activity, and radiographic grade, 0% to 30% of participants were improved. However, improvements in WOMAC scores were not associated with improvements in any of the other measures (r < 0.24 for all). Conclusion. One-quarter of participants reported significant improvements in WOMAC pain and disability after 7 years' followup. However, these improvements were not associated with similar improvements in joint ROM, disease activity, or radiographic grade. Greater understanding of the determinants of self-reported improvements in arthritis status, in particular the role of adaptation, is warranted. (First Release Dec 1 2006; J Rheumatol 2007;34:159–64) Key Indexing Terms:
OSTEOARTHRITIS From the Department of Health Policy, Management and Evaluation; Division of Rheumatology, University Health Network; Toronto Rehabilitation Institute; Toronto Western Research Institute; Department of Public Health Sciences; Division of Orthopedic Surgery, The Hospital for Sick Children; and Division of Rheumatology, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada. Supported by the Physicians' Services Incorporated Foundation. Dr. Johnson is the recipient of a research fellowship award from The Arthritis Society and the Institute for Musculoskeletal Health and Arthritis/Canadian Institutes of Health Research. Dr. Davis is supported by a Canadian Institutes of Health Research New Investigator Award. Dr. Wright is supported by the Robert B. Salter Chair in Surgical Research. Dr. Hawker is supported as a Canadian Institutes of Health Research Scientist and the F.M. Hill Chair in Academic Women's Medicine, University of Toronto. S.R. Johnson, MD, FRCPC, Department of Health Policy, Management and Evaluation and Division of Rheumatology, University Health Network; A. Archibald, MD, MDA, Osteoarthritis Research Program, Women's College Hospital; A.M. Davis, BScPT, MSc, PhD, Department of Health Policy, Management and Evaluation and Toronto Western Research Institute; E. Badley, MD, Toronto Western Research Institute and Department of Public Health Sciences; J.G. Wright, MD, FRCSC, Department of Health Policy, Management and Evaluation and Division of Orthopedic Surgery, The Hospital for Sick Children; G.A. Hawker, MD, MSc, FRCPC, Professor, Department of Health Policy, Management and Evaluation, Division of Rheumatology, Women's College Hospital, and Osteoarthritis Research Program, Women's College Hospital, University of Toronto, Toronto, Canada. Address reprint requests to Dr. G. Hawker, Women's College Hospital, 76 Grenville Street, 8th Floor East, Room 815, Toronto, Ontario M5S 1B2, Canada. E-mail: g.hawker@utoronto.ca Accepted for publication August 1, 2006. |
