Knee pain and health-related quality of life among older patients with different knee osteoarthritis severity in Saudi Arabia

Society's Misconceptions About Intra-articular Injections: A Cross-Sectional Study From Saudi Arabia

Objective This cross-sectional study aimed to identify and analyze misconceptions prevalent in Saudi Arabian society regarding intra-articular injections and their sources. It also sought to explore factors influencing patients' decision-making in the context of osteoarthritis (OA) treatment. Methods A sample of 405 adult participants from various educational backgrounds residing in Saudi Arabia completed a self-administered questionnaire. The survey focused on participants' knowledge about intra-articular injections, their sources of information, and their beliefs and perceptions related to these injections. Results The study unveiled a significant lack of awareness among the participants, with almost half (48.4%) reporting no knowledge of intra-articular injections. Of all, 16.1% held misconceptions about these injections, including believing that they are painful or they liquify the bone. Participants expressed varied thoughts on the effects of intra-articular injections, with 69.6% associating them with short-term pain relief. While 60.2% disagreed that intra-articular injections could provide long-term pain relief, 65.2% believed that these injections could delay the need for surgery. The source of knowledge varied, with 34.4% relying on orthopedics and 32.5% on friends and relatives. In those who had received intra-articular injections (n = 62), 83.9% cited the desire to delay or avoid surgery as a reason. While 56.5% were very satisfied with their doctor's guidance, 46.8% expressed concerns about relying on injections in the future. Furthermore, educational levels were correlated with knowledge, highlighting the need for more accessible and tailored patient education materials. However, even among those with a university education, misconceptions persisted. Effective patient-doctor communication was associated with secondary or university education (χ² = 11.05, p = 0.011). Conclusion The prevalence of misconceptions regarding intra-articular injections in Saudi Arabia underscores the need for comprehensive patient education and improved communication between healthcare providers and patients. Addressing these misconceptions is essential for empowering patients to make informed decisions about their healthcare and enhancing the overall quality of care they receive. This study's findings have implications not only for Saudi Arabia but also for healthcare systems globally, emphasizing the significance of patient-centered care and informed decision-making.

Associations Among Knee Osteoarthritis Severity, Body Mass Index, and Physical Functions in Saudi Arabian Adults: A Multi-Center Cross-Sectional Study

Background The purpose of this study was to investigate the associations among knee osteoarthritis severity, body mass index, and physical functions in Saudi Arabian adults. Methodology In this multi-center, cross-sectional study, we performed a secondary data analysis that included 189 adults aged 55 years or above with doctor-diagnosed knee osteoarthritis enrolled in five hospitals in Riyadh, Saudi Arabia, between March 2016 and March 2017. According to knee osteoarthritis severity, all of the individuals were divided into the following three groups: mild (n = 36), moderate (n = 75), and severe (n = 78). A high body mass index was defined as a body mass index score of >25 kg/m2. Physical function was evaluated using the 36-item physical functioning subscale. Results Severe knee osteoarthritis had a significantly 6.47-fold (95% confidence interval (CI) = 2.95-14.22, p < 0.0001) higher risk of physical function than those with mild knee osteoarthritis after adjusting for age, sex, educational status, occupational status, affected knee with osteoarthritis, knee pain, and body mass index. However, moderate knee osteoarthritis had a 1.22-fold higher risk of physical function, but the association was not statistically significant (95% CI = 0.60-2.49, p = 0.578). Conclusions Severe but not moderate knee osteoarthritis was more likely to have the worst physical function than mild knee osteoarthritis among adults with a high body mass index in Saudi Arabia.

The Relationship Between Knee Osteoarthritis-Related Pain Severity and Daily Activities Involving the Upper and Lower Limbs in Saudi Adults: A Cross-Sectional Study

Introduction Earlier research has shown an association between pain intensity and everyday activities in adults. However, it is vital to examine the relationship within the context of Saudi people who have knee osteoarthritis. Therefore, this study aimed to explore the connection between pain intensity and daily activities involving the lower and upper limbs among patients with knee osteoarthritis in Saudi Arabia. Methods This study enrolled 209 individuals aged 55 years and above who were diagnosed with radiographic knee osteoarthritis by physicians from five hospitals in Riyadh, Saudi Arabia, between March 2016 and March 2017. Participants were divided into two groups based on their pain intensity, measured using the visual analog scale. The first group included 141 individuals with mild or moderate pain, while the second group comprised 68 individuals with severe pain. The study assessed the physical functioning of these individuals by evaluating their ability to perform daily activities involving the lower and upper limbs, using the Physical Functioning Subscale of the 36-item Short Form Health Survey, which includes 10 items. Results Adjusted logistic regression analysis revealed that individuals experiencing severe pain related to knee osteoarthritis were more likely to encounter difficulties in climbing several flights of stairs (odds ratio [OR] = 1.19, 95% confidence interval [CI] = 1.09-1.29), and one flight of stairs (OR = 1.19, 95% CI = 1.06-1.34), with challenges in bending, kneeling, or stooping (OR = 1.14, 95% CI = 1.05-1.23), walking more than one mile (OR = 1.15, 95% CI = 1.06-1.25), walking several blocks (OR = 1.17, 95% CI = 1.08-1.27), and walking one block (OR = 1.19, 95% CI = 1.06-1.34) than those with mild or moderate pain. Conclusion Our study results highlight the significant impact of severe pain on activities like climbing stairs, bending, kneeling, stooping, and walking longer distances among people with knee osteoarthritis in Saudi Arabia.

Prevalence of Symptomatic Knee Osteoarthritis in Saudi Arabia and Associated Modifiable and Non-Modifiable Risk Factors: A Population-Based Cross-Sectional Study

OBJECTIVE

This study aimed to determine the prevalence of knee osteoarthritis (OA) in Saudi Arabia and the association between knee OA and modifiable and non-modifiable risk factors.

METHODS

A self-reported, population-based, cross-sectional survey between January 2021 and October 2021 was conducted. A large, population-representative sample (n = 2254) of adult subjects aged 18 years and over from all regions of Saudi Arabia was collected electronically using convenience sampling. The American College of Rheumatology (ACR) clinical criteria were used to diagnose OA of the knee. The knee injury and osteoarthritis outcome score (KOOS) was used to investigate the severity of knee OA. This study focused on modifiable risk factors (body mass index, education, employment status, marital status, smoking status, type of work, previous history of knee injury, and physical activity level) and non-modifiable risk factors (age, gender, family history of OA, and presence of flatfoot).

RESULTS

The overall prevalence of knee OA was 18.9% (n = 425), and women suffered more compared to their male counterparts (20.3% vs. 13.1%, p = 0.001). The logistic regression analysis model showed age (OR: 1.06 [95% CI: 1.05-1.07]; p < 0.01), sex (OR: 2.14 [95% CI: 1.48-3.11]; p < 0.01), previous injury (OR: 3.95 [95% CI: 2.81-5.56]; p < 0.01), and obesity (OR: 1.07 [95% CI: 1.04-1.09]; p < 0.01) to be associated with knee OA.

CONCLUSIONS

A high prevalence of knee OA underlines the need for health promotion and prevention programmes that focus on modifiable risk factors to decrease the burden of the problem and the cost of treatment in Saudi Arabia.

Factors influencing quality of life in patients with osteoarthritis: analyses from the BISCUITS study

OBJECTIVES

Osteoarthritis can have a profound effect on patients' quality of life. The Burden of Disease and Management of Osteoarthritis and Chronic Low Back Pain: Health Care Utilization and Sick Leave in Sweden, Norway, Finland and Denmark (BISCUITS) study aimed to describe the impact of osteoarthritis on quality of life and determine the association with factors such as pain severity and pharmacological treatment.

METHODS

An observational study was performed with a cross-sectional design including patients with a confirmed osteoarthritis diagnosis enrolled in the National Quality Register for Better management of patients with Osteoarthritis (BOA) between 2016 and 2017 in Sweden. Patient-reported information from BOA was linked to administrative data from three national health registers. The impact of osteoarthritis on quality of life was estimated using the EQ-5D-5L and the first developed experienced-based time-trade-off value set for Sweden to calculate the EQ-5D-5L index scores. EQ-5D-3L index scores were also estimated based on a UK hypothetical value set via a crosswalk method. Ordinary least squares regression models were used to analyse the association between quality of life and potential influencing factors.

RESULTS

For the 34,254 patients evaluated, mean EQ-5D-5L index score was 0.792 (SD 0.126). Stratifications showed that the index score varied across different levels of pain severity. Increased pain severity and use of pain-relieving medications remained significantly associated with a lower quality of life index score when controlled for potential confounders. The mean EQ-5D-3L index score was 0.605 (SD 0.192).

CONCLUSIONS

This large population-based study from Sweden highlights the substantial impact of osteoarthritis on quality of life amongst different patient groups and that currently available treatment options for osteoarthritis pain do not appropriately address the needs for many osteoarthritis patients.

Development and Validation of a New Patient-Reported Outcome Measure in the Arabic Language for Patients with Knee Osteoarthritis in Saudi Arabia

PURPOSE

In Western countries, several patient-reported outcomes (PROs) measures have been developed and validated for knee osteoarthritis (OA) patients. While few PROs have been adopted for these patients in Saudi Arabia, which do not reflect all aspects of the Saudi socio-cultural context. Given this shortcoming, this study aimed to develop a new PRO measure in Arabic that covers all concepts related to health, function, and participation encompassing environmental and personal factors.

PATIENTS AND METHODS

A cross-sectional study was conducted on 73 males and females aged ≥55 diagnosed with radiographic knee OA recruited from the orthopedic and physiotherapy departments of five hospitals in Riyadh, Saudi Arabia, between September 2016 and March 2017. Physicians confirmed knee OA according to the American College of Rheumatology standards. We examined the psychometric properties of the new Arabic PRO measure.

RESULTS

The internal consistency and test-retest (a one-week interval) reliabilities were found acceptable and excellent with Cronbach's alpha and the intra-class correlation coefficient, ranging from 0.69 to 0.85 and 0.88 to 0.91, respectively. The construct validity was found fair with the correlation between the subscales Body Function and Physical Function (rs =0.63), Activity & Participation and Physical Function (rs =0.72), and Body Function and Bodily Pain (rs =0.58). We found a weak to fair correlation between the new Arabic PRO measure's subscales and the SF-36 physical composite scale (PCS: rs =0.34-0.69) compared to the mental-composite scale (MCS: rs =0.16-0.55).

CONCLUSION

The 33-item new Arabic PRO measure is a well-accepted, reliable, and valid tool for use in knee OA patients in the Saudi cultural context.

Cross-cultural adaptation and validation of the Arabic version of the Pain Self-Efficacy Questionnaire in Arab people with chronic low back pain

BACKGROUND

The Pain Self-Efficacy Questionnaire (PSEQ) is widely used worldwide to measure pain self-efficacy. However, an Arabic translation is not available yet.

OBJECTIVE

The study aimed to culturally adapt and validate the Arabic version of the Pain Self-Efficacy Questionnaire (PSEQ-A) in Arab people with Chronic Low Back Pain (LBP).

METHODS

This study was conducted in two phases. The first phase involved translation and cross-cultural adaptation of the PSEQ into Arabic. The second phase aimed to examine the reliability and validity of the PSEQ-A. One hundred Arab people with chronic LBP completed the PSEQ-A and some self-report questionnaires, such as pain intensity, fear of movement, disability, and life quality.

RESULTS

Cronbach's alpha for the PSEQ-A was 0.90. The interclass correlation coefficient of the PSEQ-A was 0.79. The standard error of the measurement and the minimal detectable change of the PSEQ-A scores were 5.27 and 14.60, respectively. The PSEQ-A has one factor structure. The PSEQ-A correlated significantly (P < .01) with disability, fear of movement, and quality of life in the expected hypothesized directions.

CONCLUSION

The PSEQ-A was well accepted and exhibited validity and acceptable reliability in Arab people with chronic LBP.

Assessing the Burden of Osteoarthritis in Africa and the Middle East: A Rapid Evidence Assessment

Introduction/Objectives

This rapid evidence assessment (REA) was conducted to assess the burden of weight-bearing joint osteoarthritis in the developing countries of Africa and the Middle East.

Methods

Our REA methodology used a standardized search strategy to identify observational studies, published between January 1, 2010, and April 23, 2020, reporting on outcomes pertaining to the epidemiology and humanistic or economic burden of weight-bearing osteoarthritis. Relevant data from the included studies were used for qualitative analysis.

Results

Among the 20 publications reporting on knee osteoarthritis in 10 countries in Africa and the Middle East, 2 also reported on hip, and 1 on foot osteoarthritis. Prevalence of symptomatic/radiographic knee OA was 9-14% among rheumatology outpatients and 31-34% among those with mixed etiology osteoarthritis. Prevalence of knee OA diagnosed by magnetic resonance imaging was 70% among patients ≥40 years of age attending a hospital in Saudi Arabia. Quality-of-life outcomes were reported in 16 publications and suggested a substantial humanistic burden of osteoarthritis, including worse pain, function, and quality of life, and more depression; comparisons between studies were hampered by the variety of tools and scoring scales used, however. No studies reported on economic outcomes.

Conclusion

This REA indicates a substantial burden of osteoarthritis in weight-bearing joints in Africa and the Middle East, consistent with publications from other regions of the world.

Functional and biochemical improvement following total knee arthroplasty in early postoperative period

OBJECTIVE

There are very few studies about total knee arthroplasty biomechanical and biochemical effects in the early postoperative period. The aim of this study was to investigate the effect of total knee arthroplasty on pain intensity, knee joint valgus angle, malalignment, functional status, knee joint position sense, and cytokine levels.

METHODS

A total of 29 patients (female/male: 24/5) who underwent total knee arthroplasty were included in the late-stage knee osteoarthritis group, and 22 patients (female/male: 13/9) with grade 4 osteoarthritis were included in the early-stage knee osteoarthritis group. The visual analog scale and the Western Ontario and McMaster Universities Osteoarthritis Index were used to evaluate the pain intensity and functional status. Alignment and knee position sense measurements were also calculated. Systemic venous blood samples were taken to evaluate the interleukin-6, tumor necrosis factor-alpha, and interleukin-1 beta cytokine levels.

RESULTS

In the study group, there were positive improvements in pain intensity, functional status, valgus angle, malalignment, amount of joint position sense deviation at 70° knee flexion angle parameters, and interleukin-6 of patients at the postoperative 6th week compared to the preoperative period (p<0.05). The patients in the study group had similar or better results in pain intensity, functional status, valgus angle, malalignment, amount of joint position sense deviation at 35°, 55°, and 70° knee flexion angles parameters, and in interleukin-6, compared to the control group at postoperative 6th week.

CONCLUSION

Total knee arthroplasty provides improvements in pain, function, valgus angle, joint position sense, and interleukin-6 in the early postoperative period.

A Comparison Between the Effect of Combined Chain Exercises Plus Kinesio Taping With Combined Chain Exercises Alone in Knee Osteoarthritis: A Randomized Clinical Trial

OBJECTIVE

This study aimed to examine the effect of Kinesio taping as an adjunct to combined chain exercises compared with combined chain exercises alone in the management of individuals with knee osteoarthritis.

METHODS

A total of 60 (27 male, 33 female) individuals (age range = 50-71 yrs and mean age = 54.26 ± 8.83 yrs) diagnosed as having mild to moderate knee osteoarthritis (based on the Kellgren and Lawrence grade I-III classification) were randomly allocated into two groups with 30 participants each in the Kinesio taping + combined chain exercises and combined chain exercises groups. Participants in the Kinesio taping + combined chain exercises group received Kinesio taping plus combined chain exercises and those in the combined chain exercises group received only combined chain exercises. Each participant was assessed for pain, range of motion, functional mobility, and quality of life at baseline and after 8 wks of intervention. A mixed-design multivariate analysis of variance was used to analyze the treatment effect.

RESULTS

No significant differences were observed in the baseline characteristics of participants in both groups. The result indicated that there was a significant time effect for all outcomes, with a significant interaction between time and intervention (P < 0.001). The Bonferroni post hoc analyses of time and intervention effects indicated that the Kinesio taping + combined chain exercises group improved significantly better than the combined chain exercises group in all outcomes, pain (mean = 2.01 [0.64] vs. 3.94 [1.12], F[df] = 5.466[1,58], P = 0.011), flexion range of motion (mean = 121.15 [2.07] vs. 104.28 [3.24], F[df] = 26.722[1,58], P < 0.001), functional mobility (mean = 19.47 [1.95] vs. 31.01 [2.39], F[df] = 29.436[1,58], P < 0.001), and quality of life (mean = 68.76 [3.19] vs. 45.62 [2.87], F[df] = 71.984[1,58], P < 0.001), after 8 wks of intervention.

CONCLUSIONS

The findings of this study concluded that Kinesio taping + combined chain exercises and combined chain exercises were both effective but Kinesio taping plus combined chain exercises was more effective in the management of individuals with knee osteoarthritis.

TRIAL REGISTRATION

Pan African Clinical Trial Registry: PACTR201810603949411.

Mental health research studies in Saudi Arabia for the years 2009-2019; a systematic scoping review

BACKGROUND

An updated systematic scoping review and narrative analysis of all possible mental health studies done during the concerned immediate years clarifies its present condition and status for all professionals, and concerned researchers.

AIMS

To synthesize published mental health research studies in and for Saudi Arabia for the years 2009-2019 with the confidence to evaluate current situation, identify research gaps and limitations (if any), and assist in conceptualizing the forthcoming directions of future mental health research activities.

METHODS

Scoping systematic review and modified narrative analysis were the methods utilized to achieve the aim and objective set for this formal academic endeavor.

RESULTS

Of the 1006 published studies identified from chosen databases, a total of 241 papers were included and had passed the stringent criteria set for the scoping review process. Basic characteristics of the reviewed studies were quantitative survey type with about 101-500 size range of respondents, utilizing non-patients and adults for participants which were common and randomly chosen from selected population, and most research activities were self-funded. Four major research themes were found including a list of research limitations.

CONCLUSIONS

This systematic scoping review identified a wide range of results characterizing the different studies that qualified using pre-determined inclusion-exclusion criteria. Though of increasing publication volume in the past decade, most researches done were quantitative survey type whose themes seemed to show no drastic difference or change from the previous years of output. More variety in research themes would further improve the over-all quality of mental health publications.

Chinese herbal medicine Du-Huo-Ji-Sheng-decoction for knee osteoarthritis: A protocol for systematic review and meta-analysis

BACKGROUND

As a classic prescription for treating knee osteoarthritis, Du-Huo-Ji-Sheng-decoction has been widely recognized for its clinical efficacy. The purpose of this systematic review and meta-analysis is to evaluate the effectiveness and safety of Du-Huo-Ji-Sheng-decoction in the treatment of knee osteoarthritis.

METHODS

The following databases will be searched from January 2011 to December 2020: PubMed, Embase, Web of Science, Cochrane Library, Chinese Biomedical Medical Database, China National Knowledge Infrastructure, Chinese Science and Technology Periodical Database, and Wanfang Database. Statistical analysis will be processed by RevMan V.5.3 software.

RESULTS

This study will provide an assessment of the current state of DHJSD in the treatment of KOA, aiming to show the efficacy and safety of DHJSD.

CONCLUSION

This study will provide evidence to judge whether DHJSD is an effective intervention for KOA.

Health-related quality of life and its influencing factors in Chinese with knee osteoarthritis

PURPOSE

To evaluate the health-related quality of life (HRQoL) of knee osteoarthritis (KOA) patients in China, compare their HRQoL with norm population, and examine the associations between the potential influencing factors and HRQoL.

METHODS

A cross-sectional study was conducted in 912 KOA patients from 4 provinces between March and November 2017. All participants were diagnosed according to the National Institute for Health and Care Excellence (NICE)'s criterion or the Chinese Medical Association (CMA)'s criterion. Recruited patients were surveyed for HRQoL using the 12-item Short Form (SF-12) and sociodemographic, disease-related factors. We assessed the associations between potential influencing factors and HRQoL using multiple linear regression models.

RESULTS

Among the KOA patients, the mean physical component summary (PCS) of HRQoL was 40.91 ± 11.62, lower than norm (P < 0.001). And the mean mental component summary (MCS) was 50.25 ± 11.99, similar to the norm. Patients who were older (β = - 0.155, P = 0.001), women (β =  - 4.589, P < 0.001), had ever been treated (β =  - 2.426, P = 0.006), had longer course of KOA (β =  - 0.164, P = 0.012), and were in early stage (β =  - 2.968, P = 0.001) or progressive/late stage (β =  - 7.636, P < 0.001) showed lower scores of PCS. Patients who lived in Hunan (β = 4.988, P < 0.001) and had education levels of junior high school (β = 3.134, P = 0.012) or senior high school and above (β = 3.050, P = 0.010) had better mental status. Those suffered from non-knee pains (β =  - 2.308, P = 0.027) and with progressive or late KOA (β =  - 4.690, P = 0.016) had lower MCS scores.

CONCLUSION

KOA patients had worse physical condition. The mental and physical health of patients were affected by different factors. Targeted management measures should be taken to improve their HRQoL.

The knowledge and self-management educational needs of older adults with knee osteoarthritis: A qualitative study

Knee osteoarthritis (KOA) is closely related with ageing, physical disability and functional dependency. The course of KOA is considered progressive and irreversible. Engagement with self-management may, however, minimize the impact of KOA. To be fully engaged with self-management activities, knowledge about KOA is a prerequisite. There is limited empirical data on older adults’ understanding on KOA and their information needs about KOA. Therefore, the aims of this study were to explore older adults’ knowledge about KOA and their perspectives on the information required to enable self-management. Three focus groups were conducted with 16 older adults with KOA. The sample consisted of three men and thirteen women with the mean age 73.2 years (range from 61 to 89). Thematic content analysis revealed two themes which were understanding about KOA and information needed about KOA. Participants’ knowledge about KOA varied between individuals with many expressing that they needed more information about KOA. A targeted strategy is needed to educate older adults about KOA in order to support and prepare them for self-management.

Path model of factors influencing health-related quality of life among older people with knee osteoarthritis

Chronic illness has a significant effect on quality of life, and a critical measure of health outcomes. Correlations between pain, depressive symptoms, fatigue, and physical function and their direct and indirect effects on quality of life were determined among 200 Thai older population with knee osteoarthritis using the Numeric Rating Scale, the Multidimensional Assessment of Fatigue, and the Thai Geriatric Depression Scale-15. Physical function was investigated by using the Timed Up and Go test. Path analysis revealed significant negative direct paths from pain, depressive symptoms, fatigue, and Timed Up and Go test results to quality of life. Pain, fatigue, and the Timed Up and Go test results had indirect effects on quality of life, while depressive symptoms had no indirect effect on quality of life. Increases in pain, depressive symptoms, fatigue, and Timed Up and Go test results were associated with reductions in quality of life. An understanding of the complex relationship among these variables is beneficial for designing an appropriate intervention for improving quality of life among older people with knee osteoarthritis.