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• W2316730502 abstract "Purpose: Osteoarthritis (OA) of the hip and knee are common chronic conditions, often resulting in substantial pain and physical function limitations. Although many patients with OA experience multiple comorbid health conditions, there has been limited research on the impact of overall comorbidity or specific comorbid conditions among individuals with OA. The objective of this analysis was to examine the associations of different indices of comorbidity with patient-reported outcomes (PROs) in patients with hip and knee OA. Methods: Baseline data were obtained from an ongoing randomized clinical trial comparing a combined patient and provider intervention relative to usual care in the Department of Veterans Affairs healthcare system. All participants had hip and / or knee OA, were overweight, and were not meeting physical activity recommendations. Individual multivariable regression models were conducted for five PROs: pain (Western Ontario and McMasters Universities Osteoarthritis Index; WOMAC subscale); physical function (WOMAC subscale); depressive symptoms (Patient Health Questionnaire-8); fatigue (Visual Analogue Scale); and insomnia (Insomnia Sleep Index). Separate models were conducted for each of six self-reported measures of comorbidity: Self-Administered Comorbidity Questionnaire (SACQ), a modified version of the SACQ that summed the number of conditions participants indicated as activity-limiting (SACQ-AL), and individual indicators of the most selr-reported common comorbid conditions: depression, diabetes, hypertension, and back pain. Because all patients had OA, arthritis was omitted from the comorbidity scores. All models controlled for the following factors age, race (white vs. non-white), gender (male vs. female), marital status (married/living with partner vs. other), financial status (live comfortably/meet basic expenses vs. just meet basic expenses/don’t have enough), body mass index, number of joints with OA-related symptoms, and number of years with symptoms. Results: 300 patients completed baseline assessments; mean age was 61.0 (SD = 9.2) and 9.3% were female. On average, patients reported 3 comorbid conditions and 1.6 activity limiting conditions on the SACQ. The overall comorbidity score (SACQ) was associated with worse pain (β = 0.15, 95% CI 0.04-0.26, p < 0.01), depressive symptoms(β = 0.42,95% CI 0.28-0.56, p < 0.01), fatigue (β = 0.16, 95% CI 0.07-0.25, p < 0.01), and insomnia (0.58, 95% CI 0.36-0.80, p < 0.01). Comorbid activity-limiting conditions (SACQ-AL) were associated with worse scores for all PROs: pain (β = 0.67, 95% CI 0.35-0.98, p < 0.01), physical function (β = 2.11, 95% CI 1.06-3.16, p < 0.01), depressive symptoms (β = 1.41, 95% CI 1.01-1.81, p < 0.01), fatigue (β = 0.65, 95% CI 0.39-0.91, p < 0.01), and insomnia (β = 1.83, 95% CI 1.21-2.45, p < 0.01). Comorbid depression was associated with worse pain (β = 1.02, 95% CI 0.13-1.91, p = 0.03), fatigue (β = 1.61, 95% CI 0.89-2.32, p < 0.01), and insomnia (β = 5.50, 95% CI 3.79-7.21, p < 0.01); a model was not conducted for depressive symptoms. Diabetes was associated with worse fatigue (β = 0.89, 95% CI 0.17-1.60, p = 0.01), insomnia (β = 1.94, 95% CI 0.19-3.70, p = 0.03) and depressive symptoms (β = 1.34, 95% CI 0.18-2.50, p = 0.02). Back pain was only associated with worse WOMAC pain scores (β = 1.16, 95% CI 0.16-2.16, p = 0.02), and hypertension was not significantly associated with any PROs. Conclusions: Measures of comorbidity were associated with worse scores for all PROs. These associations were strongest for SACQ-AL, highlighting the particular importance of additional activity-limiting conditions on health outcomes among patients with OA. Of the individual comorbid conditions, depression and diabetes were associated with the most PROs, reinforcing the importance of standardized screening in this patient group. These results highlight the need for clinical care models and other interventions that simultaneously address the complexity and interrelationships of multiple chronic health conditions in the context of OA." @default.
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• W2316730502 date "2014-04-01" @default.
• W2316730502 modified "2023-10-16" @default.
• W2316730502 title "The association of comorbid conditions with patient reported outcomes in osteoarthritis" @default.
• W2316730502 doi "https://doi.org/10.1016/j.joca.2014.02.337" @default.
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