Physical activity and health-related quality of life in former cricketers with persistent upper-limb or lower-limb joint pain

Abstract

Purpose: Upper and lower-limb osteoarthritis (OA) has a high incidence and burden. Former sport participants with joint pain may be unable to participate in desired forms of activity with potential negative impacts on quality of life (QOL). Most research investigating OA burden has focused on the lower-limb, consequently upper-limb joint pain burden in former sport participants is poorly understood. It is also unclear whether the impact of upper-limb and lower-limb joint pain on physical activity and QOL differs in former sport participants. The purpose of this study was to investigate the relationship between upper-limb (shoulder, elbow, wrist, hand) or lower-limb (hip, knee, ankle) persistent joint pain and i) physical activity levels, and ii) health-related QOL (HRQoL), in former sport participants. Methods: 28,152 current and former cricketers of all playing standards who were registered on a national database were invited via email to complete a survey. 2,598 people responded and consented to the survey. To be eligible for this study, people must have played ≥1 cricket season, be aged ≥18 years and no longer participate in cricket (due to potential confounding of acute injury on joint pain). Persistent joint pain was evaluated by asking individuals if they had joint-specific pain on ‘most days of the last month.’ Subjects were included if they had persistent pain in one or more joints in the upper-limb (shoulder, elbow, wrist or hand) or the lower-limb (hip, knee or ankle), or had no persistent joint pain. Subjects were excluded if they had persistent pain in the upper and lower-limb, or persistent back pain. Outcomes included i) meeting vs. not meeting the physical activity guidelines (<600 METS per week assessed with the International Physical Activity Questionnaire Short-Form), and ii) HRQoL assessed with Short-Form 8 Health Survey (SF-8), Physical Component Scores (PCS) and Mental Component Scores (MCS) were calculated using norm based scoring (population norm 50 SD 10, high scorer = better HRQoL). PCS and MCS scores were dichotomised to low HRQoL (score < 50, below the population norm) vs. high HRQoL (score ≥ 50, above the population norm). Logistic regression investigated the relationship between joint pain, physical activity and HRQoL. Unadjusted and adjusted odds ratios (95% confidence intervals) were calculated. Odds ratios were adjusted for age, body mass index, and the presence of comorbidities. All assumptions for logistic regression were evaluated and satisfied. Results: A total of 570 former cricketers, aged 58 (SD 13) years, BMI of 28.2 (SD 5.4) kg/m2, who had played on average 29 (SD 14) cricket seasons, were included in the analyses. 83 (15%) former cricketers had only upper-limb pain, 170 (30%) had only lower-limb pain, and 317 (55%) had no joint pain. 79 (16%) former cricketers did not meet the physical activity guidelines, 190 (36%) reported PCS scores worse than the population norm and 134 (25%) reported MCS scores worse than the population norm. Upper-limb pain was not associated with meeting the physical activity guidelines (OR 2.3; 95% CI 0.9 to 5.8). Former cricketers with lower-limb pain had a 2.9 (95% CI 1.0 to 3.6) times greater odds of not meeting the physical activity guidelines compared to those with no pain (Table 1). The MCS means per group were: upper-limb pain: 48.75 (SD 7.79); lower-limb pain: 45.99 (SD 8.12); no pain: 52.52 (SD 6.79). The PCS mean scores were: upper limb pain: 53.44 (SD 7.76); lower-limb pain: 53.37 (SD 7.46); no pain: 52.29 (SD 8.05). Former cricketers with upper-limb pain had a 2.5 (95% CI 1.4 to 4.3) times greater odds of reporting a PCS score worse than the population norm, compared to those with no pain. Former cricketers with lower-limb pain had a 4.4 (95% CI 2.8 to 6.9) times greater odds of reporting a PCS score worse than the population norm, compared to those with no pain (Table 2). Joint pain was not associated with MCS scores (Upper-Limb: 0.7; 95% CI 0.4 to 1.4); Lower-Limb: 0.9; 95% CI 0.6 to 1.5) (Table 3). Conclusions: Individuals with lower-limb joint pain were more likely to have reduced physical activity levels compared to those with no joint pain, however this relationship was not observed for individuals with upper-limb joint pain. Both upper-limb and lower-limb joint pain was associated with worse physical components of HRQoL compared with no joint pain. In contrast, mental components of HRQoL were not associated with joint pain. Further research is needed to better understand physical activity impairments and factors influencing HRQoL in former sport participants with upper-limb and lower-limb OA. [Figure presented] [Figure presented] [Figure presented]