Purpose: In the context of patient centered care, patients suffering from chronic diseases are expected to be active partners in their treatment and take part in the management of their health condition. These factors play a key role in the chance of success of treatment efficacy in patients suffering from knee osteoarthritis (knee OA). Patients who follow their clinician's recommendations, such as exercising and losing weight, may experience less pain and have an improved functional status and quality of life. However, few studies have assessed patients' self-management ability and to our knowledge, this has never been evaluated yet in patients with knee OA. Thus, the aim of this study was to investigate the associations between self-management perceived ability, functional status and quality of life in patients with mid to late-stage knee OA. Methods: This cross-sectional study was carried out in primary care clinics in the Greater Montreal area (Quebec, Canada). General practitioners were asked to recruit patients with a clinical diagnosis of knee OA (pain, crepitus, swelling and stiffness on physical examination). Patients were selected for participation in this study if 1) they rated their worst pain in the past 7 days >= 4 on a 0-10 pain intensity scale, 2) had a Kellgren-Lawrence (KL) OA grade >= 2 on radiographs as diagnosed by a fellowship-trained musculoskeletal radiologist (NB), and 3) were able to read and understand French. Patients were excluded if they had a history of knee fracture or were currently on awaiting list for knee arthroplasty surgery. Participants were invited to complete a series of validated self-administered questionnaires including the Partners in Health Scale (PIHS), which includes 12 questions measuring the patients' perceived competency in relation to the self-management of their chronic condition in terms of knowledge and behaviors. Each item is scored on a self-rated 9-point Likert scale (range 0-8) so PIHS scores range from 0 to 96; the higher the score is, the better the patients perceive their self-management ability. Health outcomes measures included the Knee Injury and Osteoarthritis Outcome Score (KOOS), which is a widely used instrument for measuring knee OA symptoms and their impact; it comprises 5 subscales: Symptoms, Pain, Activities of Daily Living (ADL), Sports and Recreation Function (Sport/Rec) and knee-related Quality Of Life (QOL). Each question is assigned a 0-4 score and a normalized score is calculated for each subscale (100 indicating no symptoms and 0 indicating extreme symptoms). Results: 207 patients from 30 clinics with mid to late-stage knee OA participated in the study. There were 60.9% women, the mean age was 62.8 years (standard deviation SD: 9.5). More than 9 out of 10 patients completed secondary school (40.1%), high school (30%), college or higher (22.2%). About half of patients had bilateral OA (48.3%). More than twothirds had an OA KL-grade of 3 (37.2%) or 4 (31.4%). Interestingly, patients had relatively high PIHS scores on the average (mean: 79, SD: 12.6) suggesting that they perceived their knowledge and ability for selfmanagement as being good. Mean scores on the KOOS subscales were the following: symptoms (61.9; SD: 18.3), pain (59.4 ; SD: 18.7) and ADL (65.8; SD: 19.5); scores on Sports/Rec (36.8; SD: 25.9) and QOL (49.6; SD: 24.1) subscales were lower. On average, women had higher PIHS scores than men (80.3 vs 77) but the difference did not reach statistical significance. There was no significant correlation between PIHS scores and education levels. PIHS scores were significantly correlated with all KOOS subscales (Symptoms (r = 0.24), pain (r = 0.26), ADL (r = 0.33), Sports/ Rec (r = 0.25) and QOL (r = 0.34); all p < 0.01), suggesting that patients' self-management ability had some impact on their health condition. However, these correlation coefficients, although statistically significant, remain small with less than 10% of explained variability. Conclusions: The results of this study show that the patients estimated that they have a goo knowledge of their health condition and that they feel competent for self-managing it. The more competent they felt in their ability for self-management, the better their condition was. However, this perceived ability explained only a small proportion of the variation in their symptomatology. This suggests that there is still a lot of room for educating, supporting, and empowering knee OA patients so they take an active role in the management of their condition, especially through exercise programs that target functional improvements.
Cagnin, A., Choinière, M., Bureau, N. J., De Polo, L., Saïdi, H., & Hagemeister, N. (2017). Self-management, Functional Status and Knee-related Quality of Life in Older Adults with Mid to Late-stage Knee Osteoarthritis. Osteoarthritis and Cartilage, 25, S338. https://doi.org/10.1016/j.joca.2017.02.568