Coxarthrosis is one of the most common diseases of the musculoskeletal system, particularly among individuals over 50 years of age, mainly women [1,2].The term ‘arthrosis’ defines all unfavourable changes occurring in tissues, i.e. the effects of biological ageing of cells and degenerative changes inside them [3].
Various social and medical aspects of the quality of life are more often examined in order to find factors affecting mental and physical quality of life and its potential improvement. Assessment of the quality of life in coxarthrosis is a significant clinical examination[4].
The aim of the work was to analyse the quality of life in six age groups with the use of EQ-5D-3L instrument and 36-Item Short Form Health Survey (SF-36)as well as assessing pain intensity with VAS and WOMAC questionnaires. Moreover, living conditions and lifestyle were analysed and correlation between the type of activity performed and pain intensity was assessed.
The research group included 50 individuals (35 females and 15 males aged 50-80) with diagnosed coxarthrosis (ICD–M16.0), who were referred to inpatient treatment at the Rehabilitation Ward of the 3rd Municipal Hospital in Lodz due to the reported hip pain and decrease in gait quality. Patients were selected in purposive sampling and underwent one examination.
Research material was collected with the use of Euro-Quality of Life Questionnaire(EQ-5D-3L), which helps patients assess their own health state, 36-Item Short-Form Health Survey(SF-36TM), i.e. a 36-point health questionnaire including 6 subscales,Visual Analogue Scale (VAS) assessing pain intensity and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). The quality of life was assessed in six age groups: 50-55, 55-60, 60-65, 65-70, 70-75 and 75-80. Moreover, the results of female and male participants were compared.
The distribution of participants with regard togender and age is presented in table 1. In terms of gender, the research group included mainly females (70%), while in terms of age, the biggest group was constituted by the oldest patients (75-80 years of age).
Description of the study group with regard to age and gender
| Wyszczególnienie | Kobiety | Mężczyźni | Razem |
|---|---|---|---|
| 50-55 | 7 | 3 | 10 |
| 55-60 | 4 | 5 | 9 |
| 60-65 | 4 | 1 | 5 |
| 65-70 | 4 | 1 | 5 |
| 70-75 | 5 | 3 | 8 |
| 75-80 | 11 | 2 | 13 |
| Razem / Total | 35 | 15 | 50 |
Mean age in the research population was 66.54, while median age was 66 years. In the group of males, mean age and median age were lower than these values for the whole population (63.87 and 60, respectively). However, in the group of females, mean age and median age were higher than the values for the whole population (67.69 and 68, respectively). The values for age did not show a high level of changeability and oscillated around Vx=14%.
The study participants lived mainly in urban agglomerations, while one in ten patients came from a rural area. Only one in four patients had access to a lift in their place of living; however, the majority of patients lived on the second floor or on a lower level.
The patients were asked whether their families had a history of arthrosis and over half of them said they did not. Two out of five patients had a history of this disease in their families.
Two out of three patients confirmed that they were professionally active. However, it is worth noting that despite their age and medical condition, nearly half of the respondents confirmed that they were physically active in terms of physical recreation, but four out of five patients did not perceive this activity as amateur sport.
Hip pain reported by the patients appeared spontaneously regardless of the time of day while descending or ascending stairs (tab. 2). Some of the participants experienced pain mainly during longterm physical activity.
Correlation between type of activity and hip pain intensity
| Wyszczególnienie | Częstość | Wyszczególnienie | Częstość |
|---|---|---|---|
| samoistnie rano, w nocy, wieczorem/ | 32% | przy czynnościach dnia codziennego – gotowanie, itd./ | 4% |
| przy schodzeniu/wchodzeniu po schodach, podczas długotrwałej aktywności fizycznej, przy czynnościach dnia codziennego, samoistnie rano, w nocy, wieczorem/ | 20% | przy schodzeniu/wchodzeniu po schodach, podczas długotrwałej aktywności fizycznej/ | 4% |
| podczas długotrwałej aktywności fizycznej/ | 14% | przy schodzeniu/wchodzeniu po schodach, samoistnie rano i wieczorem/ | 4% |
| przy schodzeniu/wchodzeniu po schodach/ | 12% | przy schodzeniu/wchodzeniu po schodach, przy czynnościach dnia codziennego/ | 2% |
| podczas długotrwałej aktywności fizycznej, samoistnie rano i wieczorem/ | 8% |
The majority of the study participants experienced intensive pain continuously or for a few hours. Only a few of them experienced short pain incidents with low intensity. A large majority of the patients (66%) reported that the pain decreased after rest. A subjective assessment of health state and life quality was a significant part of the study conducted among patients with diagnosed coxarthrosis. The respondents defined their health state according to the outline of the Euro-Quality of Life Questionnaire(EQ-5D) with a three-level descriptive scale in the following 5 dimensions: mobility, self-care, usual activities (work, study, housework, etc.), pain/discomfort and anxiety/depression. The obtained results are illustrated in table 3.
The list of results ofEQ-5D-3L according to age and levels of problems. Level 1 indicates no problem, level 2 indicates some problems, level 3 indicates extreme problems
| Wymiary EQ-5D 3L | 50-55 lat/ | 55-60 lat/ | 60-65 lat/ | 65-70 lat/ | 70-75 lat/ | 75-80 lat/ | Całość Total | |
|---|---|---|---|---|---|---|---|---|
| zdolność poruszania się / | poziom 1 / | 20.0% | 22.2% | 40.0% | 20.0% | 25.0% | 0.0% | 18.0% |
| poziom 2 / | 80.0% | 77.8% | 60.0% | 80.0% | 62.5% | 100.0% | 80.0% | |
| poziom 3 / | 0.0% | 0.0% | 0.0% | 0.0% | 12.5% | 0.0% | 2.0% | |
| samoopieka/self-care | poziom 1 / | 60.0% | 55.6% | 80.0% | 60.0% | 50.0% | 15.4% | 48.0% |
| poziom 2 / | 40.0% | 44.4% | 20.0% | 40.0% | 37.5% | 84.6% | 50.0% | |
| poziom 3 / | 0.0% | 0.0% | 0.0% | 0.0% | 12.5% | 0.0% | 2.0% | |
| codzienne czynności / | poziom 1 / | 20.0% | 33.3% | 40.0% | 0.0% | 12.5% | 7.7% | 18.0% |
| poziom 2 / | 70.0% | 55.6% | 60.0% | 100.0% | 75.0% | 84.6% | 74.0% | |
| poziom 3 / | 10.0% | 11.1% | 0.0% | 0.0% | 12.5% | 7.7% | 8.0% | |
| ból/dyskomfort/pain/discomfort | poziom 1 / | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% |
| poziom 2 / | 90.0% | 100.0% | 100.0% | 100.0% | 75.0% | 61.5% | 84.0% | |
| poziom 3 / | 10.0% | 0.0% | 0.0% | 0.0% | 25.0% | 38.5% | 16.0% | |
| niepokój/przygnębienie / | poziom 1 / | 40.0% | 22.2% | 60.0% | 20.0% | 25.0% | 0.0% | 24.0% |
| poziom 2 / | 50.0% | 77.8% | 20.0% | 80.0% | 62.5% | 61.5% | 60.0% | |
| poziom 3 / | 10.0% | 0.0% | 20.0% | 0.0% | 12.5% | 38.5% | 16.0% | |
The respondents subjectively assessed the level of the quality of their own life and the level of coxarthrosis-relatedpain which they experienced in the VAS and WOMAC scales (tab. 4).
The list of mean values of BMI, quality of life (SF-36), pain intensity measured with the use of VAS and WOMAC in different age groups
| Wyszczególnienie | BMI | SF36 Wymiar Fizyczny / | SF36 Wymiar Mentalny / | SF36 Ogółem / | VAS | WOMAC_24 |
|---|---|---|---|---|---|---|
| 50-55 lat / yrs | 25.90 | 21.90 | 36.40 | 92.90 | 5.80 | 32.30 |
| 55-60 lat / yrs | 28.00 | 22.56 | 46.00 | 96.33 | 5.44 | 39.11 |
| 60-65 lat / yrs | 29.80 | 23.20 | 46.80 | 100.20 | 3.80 | 30.60 |
| 65-70 lat / yrs | 26.80 | 26.80 | 48.40 | 103.80 | 4.60 | 36.60 |
| 70-75 lat / yrs | 28.25 | 28.50 | 56.63 | 118.25 | 6.88 | 44.63 |
| 75-80 lat / yrs | 27.31 | 32.62 | 57.15 | 118.62 | 6.85 | 52.92 |
| Ogółem /Total | 27.50 | 26.48 | 49.00 | 106.08 | 5.86 | 41.12 |
It can be concluded from the above calculations that the group of patients aged 50-55 assessed their quality of life at the highest level. Life quality index for the physical component was 21.90 points (with the maximal value of 103 points), while for the mental component it was 36.40 points (with the maximal value of 68 points). It is worth highlighting that the group with the best subjective assessment of the quality of life was not the same group as the one that reported the lowest pain intensity. It was the group of patients aged 60-65 who complained the least about pain (VAS and WOMAC). These individuals also had the highest mean BMI. The most intensive pain associated with coxarthrosis was noted in patients aged 70-75 (a mean of 6.88 points in VAS) and 75-80 (a mean of 52.92 points in WOMAC). The results from the scales measuring pain intensity differed significantly from the values for maximal pain, which is a positive result of the study.
The discussion on the situation of patients with coxarthrosis is summarised by a multidimensional comparative analysis with regard to age (tab. 5). The analysis was carried out with the use of taxonomic techniques, i.e. similarity measures and hierarchical clustering. The obtained results led to the conclusion that patients aged 50-55 constituted the group with the best situation in terms of a high quality of life, pain intensity according to VAS and WOMAC, as well as BMI (mi=0.70). The worst results could be noted in the group of oldest patients (mi=0.07). For the purposes of the research, data were standardised and the level of similarity was assessed with the use of Euclidean distance, where values closer to “0” mean higher similarity. In a multidimensional analysis, development pattern method was applied thattakes into account the character and values of variables, which was significant in terms of values coming from different result scales. Values closer to “1” indicate the best situated objects.
Distance matrix and synthetic indicator with regard to age
| Wyszczególnienie | 50-55 lat / yrs | 55-60 lat / yrs | 60-65 lat / yrs | 65-70 lat / yrs | 70-75 lat / yrs | 75-80 lat / yrs | Miara syntetyczna / |
|---|---|---|---|---|---|---|---|
| 50-55 lat / yrs | 0.00 | 0.90 | 1.50 | 1.09 | 1.89 | 2.16 | 0.70 |
| 55-60 lat / yrs | 0.90 | 0.00 | 0.95 | 0.68 | 1.31 | 1.64 | 0.58 |
| 60-65 lat / yrs | 1.50 | 0.95 | 0.00 | 1.00 | 1.80 | 2.19 | 0.53 |
| 65-70 lat / yrs | 1.09 | 0.68 | 1.00 | 0.00 | 1.31 | 1.54 | 0.61 |
| 70-75 lat / yrs | 1.89 | 1.31 | 1.80 | 1.31 | 0.00 | 0.62 | 0.16 |
| 75-80 lat / yrs | 2.16 | 1.64 | 2.19 | 1.54 | 0.62 | 0.00 | 0.07 |
Moreover, similarities between groups of patients were identified in the study. Similarities regarding the quality of life, BMI and pain intensity were noted between the groups of patients aged 70-75 and 75-80 as well as between individuals aged 55-60 and 65-70. The biggest disproportions in the obtained results were not noted between the oldest and the youngest group but between patients aged 60-65 and 75-80.
The reliability of the obtained results was also verified. First, Pearson’s correlation coefficients were calculated and then, the reliability of variables describing patients with coxarthrosis was verified (tab. 6). A high value of Cronbach’s α coefficient proved that the survey results werereliable [5].
Correlation coefficients and reliability coefficient
| Parametr / | BMI | SF36 Wymiar Fizyczny / | SF36 Wymiar Mentalny / | SF36 Ogółem / | VAS | WOMAC_24 |
|---|---|---|---|---|---|---|
| BMI | 1.00 | 0.308* | 0.333* | 0.284* | 0.279* | 0.307* |
| SF36 Wymiar Fizyczny / | 0.308* | 1.00 | 0.590* | 0.617* | 0.457* | 0.399* |
| SF36 Wymiar Mentalny / | 0.333* | 0.590* | 1.00 | 0.897* | 0.590* | 0.713* |
| SF36 Ogółem / Total | 0.284* | 0.617* | 0.897* | 1.00 | .636* | 0.741* |
| VAS | 0.279* | 0.457* | 0.590* | 0.636* | 1.00 | 0.630* |
| WOMAC_24 | 0.307* | 0.399* | 0.713* | 0.741* | 0.630* | 1.00 |
| Statystyki rzetelności α-Cronbacha / | 0.812 |
korelacja istotne dla poziomu istotności α ≤ 0,05 / correlationsignificance α ≤ 0.05
The work presents the results of the analysis of the influence exerted by pain on the quality of life of patients with coxarthrosis. All the obtained values of correlation coefficients proved to be statistically significant, which indicated correlations between the scales of pain andquality of life assessment. These were positive correlations with a moderate and weak strength. However, it is comforting that BMI affected the way the quality of life was perceived to a low extent in all three dimensions and it did not translate into the level of pain reported by the patients. In the SF-36 survey, a mean number of points obtained by the respondents was 106.08. In the WOMAC scale, the patients most often reported moderate pain, while performing usual activities did not cause serious problems. Relatively good results of the quality of life and WOMAC scales do not guarantee the absence of limitations at work and in everyday functioning [6].
Coxarthrosis is a more and more often diagnosed disease of the musculoskeletal system. It is indicated in numerous clinical studies regarding the reasons for degenerative changes and potential preventive activities that slow down the development of the disease[2,7–11,14,16].In the analysis of coxarthrosis causes, hip dysplasia is mentioned most frequently[7].
On the basis of the results of the authors’ own questionnaire, it was concluded that the majority of patients had or still perform standing or physical work, which affects changes in body posture, joint loads and degenerative changes. Similar results were presented by the researchers from the United States.According to Knight et al., financial status exerts a huge influence on health state [8]. Individuals without higher education often have a job (e.g. a cleaner) that require effort and non-ergonomic position. French scientists revealed that cleaners, construction workers and farmers are most prone to degenerative changes[9–11]. Our research shows the influence of overloads resulting from physical work or obesity on the occurrence of degenerative changes. Nearly half of the respondents were overweight, while every fifth of them had BMI that indicated obesity. Polish and Belgian researchers concluded that obesity increased the risk of degenerative changes[12].Korean scientists confirmed the importance of overweight and obesity in the occurrence of this disease after examining 3750 individuals. Gender and age play a significant role in the aforementioned changes; they occurred more often in women regardless of the type of work done currently or in the past[13,14]. Jacobsen revealed a more common incidence of these changes in postmenopausal women [15]. In patients who underwent surgical treatment (prosthetics) of degenerative changes, an increase in the quality of life after the surgery was revealed, mainly in males [16]. Endoprosthetics performed even in the group of elderly individuals increased their quality of life [17].
In the presented analysis, only every fifth patient does sports recreationally, while the majority of the respondents spend their free time at home in front of the TV or sitting and reading (four out of five individuals). Similarly, in the research by Kuciel-Lewandowska, 61.1% of the participants spent their free time in front of the TV [18]. Irish researchers concluded that moderate physical activity or recreational sport does not affect the development of degenerative changes [19]. Unfortunately, the majority of patients perceive such activities as going to work or everyday activities (e.g. cleaning, cooking, etc.) as physical activity. Recreational sport, walking and healthy diet rich in vegetables and fruit help to maintain proper body mass and, therefore, delay or prevent complaints connected with degenerative changes. According to Lun V, Marsh A et al., the quality of life increased after implementing physical activity [20].A decreasing level of physical fitness brings about mood deterioration, which, in turn, may lead to depression and a decrease in the quality of life [21].
On the basis of the conducted research and the obtained results, the following conclusions were formulated:
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the biggest age group with coxarthrosis is constituted by patients aged 75-80;
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the highest quality of life can be noted in the group of patients aged 50-55;
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BMI and pain incidence do not affect the way the quality of life is perceived by the study participants.