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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 7  |  Issue : 1  |  Page : 49-52

Functional and higher level difficulties in knee osteoarthritis patients in Saudi Arabian populace


Department of Physiotherapy, CAMS, Majmaah University, Al Majmaah -11952, Saudi Arabia

Date of Web Publication16-Apr-2018

Correspondence Address:
Mahamed Ateef
Department of Physiotherapy, CAMS, Majmaah University, Al Majmaah-11952
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/sjhs.sjhs_112_17

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  Abstract 


Background: The primary aim of this study was to evaluate the functional and high-level difficulties using disease-specific Arabic version of the self-reported questionnaire, knee injury, and osteoarthritis outcome score-physical function short form (KOOS-PS) in primary knee osteoarthritis (OA) patients. Methods: A cross-sectional studied involving the use of KOOS-PS which was administered on 149 primary OA knee patients at the time of the first consultation before the start of the medication and physiotherapy to prevent biased outcomes and were assigned to four groups based on age ranging from 43 to 79 years. Average time to administer this Arabic translated questionnaire was 10 min. Results: The mean and standard deviation from KOOS-PS-activities of daily living (KOOS-PS-ADL) domain were 61.1 ± 19.45, KOOS-PS-Sport/rec was 57.42 ± 20.3 indicating higher level difficulties noticed. There was no significant difference existed between Group-I and II, but the significant difference existed in the other age groups of KOOS-PS-ADL domain. There was insignificant difference existed between Group-I and II, significant difference existed in rest of the age groups of KOOS-PS-Sports/rec. Conclusion: Functional and higher level difficulties noticed in OA knee patients more in sports/recreational domain than activities of the daily living domain using the KOOS-physical function short form in Saudi populace.

Keywords: Knee related higher-level functional difficulties, osteoarthritis patients, self-reported knee injury and osteoarthritis outcome score-physical function short form


How to cite this article:
Ateef M. Functional and higher level difficulties in knee osteoarthritis patients in Saudi Arabian populace. Saudi J Health Sci 2018;7:49-52

How to cite this URL:
Ateef M. Functional and higher level difficulties in knee osteoarthritis patients in Saudi Arabian populace. Saudi J Health Sci [serial online] 2018 [cited 2022 Jun 27];7:49-52. Available from: https://www.saudijhealthsci.org/text.asp?2018/7/1/49/230226




  Introduction Top


In general, patients in hospitals or clinical settings may not be able to deliver their physical sufferings in a complete and comprehensive manner due to some barriers such as language, illiteracy, and hospital phobia. At the same time, medical practitioners also may not be able to assess their patients satisfactorily in terms of functional activities. A well-designed questionnaire might provide an assessor about the daily activities and their impairments with the underlined pathology. With advanced literature today, many questionnaires have been translated and cross-culturally validated in different languages for the patient convenience to subjectively evaluate the functional activities of the patient.[1] One such questionnaire is available to evaluate the knee joint impairments in the Arabic language. Knee injury and osteoarthritis outcome score (KOOS) is one such questionnaire available to assess various injuries associated with the knee joint. The KOOS questionnaire has five different domains which include 42 items.[2] KOOS physical function short form is to assess various injuries associated with the knee joint related functional and sports/recreational activities.[2],[3] A precise form of KOOS questionnaire, (KOOS-PS) Knee Outcome Score physical function short form has been recently developed in the Arabic language to minimize the load on the subjects assessed when compared to the long questionnaire. In a geriatric population where elderly people are planned and assigned to a randomized controlled trial to furnish many questionnaires simultaneously, in such a case a short form would be preferable.[2] Extensive research done on patients with knee problems of different countries, the KOOS-PS has been evolved in the Arabic language also. Psychometric properties of subjective data have been considered as the most effective criteria in terms of management of patients undergoing physiotherapy following total knee arthroplasty.[2] Although the physical examination provides all the disease information, daily activity oriented symptoms/sufferings are difficult to document and manage therapeutically. The objective of this study is to observe the impairment to disability level in different age group patients with primary osteoarthritis (OA) knee using Arabic version of the KOOS-PS questionnaires in Arabic populace.


  Methods Top


A cross-sectional study designed involving 149 OA knee males and female patients who were aged between 43 and 79 years. All these patients were diagnosed and were divided into four age groups such as Group-I (n = 40, patients aged between 43 and 50 years). Group-II (n = 38, patients aged between 51 and 60 years). Group-III (n = 36 patients aged between 61 and 70 years). Group-IV (n = 35 patients age >70 years). All the patients were asked to fill the questionnaire sooner the diagnosis had been established before the start of analgesic medications and physiotherapy to avoid interventional effects on their self-reported disease status. As a part of evaluation of patients, activities of daily livings (ADLs), and higher difficulty level were assessed using Arabic version of KOOS-physical function short form (KOOS-PS) which was derived from long form KOOS and all the patients were explained about the self-administered questionnaire which consists of seven items of which four are related to functional ADL, rising from bed, putting on socks/stockings, rising from sitting, bending to floor and three of them were sports and recreation such as twisting/pivoting on your injured knee, kneeling, and squat. It converts the responses to the disease status as interval data.[4] Levels of function were assessed in all the groups and compared to each other to find out the disability level that existed in each age group. According to KOOS scoring algorithm, hundred represent the normal/functional independence, and zero represents the highest level of difficulty. The data were analyzed to see the functional and higher level activities such as sports and recreational inactivity in patients with knee OA. The significance level was set at P < 0.05.

Inclusion criteria

Patients diagnosed with OA knee where male patients were 43, female patients were 106.

Exclusion criteria

(i) Associated knee injuries, infections, etc., (ii) Patients excluded from the study who have undergone surgeries.


  Results Top


Post hoc analysis showed that mean difference MD was 2.38 (P< 0.05) for Group-I compared to Group-II in KOOS-PS-ADL subscale. MD was 15.6 (P< 0.01) for Group-I compared to Group-III in KOOS-PS-ADL subscale. MD was 25.84 (P< 0.01) for Group-I compared to Group-IV in KOOS-PS-ADL subscale. MD was 13.09 (P< 0.01) for Group-II compared to Group-III in KOOS-PS-ADL subscale. MD was 23.22 (P< 0.01) for Group-II compared to Group-IV in KOOS-PS-ADL subscale. MD was 10.09 (P< 0.01) for Group-III compared to Group-IV in KOOS-PS-ADL subscale. There was no significant difference existed between Group-I compared to Group-II, but there was significant difference existed between Group-I and Group-III, Group-I and Group-IV, Group-II and Group-III, Group-II and Group-IV, Group-III and Group-IV in KOOS-PS-ADL as mentioned in [Table 1].
Table 1: Arabic knee injury and osteoarthritis outcome score-physical function short form activities of daily living domain score with group comparison and P value significance in osteoarthritis knee patients

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Mean difference MD was 1.88 (P< 0.05) for Group-I compared to Group-II in KOOS-PS-Sport/rec subscale. MD was 13.25 (P< 0.01) for Group-I compared to Group-III in KOOS-PS-Sport/rec subscale. MD was 25.72 (P< 0.01) for Group-I compared to Group-IV in KOOS-PS-Sport/rec subscale. MD was 11.24 (P< 0.01) for Group-II compared to Group-III in KOOS-PS-Sport/rec subscale. MD was 23.58 (P< 0.01) for Group-II compared to Group-IV in KOOS-PS-Sport/rec subscale. MD was 12.25 (P< 0.01) for Group-III compared to Group-IV in KOOS-PS-Sport/rec subscale. There was insignificant difference existed between Group-I compared to Group-II, but there was significant difference existed between Group-I and Group-III, Group-I and Group-IV, Group-II and Group-III, Group-II and Group-IV, Group-III and Group-IV in KOOS-PS-Sport/rec as mentioned in [Table 2].
Table 2: Arabic knee injury and osteoarthritis outcome score-physical function short form sports/recreational domain score with group comparison and P value significance in osteoarthritis knee patients

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  Discussion Top


This is the first study in Saudi Arabian populace to observe the knee-related functional and higher difficulty levels among different age groups of OA knee patients using culturally available disease-specific Arabic KOOS physical function short-form questionnaire. KOOS was developed and validated by Roos et al. in the year 1998.[5] Validity, reliability, and responsiveness were good in a study conducted by Ruyssen-Witrand et al.[6] According to KOOS-PS scoring, hundred represent the normal/functional independence, and zero represents the highest level of difficulty.[2] The mean KOOS-PS ADL values such as 79.07,75.05,52.33, and 34.45 represent ADL functional difficulties observed in all the four OA age Groups-I-IV, respectively. The mean KOOS-PS sport/rec values such as 75.17, 71.78, 51.08, and 28.05.4 represent higher level difficulties observed in all the four OA age groups, respectively as mentioned in the [Table 3], [Table 4], [Table 5]. The domains of this study such as ADL and sports/rec were nearly analogs to one study concluded in terms of mean domain ADL and sports/rec.[7] In this study, the disability level was potentially noticed in Group-IV KOOS-PS-Sport/rec such as mean 28.05 and functional difficulties such as KOOS-PS ADL such as mean 34.45 as shown in [Table 3]. In one extensive study concluded that KOOS-PS short form proved to be patient easiness self-reported questionnaire in patients with OA knee related functional and sports/rec disability using KOOS-PS instead of full KOOS as it reduces the patient burden to fill the questionnaire.[8] A study concluded by Singh et al. have reported functional changes in OA knee patients.[9] A study conducted by Baldwin et al. in the year 2017 have reported disability levels in sports/rec domains in females than in males [10] When our study results such as functional and higher level tasks were compared, they were in agreement with the results produced in a validation study.[11] This study had claimed that many of the participated patients were suffering from kneel and squat difficulties noticed in OA population in [Table 6] item number 6,7 in Group-III and IV with age above 61 years. There are cardinal factors which are responsible for kneel and squat difficulties such as the disease severity with the highest prevalence of inactivity levels in females in the kingdom.[12] In one population-based cross-sectional study conducted by Al-Nozha et al. had concluded that there were poor physical activity levels observed among Saudi Arabian population where inactivity was the highest in the central region (females 97.3%; males 95%).[12] One recent study done by White and Master have concluded that there was functional disability observed in OA knee patients by administering the KOOS-PS short form.[13] Limitations of this study were that patients had not been separated in terms of gender and also unilateral from bilateral OA knee and as well patients with high BMI were not considered in this study as shown in the [Table 7].
Table 3: Arabic knee injury and osteoarthritis outcome score-physical function short form activities of daily living, sports/recreational domain and group-wise mean functional and high level of difficulty analysis in osteoarthritis knee patients

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Table 4: Arabic knee injury and osteoarthritis outcome score-physical function short form activities of daily living, sports/recreational domain-mean score, standard deviation, confidence interval in osteoarthritis knee patients (n=149)

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Table 5: Arabic knee injury and osteoarthritis outcome score-physical function short form activities of daily living, sports/recreational domain score for osteoarthritis knee patients

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Table 6: Item-wise mean functional and higher level of difficulty analysis in different age grouped osteoarthritis knee patients

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Table 7: Anthropometric characteristics of patients with osteoarthritis knee (n=149)

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  Conclusion Top


High level difficulties noticed in the age group between 61 and 79 years of OA knee patients more in sports/rec domain than ADL domain using KOOS-physical function short form which is a clinically useful questionnaire that can be used clinically to document the disease to impairment to disability/loss of higher level activities as the disease advances in knee OA patients.

Clinical implications

It can also be used to check the prognosis following physiotherapeutic interventions to prevent the knee related disability and the advancement of the disease.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Al-Qahtani M, Ateef M, Al-Shewaier S, Seyam MK. Practice of culturally validated questionnaires in health-care centers in Saudi Arabia. Saudi J Sports Med 2017;17:178.  Back to cited text no. 1
  [Full text]  
2.
Available from: http://www.koos.nu/. [Last accessed on 2017 May 13].  Back to cited text no. 2
    
3.
ICHOM, International Consortium for Health Outcomes Measurement, Data collection reference guide for Hip & Knee Osteoarthritis. Cambridge; 2015.  Back to cited text no. 3
    
4.
Tennant A, Conaghan PG. The Rasch measurement model in rheumatology: What is it and why use it? When should it be applied, and what should one look for in a Rasch paper. Arthritis Rheum 2007;57:1358-62.  Back to cited text no. 4
    
5.
Roos EM, Roos HP, Lohmander LS, Ekdahl C, Beynnon BD. Knee injury and osteoarthritis outcome score (KOOS)-development of a self-administered outcome measure. J Orthop Sports Phys Ther 1998;28:88-96.  Back to cited text no. 5
    
6.
Ruyssen-Witrand R, Fernandez-Lopez CJ, Gossec L, Anract P, Courpied JP, Dougados M. Psychometric properties of the OARSI/OMERACT, osteoarthritis pain and functional impairment scales: ICOAP, KOOS-PS and HOOS-PS. Clin Exp Rheumatol 2011;29:231-7.  Back to cited text no. 6
    
7.
Sivachidambaram K, Ateef M, Tahseen S. Correlation of self-reported questionnaire (KOOS) with some objective measures in primary OA knee patients. ISRN Rheumatol 2014;2014:301485.  Back to cited text no. 7
    
8.
Gonçalves RS, Cabri J, Pinheiro JP, Ferreira PL, Gil J. Reliability, validity and responsiveness of the Portuguese version of the knee injury and osteoarthritis outcome score – Physical function short-form (KOOS-PS). Osteoarthritis Cartilage 2010;18:372-6.  Back to cited text no. 8
    
9.
Singh JA, Luo R, Landon GC, Suarez-Almazor M. Reliability and clinically important improvement thresholds for osteoarthritis pain and function scales: A multicenter study. J Rheumatol 2014;41:509-15.  Back to cited text no. 9
    
10.
Baldwin JN, McKay MJ, Simic M, Hiller CE, Moloney N, Nightingale EJ, et al. Self-reported knee pain and disability among healthy individuals: Reference data and factors associated with the knee injury and osteoarthritis outcome score (KOOS) and KOOS-child. Osteoarthritis Cartilage 2017;25:1282-90.  Back to cited text no. 10
    
11.
Ateef M, Kulandaivelan S, Alqahtani M. Cross-cultural validation of Urdu version KOOS in Indian population with primary knee osteoarthritis. Int J Rheumatol 2017;2017:1206706.  Back to cited text no. 11
    
12.
Al-Nozha MM, Al-Hazzaa HM, Arafah MR, Al-Khadra A, Al-Mazrou YY, Al-Maatouq MA, et al. Prevalence of physical activity and inactivity among Saudis aged 30-70 years. A population-based cross-sectional study. Saudi Med J 2007;28:559-68.  Back to cited text no. 12
    
13.
White DK, Master H. Patient-reported measures of physical function in knee osteoarthritis. Rheum Dis Clin North Am 2016;42:239-52.  Back to cited text no. 13
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]



 

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