Perruccio Anthony V, Gandhi Rajiv, Lau Johnny T C, Syed Khalid A, Mahomed Nizar N, Rampersaud Y Raja
Arthritis Program, Toronto Western Hospital and Toronto Western Research Institute, University Health Network, Toronto, Ontario, Canada Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
Arthritis Program, Toronto Western Hospital and Toronto Western Research Institute, University Health Network, Toronto, Ontario, Canada Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Foot Ankle Int. 2016 Jan;37(1):24-32. doi: 10.1177/1071100715600282. Epub 2015 Sep 3.
Improving health-related quality of life (HRQoL) necessitates an understanding of the influence of patient characteristics on, and interrelationship among, HRQoL domains. In osteoarthritis (OA), these associations have predominantly been examined in hip/knee populations. We investigated whether there were differences in these associations between foot/ankle and knee OA samples.
Individuals seeking orthopedic care for foot/ankle or knee OA completed a questionnaire pre-consultation, including HRQoL domains (bodily pain [BP], physical [PF] and social functioning [SF], and mental [MH] and general health [GH]), obesity, comorbidity, and sociodemographic characteristics. Associations were examined via stratified path analysis (foot/ankle vs knee). Foot/ankle: n = 180, mean age = 55 (range: 25 to 82), 52% female. Knee: n = 253, mean age = 62 (range: 26 to 92), 51% female.
The interrelationship among HRQoL domains was generally similar between groups. However, the influence of patient characteristics differed. Low educational status was associated with worse scores for GH, MH, and SF in the foot/ankle group, whereas no significant effects were found in the knee group. Obesity was associated with worse scores for SF, BP, and GH in the foot/ankle compared to the knee group. Patient characteristics explained considerably more of the variation in domain scores in the foot/ankle group.
There are significant differences in the impact of patient characteristics on HRQoL domains in foot/ankle versus knee OA patients. Therefore, a universal approach to patient education/intervention to improve HRQoL in lower-extremity OA is not likely to achieve optimal results. Based on these findings, we recommend joint-specific patient education, with a particular emphasis on patient characteristics among the foot/ankle OA population.
Level III, retrospective comparative study.
改善健康相关生活质量（HRQoL）需要了解患者特征对HRQoL领域的影响以及这些领域之间的相互关系。在骨关节炎（OA）中，这些关联主要在髋/膝关节人群中进行了研究。我们调查了足/踝关节和膝关节OA样本在这些关联方面是否存在差异。
因足/踝关节或膝关节OA寻求骨科护理的个体在咨询前完成了一份问卷，包括HRQoL领域（身体疼痛[BP]、身体功能[PF]、社会功能[SF]、心理功能[MH]和总体健康[GH]）、肥胖、合并症以及社会人口统计学特征。通过分层路径分析（足/踝关节与膝关节）来研究这些关联。足/踝关节组：n = 180，平均年龄 = 55岁（范围：25至82岁），52%为女性。膝关节组：n = 253，平均年龄 = 62岁（范围：26至92岁），51%为女性。
两组之间HRQoL领域的相互关系总体相似。然而，患者特征的影响有所不同。低教育水平与足/踝关节组的GH、MH和SF得分较差相关，而在膝关节组中未发现显著影响。与膝关节组相比，肥胖与足/踝关节组的SF、BP和GH得分较差相关。患者特征在足/踝关节组中对领域得分变异的解释程度要高得多。
患者特征对足/踝关节与膝关节OA患者HRQoL领域的影响存在显著差异。因此，采用通用方法对下肢OA患者进行健康教育/干预以改善HRQoL不太可能取得最佳效果。基于这些发现，我们建议针对特定关节进行患者教育，尤其要重视足/踝关节OA人群的患者特征。
III级，回顾性比较研究。
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