Cijs Bastiaan, Stekelenburg Ruben, Veenhof Cindy, Knoop Jesper, Boymans Tim, de Rooij Mariëtte, Kloek Corelien
University Medical Centre Utrecht and Hogeschool Utrecht (HU) University of Applied Sciences Utrecht, Utrecht, The Netherlands.
HU University of Applied Sciences Utrecht, Utrecht, The Netherlands.
Arthritis Care Res (Hoboken). 2025 Feb;77(2):228-239. doi: 10.1002/acr.25428. Epub 2024 Sep 30.
This study aimed to systematically synthesize literature on prognostic factors of changes in either direction (ie, worsening or improvement) in pain, physical functioning, and participation in patients with knee and/or hip osteoarthritis (OA).
Studies included in two preceding reviews underwent full-text screening for inclusion in the current review. Additionally, an extensive literature search was conducted in five databases. Title/abstract screening was performed using an active learning program. Inclusion criteria comprised patients diagnosed with knee and/or hip OA, with the dependent variable assessing pain, physical functioning, or participation. Potential associated prognostic factors were measured as independent variables. The methodologic quality of studies was assessed with the Hayden criteria.
A total of 31 studies were included in this systematic review. In patients with knee OA, pain worsening was associated with lower physical functioning (strong evidence) and with higher body mass index, ethnicity, and a higher comorbidity count (moderate evidence). Also, in patients with knee OA, pain improvement was associated with less pain at baseline (moderate evidence). In patients with knee and/or hip OA, worsening of physical functioning exhibited associations with higher body mass index, more pain, more hip pain, a higher comorbidity count, higher avoidance of activities (strong evidence), and ethnicity (moderate evidence). In patients with knee OA, improvement in physical functioning showed an association with higher vitality (moderate evidence). Regarding the remaining prognostic factors, there is weak, inconclusive, or inconsistent evidence for an association with the outcomes. In patients with hip OA, only weak evidence was found for three factors predicting a change in physical functioning.
This review encompasses prognostic factors associated with changes in either direction (ie, worsening or improvement) in pain, physical functioning, and participation. The results are consistent with other reviews. Future research should place a stronger emphasis on patients with hip OA and participation as an outcome.
本研究旨在系统综合有关膝关节和/或髋关节骨关节炎（OA）患者疼痛、身体功能及参与度向任一方向（即恶化或改善）变化的预后因素的文献。
对前两项综述中纳入的研究进行全文筛选，以纳入本综述。此外，在五个数据库中进行了广泛的文献检索。使用主动学习程序进行标题/摘要筛选。纳入标准包括诊断为膝关节和/或髋关节OA的患者，其因变量评估疼痛、身体功能或参与度。潜在的相关预后因素作为自变量进行测量。采用海登标准评估研究的方法学质量。
本系统综述共纳入31项研究。在膝关节OA患者中，疼痛恶化与身体功能较低（有力证据）、较高的体重指数、种族及较高的合并症数量相关（中等证据）。此外，在膝关节OA患者中，疼痛改善与基线时疼痛较轻相关（中等证据）。在膝关节和/或髋关节OA患者中，身体功能恶化与较高的体重指数、更多疼痛、更多髋关节疼痛、较高的合并症数量、更高的活动回避率（有力证据）及种族相关（中等证据）。在膝关节OA患者中，身体功能改善与较高的活力相关（中等证据）。关于其余预后因素，与结局相关的证据薄弱、不确定或不一致。在髋关节OA患者中，仅发现三个因素对身体功能变化有微弱的预测证据。
本综述涵盖了与疼痛、身体功能及参与度向任一方向（即恶化或改善）变化相关的预后因素。结果与其他综述一致。未来研究应更加强调髋关节OA患者及将参与度作为一项结局指标。
