OA is one of the most prevalent diseases affecting people globally and being a leading cause of pain and disability among adults [9, 10]. Lately, evidence-based reports emphasize that adequate management of OA requires a combination of behavioral and medical strategies. [11, 12] Thus there is an increasing interest in interventions that target OA to improve QoL, physical health, cognitive-behavioral approaches to pain management and to reduce opioid or NSAID abuse and comorbidities.
To ensure effective design and implementation of these interventions it is necessary to know which outcomes are relevant for patients to ensure their participation and satisfaction. Empowering patients to have a more active role in their own health and engage them in research are key aspects of the improvement of health services and the current OA management strategies. Patients should be considered as another stakeholder within the health system and patients’ organizations should be considered as another healthcare agent, present in real decision making, to make patient voice heard.
The OA Patients Task Force, an alliance of patient organizations working together to raise awareness on OA and improve QoL of patients, designed and executed the GOAPPS survey. This is a pilot study aiming to collect and analyze data on OA patient perceptions regarding their health conditions, OA care, necessities and to explore the impact of OA on daily functioning and QoL. The results aim at providing a portrait of patients' perceptions of OA to provide a baseline to take better quality performance in the future.
The majority of respondents to the GOAPPS were women, this reflects the gender characteristic of OA which is more prevalent among women. [13–16] This can also be interpreted as women being more active and willing to participate in these types of surveys. Our study included individuals 18+, the minimum age reported was 25, although in lower proportions as have also been reported in other studies. [1] The range of age with a higher prevalence of OA was 65 to 74 years. Of interest, almost a third of participants were 40 to 59 years indicating that OA also affects younger groups of people like pre-menupaisic women, athletes or injured people.[17]
Also, the majority of the respondents were from the USA. This could be a consequence of the different computer literacy existing among the different countries that participated in the survey. The data could also reflect the importance and strength that patient organizations have in each country which can associate with the structure of national health systems. Knee OA has been the joint with the highest prevalence, as has been reported in other studies. Also, hand, spine, foot, and shoulder (by this order) were identified as other joints most affected by OA.
The majority of patients reported having one or more conditions, the most prevalent one was arterial hypertension. A recent meta-analysis revealed increased risks of myocardial infarction and stroke among OA patients compared to healthy controls and significantly increased markers of subclinical atherosclerosis. [18] Also, obesity affected more than one-third of respondents in line with previous studies where obesity was described as an important modifiable risk factor associated with OA. [19–21]
A high prevalence of gastrointestinal problems has also been reported. We can speculate that it can be due to the adverse effects related to the use of NSAIDs, which remain the oral treatment of choice in the majority of the cases[22]. The results related to mental health showed that almost half of the respondents reported depression and/or anxiety problems. Globally, musculoskeletal diseases and mental disorders are the leading causes of disability, and they have been reported to have a mutual relationship. [23] OA can increase the risk of social isolation, cognitive impairment, and depression. [24, 25] Also, patients with hip OA have been reported to be severely depressed preoperatively due to pain and limited daily-living activities. [26]
OA limits several aspects of the patients' life, affecting their QoL. Almost all patients reported limitations in physical and work activities, informing also of enormous limitations in their personal life. OA has been reported as a leading cause of chronic pain and disability in older adults in different studies. [1, 27–29] In our survey, the limitations reported by respondents are associated with severe symptomatology, especially, pain, stiffness, loss of flexibility among others.
According to our findings, patients reported understanding the common causes of OA and that their doctor adequately explained their OA diagnosis to them. This is in line with the results found by Baumann et al [30], in which OA patients considered that the advice and support obtained from their doctors were good. However, only 26.8% of respondents said to be satisfied with their current treatment plan, showing that there is still room for improvement in treatment and management for OA.
A pharmacological approach has been commonly used in OA. Still more then half of the respondents would like to have access to additional drug treatments, a request which underlines the urgent need for new medications for OA treatment. Currently, there is no cure for OA, pharmacological treatments can help to relieve symptoms but often they cannot be used for a long period of time due to adverse effects and are incompatible with medications used for OA- associated comorbidities. [18, 31–34] Furthermore, it has been previously reported that OA patients are concerned about possible side effects of medication. [35] This evidence, in association with our results, highlight the need for investment in research for new and more active OA pharmacological treatments.
Regarding additional non-drug/non-surgical treatments for their OA, 78% of respondents would like to have access to them. Non-pharmacological therapies such as physical activity or nutritional programs have been recommended in clinical guidelines and reported to have a positive effect on the health status and QoL of OA patients. [36, 37] Also, exercise therapy may postpone total joint replacement. [38] Additionally, self-management programs have shown to improve mental health and social connectedness by ameliorating QoL in OA patients.[21, 39, 40] These results are extremely important for all practitioners to focus their consultation and provide other options to patients, changing the traditional approach to a more holistic one that could improve patients' QoL.
Pain and other OA-related symptoms can be reduced by rehabilitation programs focused on alleviating pain and maintaining or improving physical and psychological function. Rehabilitation is widely recommended as first-line treatment for OA in evidence-based clinical guidelines[39, 41, 42], as it is safer and, in many cases, more effective at reducing pain than the best established pharmacological interventions. Also, regular exercise is considered to be a core treatment for OA and it is universally recommended amongst treatment guidelines for all individuals with OA. [43, 44].
Despite that 51.7% of patients reported having a good quality of life, 48.2% are either not satisfied with their quality of life or not sure to be. Considering the age of our sample it has to be remarked that elderly people can have, in general, lower expectations in terms of QoL than young patients. [45] Furthermore, often OA is wrongly conceived as a natural condition aging-related, this false myth may lower the expectation of QoL of OA patients while highlighting the need for patients’ educational programs which may have an impact on OA patients’ perception. Anyway, when patients were asked how they would evaluate their QoL if OA was eliminated, almost 95% of respondents said they would be satisfied. This means that there is a 45% of patients who perceive their QoL to be affected by OA. This data once more demonstrate the impact of OA on the QoL of people affected by this disease and the urgent need for OA management strategies improvement.
Limitations of the study
The results of this pilot study present limitations to acknowledge. The data used in the analyses are based on patient self-report, without clinical verification of an OA diagnosis, and thus are subject to the biases that are inherent to this type of data survey. Also, online questionnaires can be associated with gender and age-related biases, as women are more prompt in using this kind of technology while elderly people may find difficulties to respond to them. This study aimed to be an international comparative survey to detect and analyze the differences across country in the perception of OA. There is a huge difference in the number of surveys collected in each of the participant countries. Caution should be taken when interpreting these findings, as there is a clear predominance of surveys answered by patients from the United States.