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Objective: Osteoarthritis (OA) is frequently perceived as a disease of the elderly and an inevitable result of aging. Because OA studies often are restricted to older adults, there is limited information on OA in younger adults. This study describes the burden of OA across a wide age range and compares younger and older adults., Methods: Descriptive analysis of the Survey on Living with Chronic Diseases in Canada - Arthritis Component, a nationally representative survey of Canadians ≥20 years who reported an arthritis diagnosis in the Canadian Community Health Survey, a general health population survey. Analyses were restricted to those reporting OA and no other kind of arthritis (n = 1,749)., Results: In the representative group with OA, 55.4% were younger than 65 years. The mean age at diagnosis was 50 years, with 30.4% reporting being diagnosed before age 45 years. Younger adults reported similar symptom severity as their older counterparts with OA regarding the mean number of affected joint sites, severity of pain and fatigue, and activity limitations. In the youngest age group, those with OA were significantly more likely to report fair or poor overall and mental health and life dissatisfaction compared with their general counterparts; the same was not the case in the oldest age group., Conclusion: OA is not uncommon among younger and middle-aged adults, and they experience OA impacts comparable with those for older adults. These findings suggest that younger adults with OA will live many years with symptoms and disability and highlight a need for effective OA management across ages., (© 2024 The Author(s). Arthritis Care & Research published by Wiley Periodicals LLC on behalf of American College of Rheumatology.)

Objective: In osteoarthritis (OA) research, disability is largely studied within the context of activities of daily living. Broader consequences for social participation are often overlooked. In prior work, instrumental supports received and their perceived availability were shown to play a role in the maintenance of social participation. Two indicators of social participation were identified, diversity and intensity. The current study extends the findings from this prior cross-sectional work by examining these relationships longitudinally., Methods: Data are from the baseline and 3-year follow-up questionnaires of the Canadian Longitudinal Study on Aging, a population-based study of people ages 45-85 years at baseline. The sample was restricted to those who at baseline reported a doctor diagnosis of OA (n = 4104). Using structural equation modeling, latent variables were derived at each time point for activity limitations, instrumental supports perceived and received, and social participation diversity and intensity. Longitudinal factorial invariance was assessed. Model covariates included age, sex, education, income, marital status, smoking status, obesity, and number of chronic conditions., Results: For all latent variables, strong factorial longitudinal invariance was found. Activity limitations increased over time. Greater baseline social participation intensity was associated with increases in later intensity and diversity. Increasing activity limitations were associated with decreases in social participation and with increasing receipt of instrumental supports; they were not associated with changes in perceived availability of supports. However, increasing perceived availability was positively associated with social participation intensity., Conclusions: With a goal of increasing social participation, findings suggest a focus on interventions to reduce activity limitations in OA is necessary. Findings additionally highlight an important role for perceived availability of instrumental supports in maintaining or improving social participation in OA, in addition to current social participation, particularly intensity, for future social participation status., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Perruccio et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objective: The objective of this study was to investigate a profile of cardiovascular disease (CVD) risk factors by sex among individuals with and without osteoarthritis (OA) and to consider single-site and multisite joint OA., Methods: Data were sourced from Cycle 1, Comprehensive Cohort, Canadian Longitudinal Study on Aging, a national sample of individuals ages 45 to 85 years. Systemic inflammatory/metabolic CVD risk factors collected were high-sensitivity C-reactive protein (hsCRP) level, high-density lipoprotein, triglycerides, total cholesterol, body mass index (BMI), systolic blood pressure, and hemoglobin A1c. Smoking history was also collected. Respondents indicated doctor-diagnosed OA in the knees, hips, and/or hands and were characterized as yes/no OA and single site/multisite OA. Individuals with OA were age- and sex-matched to non-OA controls. Covariates were age, sex, education, income, physical activity, timed up and go test findings, and comorbidities. A latent CVD risk variable was derived in women and men; standardized scores were categorized as follows: lowest, mid-low, mid-high, and highest risk. Associations with OA were quantified using ordinal logistic regressions., Results: A total of 6,098 respondents (3,049 with OA) had a median age of 63 years, and 55.8% were women. One-third of OA respondents were in the highest risk category versus one-fifth of non-OA respondents. Apart from BMI (the largest contributor in both sexes), hsCRP level (an inflammation marker) was predominant in women, and metabolic factors and smoking were predominant in men. Overall, OA was associated with worse CVD risk quartiles compared with non-OA. OA was increasingly associated with worse CVD risk quartiles with increasing risk thresholds among women with multisite OA, but not men., Conclusion: Findings suggest unique CVD risks by sex/multisite subgroups and point to a potentially important role for inflammation in OA over and above traditional CVD risk factors., (© 2021 American College of Rheumatology.)

Objective: To understand differences between people with arthritis who do not know their type (DK) compared to those reporting osteoarthritis (OA) or inflammatory and autoimmune types of arthritis (IAA), including the receipt of appropriate health care, information, and services., Methods: Analysis of the Survey on Living with Chronic Disease in Canada-Arthritis Component. Respondents aged ≥20 years with health professional-diagnosed arthritis (n = 4,385) were characterized as reporting DK, OA or IAA. Variables: arthritis characteristics (duration, number and site of joints affected), arthritis impact (current pain and fatigue, difficulty in sleeping and daily activities, impact on life), health (self-rated general and mental health, life stress), arthritis management strategies (seeing health professionals, medication use, assistive devices, receipt of arthritis information, self-management activities). Multinomial logistic and log-Poisson regressions were used, as appropriate, to compare the DK to the OA and IAA groups., Results: In this arthritis sample, 44.2% were in the DK group, 38.3% reported OA and 17.5% reported IAA. Those in the DK group were more likely to be younger, have low income, low education, and be of non-white cultural background compared to those with OA. There were no significant differences in arthritis impact, but the DK group was less likely to have received information on, or have used, arthritis management strategies., Conclusions: The sociodemographic characteristics of the DK group suggest they likely have lower health literacy. They were less likely to have accessed health care and other support services, indicating this is an important group for health education, both for individuals with arthritis and health care providers., Competing Interests: The authors have declared that no competing interests exist.

Objective: The focus on disability in osteoarthritis (OA) has largely been on the ability to perform specific activities, which neglects the greater implications for social participation. We investigated the association between OA and social participation, considering activity limitations and instrumental supports as intervening variables in the association., Methods: Data were from 21,214 respondents, ages 45-85 years, from cycle 1 of the Canadian Longitudinal Study on Aging. The questionnaire elicited information regarding self-reported doctor-diagnosed OA, difficulty with 14 activities, perceived availability and receipt of instrumental supports, and 17 social participation activities. Structural equation modeling was used. The primary outcome was social participation, and the primary predictor was OA. The intervening variables included activity limitations, received instrumental supports, and perceived instrumental supports. Latent variables were developed for intervening and social participation variables. The covariates included age, sex, body mass index, income, education, smoking, and comorbidity count., Results: The mean age of the respondents was 63 years, 51% were female, and 26.5% reported having OA. Two distinct social participation indicators were identified, including social participation-diversity and social participation-intensity. When intervening variables were not considered, minimal/no association was found between OA and social participation. When intervening variables were considered, unique pathways linking OA and social participation were found. The overall negative association between activity limitations and social participation was partially direct and partially buffered by both receipt of and perceived availability of instrumental supports. In the absence of activity limitations, OA was associated with greater social participation., Conclusion: Enhanced social participation in people with OA who do not have activity limitations may reflect proactive steps taken by those with mild OA to maintain activity and social engagement. For those with activity limitations, findings highlight the need for interventions to mitigate limitations and draw particular attention to the importance of both provision and awareness of available instrumental supports in maintaining social participation., (© 2020, American College of Rheumatology.)

Objective: To investigate the association of OA risk factors with number of painful joint sites in a representative population sample., Methods: Analysis of the 2009 Survey on Living with Chronic Diseases in Canada - Arthritis Component (n = 1614) for respondents reporting symptomatic OA. Variables: painful joints sites (hands, wrists, elbows, shoulders, hips, knees, ankles, feet, back, neck), joint symptom duration, sociodemographic characteristics, smoking, comorbidities and BMI. Zero-truncated negative binomial regressions were used to investigate the association between number of painful joint sites and the variables. Generalizability of findings was assessed by a similar analysis in a clinical hip/knee OA sample., Results: The sample comprised 73% women and 56% were aged <65 years. The mean number of painful joint sites was 3.8: 84% reported pain at ≥2 sites, and 45% at ≥4 sites. Age, BMI, education and smoking were not associated with the number of joint sites. Significant associations were found with being female [rate ratio (RR) = 1.23, 95% CI 1.09, 1.39], having more comorbidities (RR = 1.11, 95% CI 1.07, 1.15) and longer symptom duration (RR = 1.16, 95% CI 1.09, 1.24), although the increase in joint sites with duration was small. Similar regression results were found with the clinical OA sample., Conclusion: The lack of an association of age and BMI (obesity) with number of painful joint sites in OA raises questions about the role of these risk factors and our understanding of OA as a multi-joint disease. Filling this knowledge gap is critical to making progress with defining OA phenotypes and identifying potential aetiological mechanisms., (© The Author(s) 2020. Published by Oxford University Press on behalf of the British Society for Rheumatology.)

Introduction: Physicians are often challenged with accessing relevant up-to-date arthritis information to enable the delivery of optimal care. An online continuing medical education programme to disseminate arthritis clinical practice guidelines (CPGs) was developed to address this issue., Methods: Online learning modules were developed for osteoarthritis (OA) and rheumatoid arthritis (RA) using published CPGs adapted for primary care (best practices), input from subject matter experts and a needs assessment. The programme was piloted in two rural/remote areas of Canada. Knowledge of best practice guidelines was measured before, immediately after completion of the modules and at 3-month follow-up by assigning one point for each appropriate best practice applied to a hypothetical case scenario. Points were then summed into a total best practice score., Results: Participants represented various professions in primary care, including family physicians, physiotherapists, occupational therapists and nurses (n = 89) and demonstrated significant improvements in total best practice scores immediately following completion of the modules (OA pre = 2.8/10, post = 3.8/10, P < 0.01; RA pre = 3.9/12, post = 4.6/12, P < 0.01). The response rate at 3 months was too small for analysis., Conclusions: With knowledge gained from the online modules, participants were able to apply a greater number of best practices to OA and RA hypothetical case scenarios. The online programme has demonstrated that it can provide some of the information rural/remote primary care providers need to deliver optimal care; however, further research is needed to determine whether these results translate into changes in practice., Competing Interests: None

Objective: To synthesise, quantify and compare risks for incident myocardial infarction (MI) across five major types of arthritis in population-based studies., Methods: A systematic search was performed in MEDLINE, EMBASE and CINAHL databases with additional manual/hand searches for population-based cohort or case-control studies published in English of French between January 1980 and January 2015 with a measure of effect and variance for associations between incident MI and five major types of arthritis: rheumatoid arthritis (RA), psoriatic arthritis (PsA), ankylosing spondylitis (AS), gout or osteoarthritis (OA), adjusted for at least age and sex. All search screening, data abstraction quality appraisals were performed independently by two reviewers. Where appropriate, random-effects meta-analysis was used to pool results from studies with a minimum of 10 events., Results: We identified a total of 4, 285 articles; 27 met review criteria and 25 criteria for meta-analyses. In studies adjusting for age and sex, MI risk was significantly increased in RA (pooled relative risk (RR): 1.69, 95% CI 1.50 to 1.90), gout (pooled RR: 1.47, 95% CI 1.24 to 1.73), PsA (pooled RR: 1.41, 95% CI 1.17 to 1.69), OA (pooled RR: 1.31, 95% CI 1.01 to 1.71) and tended towards increased risk in AS (pooled RR: 1.24, 95% CI 0.93 to 1.65). Traditional risk factors were more prevalent in all types of arthritis. MI risk was attenuated for each type of arthritis in studies adjusting for traditional risk factors and remained significantly increased in RA, PsA and gout., Conclusions: MI risk was consistently increased in multiple types of arthritis in population-based studies, and was partially explained by a higher prevalence of traditional risk factors in all types of arthritis. Findings support more integrated cardiovascular (CV) prevention strategies for arthritis populations that target both reducing inflammation and enhancing management of traditional CV risk factors., Competing Interests: Competing interests: None declared., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)

Objective: To estimate sex-specific effects of arthritis and activity limitation on incident heart disease in a nationally representative, Canadian longitudinal population-based survey., Methods: Information on sociodemographic variables, self-reported physician-diagnosed chronic conditions (including arthritis and heart disease), activity limitations, and traditional risk factors was collected every 2 years from 1994-1995 through 2010-2011 as part of the longitudinal Canadian National Population Health Survey. Deaths due to ischemic heart disease (International Classification of Diseases, Tenth Revision [ICD-10] codes I20-I25) and heart failure (ICD-10 codes I50.0-I50.9) were confirmed against the Canadian Vital Statistics Database. Discrete-time survival analysis stratified by sex was used to estimate effects of arthritis and activity limitation on first heart disease event occurrence., Results: The study included 12,591 participants with no prior history of heart disease and 1,783 incident heart disease events. After adjusting for common risk factors, arthritis was associated with a significant increased risk of incident heart disease in women (adjusted odds ratio [OR] 1.58, 95% confidence interval [95% CI] 1.23-2.02). Even higher risks were reported in women with arthritis and activity limitation (OR 2.19, 95% CI 1.61-2.97). Arthritis was not associated with incident heart disease in men, except for when also reported with activity limitation (OR 1.60, 95% CI 1.14-2.26)., Conclusion: Women with arthritis, and men with arthritis and activity limitation, have significant excess risks for developing heart disease in the general population. These findings point to the need for improved access to arthritis care, cardiovascular prevention strategies, particularly in women with arthritis, and directed interventions toward prevention of activity limitation., (© 2016, American College of Rheumatology.)

Objective: Research points to many potential benefits of physical activity (PA) for those with arthritis. However, PA has not typically been examined within the context of other life roles. This study examined the perceptions of PA among individuals managing arthritis in addition to employment and other role demands., Methods: Eight focus groups were conducted with 24 women and 16 men (age range 29-72 years) who were currently or recently employed (within 2 years) and had osteoarthritis or inflammatory arthritis. Participants were recruited from community newspaper advertisements, rheumatology clinics, and arthritis groups. Discussions were audiotaped and transcribed. Transcripts were analyzed using qualitative content analysis., Results: All groups discussed the impact of arthritis on a range of PAs. Overall, participants discussed PA as positively influencing their health and well-being. Yet, several overarching themes highlighted the complexity of PA, including 1) PA as a potential cause of arthritis; 2) the reciprocal impact of arthritis on PA and PA on arthritis; 3) physical and psychological benefits and harms of PA, such as difficulty making PA decisions when living in pain or when faced with episodic symptoms; 4) perceived choices about engagement in PA (e.g., role overload); and 5) social support., Conclusion: The relationships among work, health, and other roles were complex. Competing demands, pain, energy, episodic symptoms, support, and decisions to disclose one's illness at work influenced PA. Changes to PA not only affected physical health but also people's self-identity. PA interventions may be improved by taking into account the demands of multiple life roles., (Copyright © 2013 by the American College of Rheumatology.)

Little is known about life course differences in social role participation among those with chronic diseases. This study examined role salience (i.e., importance), role limitations, and role satisfaction among middle- and older-aged adults with and without osteoarthritis (OA) and its relationship to depression, stress, role conflict, health care utilization and coping behaviours. Participants were middle- and older-aged adults with OA (n = 177) or no chronic disabling conditions (n = 193), aged ≥40 years. Respondents were recruited through community advertising and clinics in Ontario, Canada (2009-2010). They completed a 45-50 min telephone interview and 20 min self-administered questionnaire assessing demographics (e.g., age, gender); health (e.g., pain, functional limitations, health care utilization); the Social Role Participation Questionnaire (SRPQ) (role salience, limitations, satisfaction in 12 domains), and psychological variables (e.g., depression, stress, role conflict, behavioural coping). Analyses included two-way ANOVAs, correlations, and linear regression. Results indicated that middle-aged adults (40-59 years) reported greater role salience than older-aged adults (60 + years). Middle-aged adults with OA reported significantly greater role limitations and more health care utilization than all other groups. Middle-aged adults and those with OA also reported greater depression, stress, role conflict, and behavioural coping efforts than older adults or healthy controls. Controlling for age and OA, those with higher role salience and greater role limitations reported more health care utilization. Those with greater role limitations and lower role satisfaction reported greater depression, stress, role conflict, and behavioural coping. This study has implications for research and interventions, highlighting the need to characterize role participation as multidimensional. It points to the importance of taking into account the meaning of roles at different ages among those with chronic diseases like OA when developing interventions to help understand the impact of roles on psychological well-being., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Objective: To describe the evaluation of a community-based continuing health education program designed to improve the management of rheumatoid arthritis (RA) and osteoarthritis (OA), and to examine the results by discipline., Methods: The Getting a Grip on Arthritis(©) program was based on clinical practice guidelines adapted for the primary care environment (best practices). The program consisted of an accredited inter-professional workshop and 6 months of activities to reinforce the learning. Analyses compared best practice scores derived from responses to 3 standardized case scenarios (early and late RA; moderate knee OA) at baseline and 6 months post-workshop using the ACREU Primary Care Survey., Results: In total, 553 primary care providers (nurses/licensed practical nurses 30.9%, rehabilitation professionals 22.5%, physicians 22.5%, nurse practitioners 10.9%, other healthcare providers/non-clinical staff/students 13.1%) attended one of 27 workshops across Canada; 275 (49.7%) completed followup surveys. Best practice scores varied by discipline at baseline (p < 0.05) and improved for all 3 case scenarios, with nurse practitioners and rehabilitation therapists improving the most (p ≤ 0.05)., Conclusion: Results suggest that inter-professional education may be an effective method for dissemination of guidelines and has potential to improve the delivery of arthritis care, particularly when nurse practitioners and rehabilitation therapists are involved in the care of patients.

Objective: Arthritis often impacts a worker's ability to be productive while at work. However, the ideal approach to measuring arthritis-attributable at-work productivity loss remains unclear. Our objective was to evaluate the relative strengths and weaknesses of 5 measures aimed at quantifying health-related at-work productivity loss and to determine the best available instrument for this population., Methods: In a 12-month longitudinal design, the psychometric properties (reliability, validity, and responsiveness) of 5 self-reported measures of at-work productivity were compared in workers with either rheumatoid arthritis (RA) or osteoarthritis (OA). We tested the Workplace Activity Limitations Scale (WALS), 6-item Stanford Presenteeism Scale (SPS-6), Endicott Work Productivity Scale (EWPS), RA Work Instability Scale (WIS), and Work Limitations Questionnaire (WLQ)., Results: Across all measures, participants (n = 250, 120 with RA and 130 with OA) consistently reported mild losses of at-work productivity. The Cronbach's alpha of the scales ranged from 0.71 (for SPS-6) to 0.94 (for EWPS), indicating some concerns over the internal consistency of the SPS-6. The RA WIS demonstrated the strongest construct validity (|r| = 0.54-0.74), whereas the WALS was most responsive to perceived changes in work ability. Despite its increasing popularity and potential application for costing analysis, the WLQ did not compare favorably with the other scales, possibly due to psychometric concerns with its physical demands subscale., Conclusion: Measures revealed unique conceptualization of at-work disability, but no single scale emerged as clearly superior. However, current results slightly favor the WALS and RA WIS as superior instruments for measuring at-work productivity loss in workers with arthritis.

Background: Multi-faceted interventions are among the strongest methods for changing provider behavior., Aims: This paper reports the design, implementation and process evaluation of an educational program to disseminate clinical practice guidelines (CPGs) on the management of rheumatoid arthritis (RA) and osteoarthritis (OA) in primary care., Methods: Organizations were invited to participate in inter-professional workshops on OA and RA followed by six months of activities to support the delivery of care in the community. Confidence in ability to manage arthritis was assessed at baseline using a 10 point numerical rating scale. Qualitative assessments were done immediately and 3-12 months post workshop., Results: 646 multidisciplinary providers from 216 organizations attended one of 30 workshops. Providers (n = 584) reported moderate confidence in managing arthritis: family physicians: mean: SD = 7.46(1.42), n = 145; nurse practitioners: 6.10(1.84), n = 73; other health care professionals: 5.23(2.83), n = 389. Participants identified team learning, the opportunity to network and the involvement of trained patient educators as strong features of the workshops. At follow-up, participants indicated the greatest impact of the program was on collaborative care (83%) and patient self-management (79%)., Conclusions: Qualitative results suggest that inter-professional learning may be a successful strategy for improving the delivery of collaborative arthritis care and supporting patient self-management.

Objective: Prevalence of osteoarthritis (OA) is expected to increase due to population aging. However, there is little information on the trends in the incidence of OA over time. The purpose of this study was to describe changes in physician-diagnosed OA incidence rates between 1996-1997 and 2003-2004 in British Columbia (BC), Canada., Methods: We used data on all visits to health professionals and hospital admissions covered by the Medical Services Plan of BC (population approximately 4 million) for the fiscal years 1991-1992 through 2003-2004. Rates were standardized to the BC population in 2000. We used 2 definitions of OA: 1) at least 1 visit or hospitalization with a diagnostic code for OA, and 2) at least 2 visits or 1 hospitalization with a code for OA. Incidence rates were calculated with a 5-year run-in period to exclude prevalent cases., Results: Between 1996-1997 and 2003-2004, crude incidence rates of OA based on definition 1 increased from 10.5 to 12.2 per 1,000 in men and from 13.9 to 17.4 per 1,000 in women. The age-standardized rates did not change in men and increased from 14.7 to 16.7 per 1,000 in women. Incidence rates based on definition 2 were almost 50% lower, but the trends were similar., Conclusion: We observed an increase in the incidence of OA in both men and women due to population aging and an additional increase in women beyond the effect of aging. These trends have important implications for public health and provision of health services to this very large group of patients.

Background: Fatigue is recognized as a disabling symptom in many chronic conditions including rheumatic disorders such as rheumatoid arthritis (RA) and lupus. Fatigue in osteoarthritis (OA) is not routinely evaluated and has only been considered in a very limited number of studies. To date, these studies have focused primarily on patients with OA under rheumatological care, which represent the minority of people living with OA. The purpose of this study was to increase our understanding of the fatigue experience in community dwelling people with OA., Methods: In 2004, 8 focus groups were conducted with 28 men and 18 women (mean age 72.3) with symptomatic hip or knee OA recruited from a population-based cohort. Participants completed a self-administered questionnaire, which included demographics, measures of OA severity (WOMAC), depression (CES-D) and fatigue (FACIT). Sessions were audio taped and transcribed verbatim. Two researchers independently reviewed the transcripts to identify themes. Findings were compared and consensus reached., Results: Mean pain, disability, depression and fatigue scores were 8.7/20, 27.8/68, 15.4/60, and 30.9/52, respectively. Participants described their fatigue as exhaustion, being tired and "coming up against a brick wall". Participants generally perceived fatigue as different from sleepiness and distinguished physical from mental fatigue. Factors believed to increase fatigue included OA pain and pain medications, aging, various types of weather and poor sleep. Mental health was identified as both affecting fatigue and being affected by fatigue. Participants described fatigue as impacting physical function, and their ability to participate in social activities and to do household chores. Rest, exercise, and avoiding or getting assistance with activities were cited as ways of coping. Participants generally did not discuss their fatigue with anyone except their spouses., Conclusion: Participants with OA described experiencing notable amounts of fatigue and indicated that it had a substantial impact on their lives. Further research is required to better understand the role of fatigue in OA in order to identify strategies to reduce its impact.

Objective: Research emphasizes the negative impact of osteoarthritis (OA) on social participation, yet few studies have examined the roles of symptoms, activity limitations, and depression in this relationship. The present longitudinal study tested a model that hypothesizes that the relationship between physical symptoms and later participation restrictions among older adults with OA is mediated by activity limitations and depressive symptoms., Methods: Participants were 184 community-dwelling senior adults (age>or=55 years) with a physician diagnosis of OA who were interviewed at 2 time points 18 months apart. Measures included demographic variables; a derived physical symptoms measure based on severity of pain, stiffness, and fatigue in the previous week; and depressive symptoms measured by the Center for Epidemiologic Studies Depression Scale. Measures of activity limitations and participation restrictions were derived by factor analysis of questions about difficulty in everyday life. Sequential multiple linear regression analyses controlling for demographic and illness-related variables were used to test for mediation., Results: Severity of time 1 physical symptoms was associated with difficulties in participation 18 months later. Sequential introduction of variables showed that this relationship was partially mediated by time 1 activity limitations and time 1 depressive symptoms. When both of these variables were included in the model, the effect of symptoms severity was completely mediated., Conclusion: This study demonstrates the importance of taking into account both the physical (activity limitations) and psychological (depressive symptoms) consequences of OA symptoms and suggests that these factors act as a pathway to subsequent participation restrictions.

Objective: To develop a measure of job strain related to differing aspects of working with arthritis and to examine the demographic, illness, work context, and psychosocial variables associated with it., Methods: Study participants were 292 employed individuals with osteoarthritis or inflammatory arthritis. Participants were from wave 3 of a 4-wave longitudinal study examining coping and adaptation efforts used to remain employed. Participants completed an interview-administered structured questionnaire, including a Chronic Illness Job Strain Scale (CIJSS) and questions on demographic (e.g., age, sex), illness and disability (e.g., disease type, pain, activity limitations), work context (e.g., job type, job control), and psychosocial variables (e.g., arthritis-work spillover, coworker/managerial support, job perceptions). Principal component analysis and multiple linear regression were used to analyze the data., Results: A single factor solution emerged for the CIJSS. The scale had an internal reliability of 0.95. Greater job strain was reported for future uncertainty, balancing multiple roles, and difficulties accepting the disease than for current workplace conditions. Participants with inflammatory arthritis, more frequent severe pain, greater workplace activity limitations, fewer hours of work, less coworker support, and greater arthritis-work spillover reported greater job strain., Conclusion: The findings underscore the diverse areas that contribute to perceptions of job strain and suggest that existing models of job strain do not adequately capture the stress experienced by individuals working with chronic illnesses or the factors associated with job strain. Measures similar to the CIJSS can enhance the tools researchers and clinicians have available to examine the impact of arthritis in individuals' lives.

Objective: Osteoarthritis (OA) is a highly prevalent and often disabling disease. Data on the incidence of OA in the general population are limited. Our objectives were (1) to estimate OA prevalence and incidence rates by age and sex in a geographically defined population of 4 million people [British Columbia (BC), Canada] using an administrative database; and (2) to determine the effects of different administrative definitions of OA and observation (run-in) time on such estimates., Methods: We used data on all visits to health professionals and hospital admissions covered by the Medical Services Plan (MSP) of BC for the fiscal years 1991-92 through 2000-01. OA was defined based on International Classification of Diseases, 9th Revision, diagnostic codes required for administrative purposes., Results: The overall prevalence of OA in 2001 was 10.8%: 8.9% in men and 12.6% in women. Prevalence was higher in women in all age groups. By age 70-74 years, about one-third of men and 40% of women had OA. Incidence rates in 2000-01 were 11.7 per 1000 person-years in the total population, 10.0 in men and 13.4 in women. Rates increased linearly with age between 50 and 80 years. Both prevalence and incidence depended strongly on the definition of OA and the run-in period., Conclusion: Prevalence of physician-diagnosed OA in BC was slightly lower than self-reported prevalence of arthritis in population surveys. Routinely collected administrative data could be a valuable source of information for OA surveillance, but more research is needed on the validity of OA diagnosis in administrative databases.

Objective: To compare the health experiences of middle- and older-age adults with moderate osteoarthritis (OA) symptoms with experiences of individuals with no chronic health conditions. Similarities and differences in health changes, the meaning of these changes, and their impact were examined., Methods: Sixteen focus groups (10 OA, 6 control) were conducted with 53 women and 37 men (age 39-88 years). OA participants were recruited from practitioners' offices and The Arthritis Society, Ontario Division. Additional OA participants and controls were recruited from community centers and newspaper advertisements. All participants were asked about changes in health, the impact of these changes, and self-management strategies. Participants also completed standardized measures including demographic information; the Short Form 36; Western Ontario and McMaster Universities Osteoarthritis Index; and Disabilities of the Arm, Shoulder and Hand questionnaire., Results: Differences in the depth, breadth, and meaning of symptoms such as pain, stiffness, and fatigue were reported with little overlap between OA and control groups. OA was often seen as part of a normal aging process requiring acceptance, not treatment. However, younger OA participants reported more distress and frustration managing the disease. OA participants reported an impact of their health on work, leisure, social activities, and relationships that was described as upsetting compared with controls., Conclusion: This study illuminates personal and social factors associated with OA by comparing health experiences of individuals with OA and controls. It highlights directions for future research that can improve our understanding of the needs of individuals with OA and can help link individuals' health status to the broader framework of their lives.

Objective: To understand arthritis-related workplace changes, including occasional work loss and changes to the type and hours of work, and the factors associated with them using theories of adaptation and behavior change as a framework., Methods: Participants were 492 employed individuals with rheumatoid arthritis or osteoarthritis. They completed an interview-administered, structured questionnaire assessing demographic, workplace, and psychosocial variables, as well as such work transitions as changes to the hours, type, and nature of work. Hypotheses were examined using multiple linear regression., Results: Seventy percent of respondents made at least 1 work change. Younger participants and those with greater workplace activity limitations reported more changes. Work changes were associated with greater depression. A hypothesized 3-way interaction among people's perceptions of their capacity, their future job expectations, and whether they had told their employer about their arthritis was significant., Conclusion: This study extends arthritis employment research by examining a range of work changes. It highlights the dynamic interplay among arthritis, workplace, and psychosocial variables to understand adaptation to arthritis disability.

Objective: To propose statistical measures to identify different longitudinal patterns of change in quantitative health indicators., Methods: The authors propose several simple measures to discriminate between stable-unstable, increasing-decreasing, linear-nonlinear, monotonic-nonmonotonic patterns of change. They then suggest using factor analysis to select the subset of nonredundant measures, and cluster analysis, based on the selected measures, to identify subgroups of patients with similar longitudinal trajectories. The proposed approach is illustrated using data on osteoarthritis disability from a longitudinal study undertaken in Toronto, Ontario, in 1996-2001. Disability was measured at four points in time for 835 patients, using the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index., Results: The proposed measures allowed the detection of individual patients with specific patterns of change and identification of four different groups of patients with WOMAC scores that are (1) regularly increasing, (2) regularly decreasing, (3) stable over time, or (4) highly unstable, with abrupt changes or short-term fluctuations., Conclusion: The proposed approach may be used to (1) screen even large databases to identify particular patterns of change; or (2) summarize different patterns of change by classifying patients into groups with similar trajectories. Once identified, the groups can be investigated to determine whether there are differences in patient characteristics or outcomes.

Objective: This study examines whether the relationships between activity limitations and independence are mediated by coping efficacy., Method: Data come from a cross-sectional survey of 286 adults, aged 55 or older, with osteoarthritis (OA) and/or osteoporosis (OP). Physical independence was assessed by asking to what extent respondents' OA/OP had affected their independence on a 5-point scale from 'not at all' to 'a great deal'. Activity limitations were examined in three domains: personal care, community mobility, and household activity. A coping efficacy scale was derived from three items scored on a 5-point Likert-type scale from strongly disagree to strongly agree. Structural equation modelling was used to test the model., Results: Activity limitation in household activities was directly associated with perceptions of independence, with a statistically significant standardized path coefficients of -0.32. The effect of activity limitation in personal care was partially mediated by coping efficacy with a direct effect of -0.41 which was partially offset by coping efficacy to give a net effect of -0.308. The effect of community mobility on independence was completely mediated through coping efficacy with significant standardized path coefficients of -0.85 (community mobility to coping efficacy) and -0.14 (coping efficacy to independence). The overall model's goodness of fit was excellent (R =0.59, ch-square/df=1.4, CFI=0.97, and NNFI=0.97)., Conclusion: Activity limitation had a detrimental effect on the level of self-perceived independence. Coping efficacy showed a significant mediating effect between activity limitation and self-perceived independence for the domains of personal care and community mobility, but not household tasks. This study suggests that how activity limitation affects perceptions of independence varies across activity limitation domains, and indicates the importance of incorporating activity limitation domains in future studies.

This research extends the use of P. B. Baltes and M. M. Baltes's (1990) theory of selective optimization with compensation (SOC) in an effort to conceptually integrate the adaptational behaviors of 248 older adults with disability arising from osteoarthritis. The authors also studied the relationship of SOC to age, illness variables, disability, illness perceptions, and support. The results highlight the variability and plasticity of older adults' efforts to manage disability, with most efforts aimed at compensation and optimization rather than selection. The benefit of using SOC to study adaptation to chronic illness and disability is discussed.

Objective: The vast majority of published estimates of osteoarthritis (OA) burden are based on an OA diagnosis. These data are limited, as individuals often do not visit a physician until their symptoms are moderate to severe. This study compared individuals with an OA diagnosis to those with OA joint symptoms but without a diagnosis considering a number of sociodemographic and health characteristics. A further distinction was made between individuals with symptoms in one joint site and those with symptoms in multiple joint sites. Methods: Data are from 23 186 respondents aged 45 to 85 years from the first cycle of the Canadian Longitudinal Study on Aging. A multinomial logistic regression model examined the relationship between sociodemographic‐ and health‐related characteristics and OA status (diagnosed OA, joint symptoms without OA, no OA or joint symptoms). In addition, logistic regression models assessed the relationship between OA status and usually experiencing pain and having some degree of functional limitation. Results: Twenty‐one percent of respondents reported a diagnosis of OA, and 25% reported symptoms typical of OA but without an OA diagnosis. Other than being slightly younger, the characteristic profile of individuals with symptoms in two or more joint sites was indistinguishable from that of those with diagnosed OA. Conclusion: It may be warranted to consider OA‐like multiple joint symptoms when deriving estimates of OA‐attributed population health and cost burden. [ABSTRACT FROM AUTHOR]

Background: Orthopaedic procedures for degenerative musculoskeletal conditions (predominantly osteoarthritis and spinal stenosis) represent an increasing burden on the health-care system. These procedures are also associated with adverse event rates and related cost. The objective of this study was to identify risk factors for adverse events associated with orthopaedic surgeries as captured within a common clinical point-of-care system for documenting adverse events (Orthopaedic Surgical AdVerse Events Severity [OrthoSAVES] system).Methods: In-hospital adverse events were recorded at the point of care over a 2-year period for inpatient elective knee, hip, and spine orthopaedic procedures for degenerative musculoskeletal conditions. Multivariable logistic regression was employed to investigate the association between various factors (age, sex, surgical site, body mass index, surgical risk classification, operative duration, length of stay, and medical comorbidities) and the occurrence of adverse events.Results: The sample included 2,146 patients. The overall adverse event rate was 27% (571 of 2,146), and by surgical site, the rates were 29% (130 of 442) for spine; 27% (266 of 998) for knee; and 25% (175 of 706) for hip. The most common adverse events had a low severity grade, but spinal procedures demonstrated more adverse events with a severity grade of ≥3. Increasing age (odds ratio [OR] = 1.21, 95% confidence interval [CI] =1.05 to 1.41, per 15-year interval), male sex (OR = 1.43, 95% CI =1.16 to 1.77), increasing operative duration (OR = 1.13, 95% CI = 1.03 to 1.23, per 30-minute increase), length of stay (OR = 1.13, 95% CI = 1.10 to 1.17, per day), and undergoing revision surgery (OR = 2.23, 95% CI = 1.35 to 3.70) were independently associated with a greater likelihood of the occurrence of an adverse event. Spine surgery demonstrated decreased odds of an adverse event compared with knee surgery (OR = 0.38, 95% CI = 0.23 to 0.61) when operative duration and length of stay were taken into account.Conclusions: On the basis of our adjusted analysis, we found increasing age, male sex, revision surgery, length of stay, and increasing operative duration to be common independent risk factors for an adverse event across the population studied. The first 3 risk factors are not modifiable. The association between increasing operative duration and the risk of an adverse event across all anatomical regions and surgical procedures is a unique finding. However, modification of procedural efficiency is multifactorial and warrants further investigation.Level Of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Objective: While osteoarthritis (OA) has mainly been viewed as a disease affecting older people, its prevalence in younger adults is substantial. However, there is limited research on how younger adults understand knee symptoms. This article explores the meaning of knee symptoms to adults ages 35-65 years.Methods: This qualitative study comprised 6 focus groups and 10 one-on-one interviews with 51 participants (median age 49, 61% female), who self-reported knee OA or reported knee symptoms (i.e., pain, aching, or stiffness) on most days of the past month. Constructivist grounded theory guided the sampling, data collection, and analysis. Data were analyzed using a constant comparative method.Results: Central to participants' understanding of knee symptoms was the perception that symptoms were preventable, meaning that there was the potential to prevent the onset of symptoms and to alter the course of symptoms. This understanding was demonstrated in participants' explanation of symptoms. Participants commented on the cause, prevention, and course of symptoms. Moreover, participants reflected on their experience with symptoms, indicating that symptoms made them feel older than their current age. However, they did not perceive their symptoms as normal or acceptable.Conclusion: Participants interpreted knee symptoms as potentially preventable, suggesting that they may be open to primary and secondary prevention strategies. [ABSTRACT FROM AUTHOR]

The International Classification of Functioning, Disability and Health (ICF) published in 2001 describes the consequences of health conditions with three components of impairments in body structures or functions, activity limitations and participation restrictions. Two of the new features of the conceptual model were the possibility of feedback effects between each ICF component and the introduction of contextual factors conceptualized as moderators of the relationship between the components. The aim of this longitudinal study is to provide empirical evidence of these two kinds of effect. Structural equation modeling was used to analyze data from a French population–based cohort of 548 patients with knee osteoarthritis recruited between April 2007 and March 2009 and followed for three years. Indicators of the body structure and function, activity and participation components of the ICF were derived from self-administered standardized instruments. The measurement model revealed four separate factors for body structures impairments, body functions impairments, activity limitations and participation restrictions. The classic sequence from body impairments to participation restrictions through activity limitations was found at each assessment time. Longitudinal study of the ICF component relationships showed a feedback pathway indicating that the level of participation restrictions at baseline was predictive of activity limitations three years later. Finally, the moderating role of personal (age, sex, mental health, etc.) and environmental factors (family relationships, mobility device use, etc.) was investigated. Three contextual factors (sex, family relationships and walking stick use) were found to be moderators for the relationship between the body impairments and the activity limitations components. Mental health was found to be a mediating factor of the effect of activity limitations on participation restrictions. [ABSTRACT FROM AUTHOR]

The article discusses the authors' claim that musculoskeletal disorders (MSDs) are not addressed at very many epidemiology and public health conferences in the North American nations of Canada and the U.S., and it mentions the MSD osteoarthritis, as well as the "Global Burden of Disease, Injuries, and Risk Factors" study report. An online literature review search is examined, along with America's public health community and the implication that MSDs can lead to chronic pain and disability.

Background Context: In the lumbar spine osteoarthritis (LS-OA) population having surgery for lumbar spinal stenosis (LSS) symptoms, a significant proportion of patients experience limited benefit following the intervention. Thus, identifying contributing factors to this is important. Individuals with OA often have multiple joint symptoms, yet this has received limited attention in this population.Purpose: Document the occurrence of joint symptoms among patients undergoing surgery for LS-OA, and investigate the influence of these symptoms on disability postsurgery.Design: Prospective study of consecutive patients followed to 12-month postsurgery.Patient Sample: Patients undergoing surgery (decompression surgery, with or without fusion) for neurogenic claudication with or without back pain due to LSS with a primary pathology diagnosis of LS-OA.Outcomes Measures: Patient self-reported: Oswestry Disability Index (ODI), completed pre- and 12-month postsurgery; and, completed presurgery, age, sex, education, smoking, comorbid conditions, opioid use, short/long-term disability, depression and anxiety symptoms, back and leg pain intensity, presence of spondylolisthesis, procedure, prior spine surgery, and joints with arthritis and "pain/stiffness/swelling most days of the month" indicated on a homunculus (a joint site count was derived).Assessments: Height and weight, used to calculate body mass index; timed-up-and-go performance-based test.Methods: Outcome of interest was achieving a clinically important improvement (CII) in ODI by 12-month postsurgery (yes/no). The association between joint site count and achieving a CII was examined by multivariable logistic regression analyses, adjusted for other measures.Results: In all, 165 patients were included. The mean age was 67 years (range: 44-90) and 47% were female. Seventy-seven percent reported 1+ joint site other than the back, 62% reported 2+, and 25% reported 4+. Among those achieving a CII, 21% had 4+ joint sites, compared with 31% among those not achieving a CII. Adjusted analyses: Increasing joint site count was associated with increasing risk (odds ratio [OR]: 1.32, 95% confidence interval [CI]: 1.05, 1.66) of not achieving a CII; for those with 4+ joints, adjusted probability of not achieving a CII exceeded 50%. Also associated with an increased risk of not achieving a CII was presurgery anxiety (OR: 2.97, 95% CI: 1.02, 8.65), opioid use (OR: 2.89, 95% CI: 1.07, 7.82), and worse back pain intensity score (OR: 1.27, 95% CI: 1.05, 1.53).Conclusions: Multijoint involvement was highly prevalent in this LS-OA surgical sample. Its association with poorer postsurgery outcome supports a comprehensive approach to OA management and care. Knowledge of multijoint symptoms should inform patient education, shared decision-making, and recommendations for postsurgical rehabilitation and self-management strategies. [ABSTRACT FROM AUTHOR]