The natural history of disability and its determinants in adults with lower limb musculoskeletal pain.
OBJECTIVE
To investigate determinants of deterioration or improvement in disability in people with chronic hip and knee pain.


METHODS
We analyzed data from the Somerset and Avon Survey of Health, a longitudinal, community-based cohort study containing data collected in 1994-95 and again in 2002-03. The Medical Outcomes Study Short-Form 36 was completed by subjects at both timepoints, and used to categorize people as disabled or not. Baseline data were used to explore possible determinants of change in functional status over the 8-year time period. Adjusted odds ratios (OR) were derived from a multivariate, multinomial logistic model.


RESULTS
Data were available on 1072 subjects, all of whom reported chronic hip and/or knee pain at baseline. At baseline, 56.8% of women and 42.0% of men were disabled. Of 545 people with disabilities at baseline, 107 (19.6%) reported no disability at followup; of 527 with no disability at baseline, 177 (33.6%) became disabled. The development of disability was significantly associated with older age (OR 2.1), living in the most deprived areas (2.4), the presence of 3 or more comorbidities (3.6), more problems with physical function at baseline (2.0), and more severe pain (2.4). The determinants of improvement mirrored those of deterioration. The data suggest a "threshold effect" at which recovery becomes unlikely.


CONCLUSIONS
Of people presenting with hip or knee pain, healthcare professionals should be most concerned about those who are older, of lower socioeconomic status, with comorbidities, and who have more severe pain. Much longstanding disability might be preventable.
Ayis
Salma
S
Department of Social Medicine, University of Bristol, Bristol BS8 2PR, UK. S.ayis@bristol.ac.uk
Dieppe
Paul
P
D000203:Activities of Daily Living; D000328:Adult; D000367:Age Factors; D000368:Aged; D018771:Arthralgia / Q000503:physiopathology*; D004185:Disability Evaluation; D018450:Disease Progression; D005260:Female; D006621:Hip Joint / Q000503:physiopathology*; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010147:Pain Measurement; D012720:Severity of Illness Index; D012923:Social Class