title: The association of comorbid conditions with patient-reported outcomes in Veterans with hip and knee osteoarthritis.
abstract: There is limited understanding of how comorbid health conditions affect osteoarthritis (OA)-related outcomes. This study examined associations of different comorbidity measures with baseline OA-related patient-reported outcomes (PROs) among patients with hip and knee OA. Data were from patients (N = 300, 9 % female, mean age = 61.1; SD = 9.2) enrolled in a randomized control trial at the Durham Veterans Affairs Medical Center. Separate multivariable regression models, adjusted for demographic and clinical characteristics, examined the association of each comorbidity measure with baseline PROs: pain, physical function, depressive symptoms, fatigue, and insomnia. Comorbidity measures included the Self-Administered Comorbidity Questionnaire (SACQ), conditions reported as activity-limiting (SACQ-AL), and indicators of depression, diabetes, hypertension, and back pain. Mean (SD) numbers of comorbid conditions and activity-limiting conditions were 3.4 (1.8) and 1.6 (1.4), respectively. Comorbidity scores (SACQ overall and SACQ-AL) and individual comorbidity conditions were each associated with worse OA-related PROs adjusting for demographic and clinical factors. Worse SACQ overall and SACQ-AL scores were associated with worse mean scores for pain, depressive symptoms, fatigue, and insomnia (p values <0.01). Additionally, increasing SACQ-AL scores were associated with worse mean scores for function (p < 0.01). Depression was associated with worse pain (p = 0.03), fatigue, and insomnia (p values <0.01). Diabetes was associated with worse fatigue (p = 0.01), depressive symptoms (p = 0.02), and insomnia (p = 0.03). Back pain was associated with worse pain scores (p = 0.02). Results provide evidence that comorbidity burden, particularly activity-limiting conditions, is associated with worse OA-related PROs. Interventions for patients with OA need to address comorbid conditions and their impact on key outcomes.
authors.affiliation: Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA.
authors.forename: Leah L
authors.initials: LL
authors.lastname: Zullig
authors.forename: Hayden B
authors.initials: HB
authors.lastname: Bosworth
authors.forename: Amy S
authors.initials: AS
authors.lastname: Jeffreys
authors.forename: Leonor
authors.initials: L
authors.lastname: Corsino
authors.forename: Cynthia J
authors.initials: CJ
authors.lastname: Coffman
authors.forename: Eugene Z
authors.initials: EZ
authors.lastname: Oddone
authors.forename: William S
authors.initials: WS
authors.lastname: Yancy
authors.forename: Kelli D
authors.initials: KD
authors.lastname: Allen
mesh_terms: D000368:Aged; D003863:Depression / Q000150:complications* / Q000503:physiopathology; D005221:Fatigue / Q000150:complications* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000150:complications* / Q000503:physiopathology; D020370:Osteoarthritis, Knee / Q000150:complications* / Q000503:physiopathology; D010147:Pain Measurement; D007319:Sleep Initiation and Maintenance Disorders / Q000150:complications* / Q000503:physiopathology; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014728:Veterans