title: Domains of quality of life affecting elderly patients with hand osteoarthritis: a qualitative study in the Asian perspective.
abstract: OBJECTIVE
  Hand osteoarthritis (HOA) is common but little is known about how HOA has impact on disability and quality of life (QoL).We aim to identify important domains of concern among participants suffering from symptomatic HOA in Singapore, representing an Asian socio-cultural context.
  
  
  METHODS
  A qualitative study using a focus group technique was performed. We ran focus groups stratified by gender, ethnicity and language. Two independent, trained analysts identified relevant categories and assigned codes to text segments through open coding, with discrepancies resolved through consensus. The final lists of domains and subthemes descriptive of QoL were then compared to the following commonly used HOA specific instruments: Functional Index for Hand Osteoarthritis (FIHOA), Score for Assessment and quantification of Chronic Rheumatic Affections of the Hand (SACRAH), Australian/Canadian Hand Osteoarthritis Index (AUSCAN); and Health Assessment Questionnaire (HAQ).
  
  
  RESULTS
  Twenty-six patients (23 women, three men; 24 Chinese and two Malay; mean ± SD age 62.9 ± 7.5 years) with symptomatic HOA according to the American College of Rheumatology Classification Criteria participated in seven focus groups. Two and five focus groups were conducted in Chinese and English, respectively. The qualitative analysis revealed pain, stiffness and functional disability as the main domains. However, psychological consequences, aesthetic concerns, participation in leisure activities, participation in family roles were important concepts from the focus groups which were not covered by existing instruments. Impact on work productivity by HOA and the unmet health care need is revealed.
  
  
  CONCLUSIONS
  The domains of concepts important to people with HOA in an Asian socio-cultural context are not fully represented in the most commonly used instruments. Further studies on the selection of main domains relevant to HOA patients are necessary.
authors.affiliation: Department of Rheumatology & Immunology, Singapore General Hospital, Singapore, Singapore.|Duke-NUS Medical School, Singapore, Singapore.|Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
authors.forename: Julian
authors.initials: J
authors.lastname: Thumboo
authors.affiliation: Duke-NUS Medical School, Singapore, Singapore.
authors.forename: Li
authors.initials: L
authors.lastname: Wu
authors.affiliation: Department of Rheumatology & Immunology, Singapore General Hospital, Singapore, Singapore.|Duke-NUS Medical School, Singapore, Singapore.
authors.forename: Ying Ying
authors.initials: YY
authors.lastname: Leung
mesh_terms: D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D000375:Aging / Q000208:ethnology* / Q000523:psychology*; D044466:Asian People / Q000523:psychology*; D002681:China / Q000208:ethnology; D017281:Cost of Illness; D003466:Cultural Characteristics; D004185:Disability Evaluation; D005260:Female; D017144:Focus Groups; D050823:Hand Joints / Q000503:physiopathology*; D006801:Humans; D008296:Malaysia / Q000208:ethnology; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000175:diagnosis / Q000208:ethnology* / Q000503:physiopathology / Q000523:psychology*; D010147:Pain Measurement; D036301:Qualitative Research; D011788:Quality of Life; D012846:Singapore / Q000453:epidemiology; D011795:Surveys and Questionnaires
keywords: hand osteoarthritis; qualitative study; quality of life