Comparison of Health-Related Quality of Life, Work Status, and Health Care Utilization and Costs According to Hip and Knee Joint Disease Severity: A National Australian Study
Comparison of Health-Related Quality of Life, Work Status, and Health Care Utilization and Costs According to Hip and Knee Joint Disease Severity: A National Australian Study
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DOI：
10.2522/ptj.20120423
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发表时间：
2013-07-01
期刊：
影响因子：
3.2
通讯作者：
Liew, Danny
中科院分区：
文献类型：
--
作者：
Ackerman, Liana N.;Ademi, Zanfina;Liew, Danny
背景。还没有基于人群的研究调查髋关节和膝关节疾病的影响如何随着严重程度的增加而变化。 目的。本研究的目的是根据髋关节和膝关节疾病的严重程度评估与健康相关的生活质量（HRQoL）、工作状态以及卫生服务利用和费用。进行了全国横断面调查。方法。从澳大利亚选民名册中随机抽取 5000 人，并受邀填写一份调查问卷，以筛查医生诊断的髋关节炎、髋骨关节炎 (OA)、膝关节炎和膝 OA。严重程度通过西安大略大学和麦克马斯特大学骨关节炎指数 (WOMAC) 评分（范围 = 0-100）进行分类： = 39 = 严重。与健康相关的生活质量通过生活质量评估（AQoL）工具进行评估（范围=-0.04至1.00；得分最差-最佳）。收集有关工作状况和医疗服务利用情况的自我报告数据，并使用政府数据估算医疗保健费用。结果。可获得 1,157 名参与者的数据，其中 237 名 (20%) 报告髋关节或膝关节疾病。其中，16% (n=37) 被分类为无症状，51% (n=120) 被分类为轻度至中度，27% (n=64) 被分类为重度。与轻中度组（调整后平均 AQoL=0.72，95% CI=0.69-0.75）和无症状组（调整后平均 AQoL=0.80，95%）相比，重度组报告的 HRQoL 非常低（调整后平均 AQoL=0.43，95% 置信区间 [95% CI]=0.38-0.47） CI=0.74-0.86）。与无症状组相比，重症组从事有偿工作的可能性要低 3 倍以上（调整后优势比=0.28，95% CI=0.09-0.88），从事无偿工作的可能性要低 >4 倍（调整后优势比=0.24，95% CI=0.10-0.62）。尽管物理治疗服务很少使用，但重症组的初级和专科护理利用率和费用最高。局限性。其他费用（包括物理治疗咨询）无法获得。结论。随着关节疾病严重程度的增加，HRQoL 恶化、工作参与度降低和医疗保健利用率提高的明显模式出现。
Background. No population-based studies have investigated how the impact of hip and knee joint disease may vary with increasing severity.Objective. The purpose of this study was to evaluate health-related quality of life (HRQoL), work status, and health service utilization and costs according to severity of hip and knee joint disease.Design. A national cross-sectional survey was conducted.Methods. Five thousand individuals were randomly selected from the Australian electoral roll and invited to complete a questionnaire to screen for doctor-diagnosed hip arthritis, hip osteoarthritis (OA), knee arthritis, and knee OA. Severity was classified by means of Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores (range=0-100): = 39=severe. Health-related quality of life was evaluated by means of the Assessment of Quality of Life (AQoL) instrument (range=-0.04 to 1.00; scored worst-best). Self-reported data on work status and health service utilization were collected, with health care costs estimated with the use of government data.Results. Data were available for 1,157 participants, with 237 (20%) reporting hip or knee joint disease. Of these, 16% (n=37) were classified as asymptomatic, 51% (n=120) as mild-moderate, and 27% (n=64) as severe. The severe group reported very low HRQoL (adjusted mean AQoL=0.43, 95% confidence interval [95% CI]=0.38-0.47) compared with the mild-moderate group (adjusted mean AQoL=0.72, 95% CI=0.69-0.75) and the asymptomatic group (adjusted mean AQoL=0.80, 95% CI=0.74-0.86). Compared with the asymptomatic group, the severe group was >3 times less likely to undertake paid work (adjusted odds ratio=0.28, 95% CI=0.09-0.88) and >4 times less likely to undertake unpaid work (adjusted odds ratio=0.24, 95% CI=0.10-0.62). Although physical therapy services were used infrequently, primary and specialist care utilization and costs were highest for the severe group.Limitations. Other costs (including physical therapy consultations) were unavailable.Conclusions. A clear pattern of worsening HRQoL, reduced work participation, and higher medical care utilization was seen with increasing severity of joint disease.