Critical Appraisal Of A Research Article On The Relationship Between Obesity And Joint Disease

Discuss about the Critical Appraisal Of A Research Article Relationship Between Obesity and the Diseases.

In this assignment we are going to critically appraise the article by Ackerman and Osborne in which the relationship between obesity and the diseases related to knee and hip joint is established.

Problem with knee and hip joint is now a day very common among the aged persons in our society (Medeiros, Araújo & Araújo, 2013). According to a survey carried out by the Government of Australia in the year 2011- 2012, around 3.3 million Australians are suffering from some kind of arthritis. Among them around 55.9% people are suffering from OA or osteoarthritis (Health.vic.gov.au, 2015). It has also been reported that the knee and hip joint diseases have more prevalence in women rather than men (Aihw.gov.au, 2015). Along with this with the advancement in technology, more and more people are leading a sedentary lifestyle, which increases the number of people affected by obesity. According to a study carried out by the government of Australia (2015), around 61% population of Australia are suffering from obesity or with the problem of overweight. It has been found that obesity increases the pressure on the joints which in case of aged persons is a serious problem as with the aging, the bone density decreases and risk of getting joint diseases increases (Hsu, Chou & Woollacott, 2012).

Studies have been carried out to relate hip OA and obesity and knee OA and obesity separately, but the studies carried out by the authors relating the obesity and hip and knee joint problems is the first of its kind in Australia.

In this part the article is critically appraised. Here we are going to discuss the aim of the study, methods used by the authors, the results and the interpretation of the result as well as the strength and weaknesses of the study.

The aim set by the authors include-

• Evaluating the relationship between the occurrence of the knee and hip diseases such as arthritis and osteoarthritis and obesity in the population of Australia.
• To determine whether obesity increases the severity of the joint related diseases i.e. increased pain, stiffness and decrease in HRQoL and the physical activity.

For carrying out the research, the authors collected the data based on national cross sectional survey. The authors randomly selected 10000 individuals, aged above 39 years, based on the survey from almost all territories and states of Australia. Questionnaires were mailed to the selected persons along with proper introductory letters. The questionnaire consisted of three instruments:

• Assessment of Quality of Life Instrument or AQoL. This instrument was used to evaluate the psychological well being, social relationships, independent living and physical senses of the selected individuals (Richardson et al., 2012).
• The Hip and Knee MAPT also known as Hip and Knee Multi- Attribute Prioritisation tool which indicates the severity of the joint diseases. The result of the MAPT was obtained as scores.
• The Western Ontario and McMaster Universities Osteoarthritis Index or WOMAC Index. This instrument was used to indicate the health condition related to a specific disease in this case the joint related diseases (Ackerman, 2009). The results were given as scores.

BMI was calculated as an indication of obesity or overweight. It was done using the height and weight data provided by the selected individuals. Depending of the calculated BMI, the samples were divided into three categories-

• Normal weight or under weight – if the BMI is less than 24.99 kg/m².
• Overweight- if the BMI is between 25- 29.99 kg/m².
• Obese- if the BMI is greater than 30 kg/m².

Aim and Methods

The age of the persons were calculated based on the provided date of birth.

Statistical analysis methods are applied on the obtained data in order to correlate the knee and hip joint diseases and the weight of a person. The chi- square test method was used to establish the differences between the participants and the non participants. In order to determine the adjusted odd ratio for the knee OA, multiple binary logistic regression method was used. Analysis of covariance method was applied to the persons who reported to have knee or hip arthritis or OA, in order to evaluate the association between the severities of the diseases i.e. stiffness, physical function and pain and the calculated BMI. In order to detect the relationship between the disease severity and BMI category, Kruskal- Wallis tests were applied.

The questionnaire was sent to 10, 000 people, but the filled copies were received from only 1,158 individuals.

Using the chi square method of analysis, the comparison between the non participants and the participants were done. The results that were obtained indicated that the number of female participants were comparatively greater than the male than the female non participants-

• 52% female non participants
• 57% female participants
• Chi square value- 8.3 (p< 0.01)

Among the participants and non participants the proportion of the participants belonging to higher socio economic class was greater-

• Participants from higher socioeconomic class- 17%
• Non participants belonging to higher socioeconomic class- 14%
• The chi square value- 22.9 (p= 0.01).

The values also showed that among the participants and the non participants, 67% of both the categories stay in the metropolitan area.

From the study of the demographic characteristics, it had been found that the chances of developing hip as well as knee arthritis were double for the obese people. There was also a strong relation between the prevalence of knee and hip arthritis and increase in age. Persons belonging to the age of 80 years and more had the most increased risk of developing knee and hip arthritis.

In case of knee joint problems-

• Persons having knee arthritis- 169
• Persons having knee OA – 98.

Among them-

• Asymptomatic- 15%
• Moderate- 52%
• Severe- 27%

In case of hip joint diseases-

• Persons having hip arthritis- 98
• Persons having hip OA- 57

Among them-

• Asymptomatic- 8%
• Moderate- 45%
• Severe- 40%.

As per the data of the post hoc test, obesity is associated with increased pain in the hip and knee joint diseases. The result was also similar in case of stiffness and obesity. The reports also depicted that persons affected by obesity and overweight showed worse physical functions (adjusted mean 43.8).

The result also showed that patients with hip arthritis had low HRQoL and the result became worsen with the increase in BMI. It was also showed that the association between the BMI and the severity of the hip and knee joint diseases was great.

Results

The studies carried out by the authors clearly indicated that there is significant relationship between the increased risk in the development of joint related diseases and obesity. Also persons with obesity experiences greater pain and other severity of the hip and knee joint diseases. As per the authors, this study will provide guidance to the clinicians and health planner while treating the joint related diseases. This study strongly indicated that while addressing the joint related problems in an aged person, the health care providers should also take under consideration whether the person is affected by obesity or not. So, the authors emphasized on the multifaceted approach that should be taken while providing treatment for knee and hip joint diseases in order to provide better care to the affected persons. This approach will require proper knowledge that should be spread among the public, regarding the effectiveness of weight loss and physical activity in order to decrease the risk of getting joint diseases.

In the discussion, carried out by the authors, they have also pointed out the comparison between their study and other relevant studies. The findings of the authors were very similar to the studies relating obesity and knee OA carried out in other countries such as US, Netherlands, UK and Norway. Again, most of the studies were unable to reflect clearly, the association between hip OA and obesity. Some studies indicated that obese persons are at greater risk of developing hip OA. The study carried out by the authors showed no significant relation. The study also showed that in comparison to the hip arthritis, the association between knee arthritis and obesity is much more prevalent.

 The study was carried out based on random sampling method which was very relevant to perform a study on the national level as random sampling incorporates participants from various backgrounds and socio economic classes. This also provides a clear idea regarding the relation between obesity and knee and hip diseases.

The author described the sample collection methods in a detailed way which included the detailed process of sample selection, the format of the questionnaire and the methods that were used to distribute and to collect the questionnaire.

While collecting the data, the authors were concerned regarding the ethical issues. so, they sent an introductory letter and a simple statement along with the questionnaire in order to provide all round information to the participants about the study. The mail also contained reply paid envelops so that the process of sending the filled questionnaire became hustle free.

Discussion of Results

The main limitation of the study, as depicted by the authors, was the lower response rate. Among the 10000 participants only 1,158 individuals showed response which was only 23%. The reason behind the reduced response may be the process of data collection i.e. the questionnaire process. It has been reported that the process of face to face interview has higher success rate i.e. the rate of participation increases up to 65%.

Conclusion:

Both obesity and the knee and hip joint diseases i.e. arthritis poses great threat to the society. Both the health problems are regarded as the National Health Priority Areas by the government of Australia. The authors in their study clearly showed that obesity creates additional burden to the hip and knee arthritis. The suffering of the arthritis patient increases many folds if their BMI is high. So, by controlling the weight of a person, the risk of developing joint diseases can be prevented. So, according to Ackerman & Osborn, while treating the joint related problems the physicians should also consider the BMI of the patient in order to provide all round treatment to the patients. Again proper knowledge is also important which can help the people to relate the joint diseases with obesity and they will understand the importance of controlling weight in the older age to reduce the risk of joint diseases.

The study clearly depicts the relationship between joint diseases and obesity, but further studies are necessary in order to implement proper plans which will highlight both the issues in the aged people.

References:

Medeiros, H., Araújo, D., & Araújo, C. (2013). Age-related mobility loss is joint-specific: an analysis from 6,000 Flexitest results. AGE, 35(6), 2399-2407. doi:10.1007/s11357-013-9525-z

Hsu, W., Chou, L., & Woollacott, M. (2012). Age-related changes in joint coordination during balance recovery. AGE, 35(4), 1299-1309. doi:10.1007/s11357-012-9422-x

Aihw.gov.au,. (2015). Retrieved 16 May 2015, from https://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=6442460004

Health.vic.gov.au,. (2015). Background: Osteoarthritis (OA) Hip & Knee Service - Department of Health and Human Services, Victoria, Australia. Retrieved 16 May 2015, from https://www.health.vic.gov.au/oahks/background.htm

Ackerman, I. and Osborne, R. (2012). Obesity and increased burden of hip and knee joint disease in Australia: Results from a national survey. BMC Musculoskeletal Disorders, 13(1), p.254.

Ackerman, I. (2009). Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Australian Journal Of Physiotherapy, 55(3), 213. doi:10.1016/s0004-9514(09)70088-1

Richardson, J., Peacock, S., Hawthorne, G., Iezzi, A., Elsworth, G., & Day, N. (2012). Construction of the descriptive system for the assessment of quality of life AQoL-6D utility instrument. Health And Quality Of Life Outcomes, 10(1), 38. doi:10.1186/1477-7525-10-38

Aihw.gov.au, (2015). Overweight and obesity (AIHW). [online] Available at: https://www.aihw.gov.au/overweight-and-obesity/ [Accessed 16 May 2015].