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Article

The Role of Disease Severity, Affected Joints, and Physical Activity Levels on Functional Impairment in Osteoarthritis after the COVID-19 Pandemic

by
Rodrigo Gallardo-Rodríguez
1,2,*,
Felipe Poblete-Valderrama
3,
Viviana Rodas-Kürten
4 and
João Paulo Vilas-Boas
2,5
1
School of Education, Universidad Viña del Mar, Viña del Mar 2572007, Chile
2
Faculty of Sport (FADEUP), University of Porto, 4200-450 Porto, Portugal
3
Department of Sport Science and Physical Conditioning, Universidad Católica de la Santísima Concepción, Concepción 4090541, Chile
4
School of Nursing, Universidad Santo Tomás, Sede Valdivia, Valdivia 5110547, Chile
5
Porto Biomechanics Laboratory (LABIOMEP-UP), University of Porto, 4200-450 Porto, Portugal
*
Author to whom correspondence should be addressed.
Appl. Sci. 2024, 14(20), 9205; https://doi.org/10.3390/app14209205
Submission received: 2 September 2024 / Revised: 29 September 2024 / Accepted: 5 October 2024 / Published: 10 October 2024
(This article belongs to the Special Issue Physical Activity, Exercise and Chronic Disease)
Versions Notes

Abstract

:

Featured Application

Featured Application: This study underscores the impact of osteoarthritis (OA) severity, bilateral involvement, and pain on functional impairment in older adults. The findings suggest that promoting physical activity may enhance functionality and improve the quality of life for individuals with OA. These insights can guide healthcare professionals and stakeholders in developing targeted interventions for older adults with OA.

Abstract

Hip and knee osteoarthritis (OA) is common among Chilean adults over 60, impacting their functionality. This study aimed to determine how health factors such as disease severity, type of OA, medication use, and physical activity levels relate to functionality in individuals with OA. The sample size included 67 women and 13 men aged 38 to 92 (66.6 ± 11.2) with diagnosed knee or hip OA. The International Physical Activity Questionnaire-Short Form (IPAQ-SF) was used to estimate physical activity, the Lequesne Index for functional impairment, and the VAS (Visual Analog Scale) for pain. Data were collected from December 2022 to March 2023. We performed bivariate analyses, which indicated that greater OA severity and bilateral OA are associated with increased functional impairment and pain. Medication use was correlated with higher pain levels, and physical activity was correlated with functionality; there was no correlation with age. Here, 65.4% of the variance in functionality problems was explained by OA severity, bilateral involvement, and pain level, highlighting their impact on functionality. Functionality problems were higher in individuals who suffered higher levels of severity when they performed lower levels of physical activity. These findings underscore the importance of promoting physical activity to improve the quality of life for individuals with OA.

1. Introduction

According to the Chilean Ministry of Health, osteoarthritis (OA) is common among Chilean adults over 60 years old, particularly affecting the hip (9%) and knee (14%). Additionally, 4.6% of this age group have OA in both joints [1]. OA is a chronic joint disease characterized by cartilage degeneration, leading to pain and mobility difficulties [2]. Diagnosis of the disease usually includes physical examinations in which patients provide information about health antecedents, the use of pain medication, and their primary concern, detailing the pain’s duration, location, and characteristics [3]. The most objective examinations include anteroposterior radiographs of the patient standing in flexion, magnetic resonance imaging, which highlights different tissues, and optical coherence tomography (OCT), which provides real-time images of the articular cartilage during arthroscopy to assess osteoarthritis-related changes [4]. The chance of falls in early-diagnosed knee and hip osteoarthritis is greater compared to those without osteoarthritis [5], and, like other musculoskeletal diseases, there is an increased risk of fractures [6], which results in longer hospital stays and reduced mobility [7]. Thus, this condition often results in a decreased quality of life and functionality, primarily due to pain, the severity of the disease, and in some cases, bilateral joint involvement [8]. The likelihood of developing OA increases with age, and older adults frequently suffer from other pathologies, further exacerbating the impact of OA on functionality and pain levels [9,10].
Although OA primarily affects older adults, it can also occur in younger individuals due to factors such as joint injuries, genetics, and lifestyle [11]. Physical activity can help alleviate OA symptoms by reducing stress on affected joints [12]. However, physical inactivity has been a significant problem in Chile even before the COVID-19 pandemic, with more than 30% of Chileans considering themselves physically inactive [13]. This sedentary lifestyle is a risk factor for noncommunicable diseases, including OA [14]. The COVID-19 pandemic has aggravated this situation, causing delays in the diagnosis, treatment, and monitoring of various diseases worldwide [15,16,17], negatively impacting the quality of life of OA patients. In this regard, a study by Maccarone et al. [18] states that persistent symptoms of COVID-19 include high levels of fatigue, motor difficulties, and, to a lesser extent, weakness. Likewise, those who have had COVID-19 present joint and muscle pain, which resembles early aging related to osteoarthritis, indicating a greater participation of the musculoskeletal system in the symptoms of long-term COVID, which is characterized by an increase in the prevalence of fatigue and weakness over time [19]. Unfortunately, the COVID-19 pandemic caused several problems in the Chilean context, including long waiting lists for people with OA to undergo surgery, generating a significant increase in economic costs for the health system [20]. In addition to that, confinement and social distancing measures have increased sedentary behavior, worsening symptoms, and overall physical fitness [21,22]. Light to moderate physical activity can effectively manage pain in people with OA [23], but only a small percentage of those with knee and hip OA follow physical activity recommendations [24].
Understanding the relationship between physical activity levels and OA antecedents can significantly enrich the existing knowledge about the impact of including specific physical activity as a treatment for OA. Recognizing individual differences is essential for developing effective strategies to improve the quality of life and physical function in people with OA, considering their specific characteristics and needs [25]. One of the relevant aspects to consider is medication use. People with knee and hip OA have a high prevalence of medication use, which is associated with lower levels of physical activity [26]. This may be because individuals who use medication perceive higher levels of pain and have more difficulty moving [27,28].
Given the significant impact of OA and the current challenges exacerbated by the COVID-19 pandemic, this study aims to (a) assess the relationship between age, health antecedents (such as disease severity, bilaterality, and type of OA (knee, hip, or both), medication use, levels of physical activity, and functionality reported by Chilean individuals with OA; and (b) explore whether self-reported physical activity, age, health antecedents, and adherence to medication through a multivariate model can explain the functionality of individuals with OA.
Based on the abovementioned aims, the current study presents the following research questions:
What is the relationship between age, health antecedents (such as disease severity, bilaterality, type of OA, and medication use), self-reported physical activity levels, and functionality levels in Chilean individuals with OA?
Can the functionality of individuals with OA be explained through a multivariate model based on age, self-reported physical activity, health antecedents, and medication use?
Therefore, we hypothesize that at an older age, lower levels of physical activity, higher disease severity, bilateral OA, and the coexistence of OA in both the knee and hip are associated with greater functional impairment.

2. Materials and Methods

2.1. Participants

Preliminary power analyses were conducted to establish the sample size required for the present study. These analyses, based on linear regressions with at least four predictors and moderate effects (k = 4, f2 = 0.15—equivalent to R2 = 0.18, α = 0.05, and 1 − β = 0.80), indicated that 80 individuals were required for the minimum sample size. Therefore, the sample size consisted of 80 participants selected through non-probabilistic sampling. The inclusion criteria for this study required participants to have a diagnosis of knee or hip osteoarthritis (unilateral or bilateral) at any severity level, regardless of current treatment status. This criterion helps to ensure that this study captures a diverse population of individuals with osteoarthritis, providing a more comprehensive understanding of the condition and its effects. Conversely, the exclusion criteria stipulated that individuals with any condition associated with cognitive decline, including dementia (such as Alzheimer’s disease or vascular dementia), would not be eligible to participate in this study. This ensures that cognitive impairment does not influence the outcomes related to osteoarthritis. This information was verified using data from a registered pension advisor from the Superintendence of Pensions in Chile, including clients’ medical records and disease-related reports obtained from the Pension Fund Administrator (AFP, which is its acronym in Spanish). Medical records included the name of the condition, date of the diagnosis, severity grade (based on the Kellgren–Lawrence Scale), which is a rating provided by doctors through X-rays [29], and whether the affected joints are unilateral (occurring on one side) or bilateral (occurring on both sides), which was diagnosed by radiography and magnetic resonance imaging [4].
Participants were recruited by contacting the pension advisor, who described this study to their clients. Those who agreed to participate were then visited at their homes, where they received a thorough explanation of this study and were asked to provide informed consent. Data were collected from December 2022 to March 2023.

2.2. Instruments

2.2.1. International Physical Activity Questionnaire-Short Form (IPAQ-SF)

The International Physical Activity Questionnaire-Short Form (IPAQ-SF) [30] is a self-administered tool that evaluates an individual’s physical activity over one week. It is suitable for individuals aged 18 to 69, with a specific version known as IPAQ-E for those aged 65 and older. Both versions are available and validated in Spanish [31,32]. The tool gathers data on the time spent on vigorous activities, moderate activities, and walking. To compute the Metabolic Equivalent of Task (MET), the daily minutes spent on each type of activity (vigorous, moderate, and walking) are multiplied by the number of days per week the activity was performed. These results are then multiplied by specific factors: 3.3 for walking, 4 for moderate activities, and 8 for vigorous activities. Higher scores reflect greater levels of physical activity and are classified as high physical activity, moderate physical activity, and low physical activity.

2.2.2. The Lequesne Index

The Lequesne Index [33] is a validated clinical tool used to assess the functional impact of osteoarthritis (OA) in the hip and knee joints. This widely recognized instrument measures the effects of OA on patients’ quality of life and includes three main sections: pain and discomfort, which evaluates the intensity, frequency, and duration of symptoms; function and physical activity, focusing on physical limitations in daily activities, such as walking, climbing stairs, and standing for extended periods; and maximum walking distance, which measures the farthest distance a patient can walk before needing to stop due to pain. Each question is scored, and the total score indicates the severity of functional impairment caused by OA, with a higher score reflecting greater problems with functionality and a more significant impact on daily activities.

2.2.3. VAS

The Visual Analog Scale (VAS) [34] is a commonly utilized instrument for assessing pain intensity. Patients are instructed to mark their level of perceived pain along a horizontal line typically 100 mm in length. The pain score is then determined by measuring the distance in millimeters from the left end of the line to the point marked by the individual who is being evaluated. This tool is simple, yet effective, for capturing many pain experiences. The left end of the line often represents ‘no pain’, while the right end represents ‘worst imaginable pain’. Patients can place a mark anywhere along the line, providing a personalized measure of pain intensity.

2.3. Data Analysis

To investigate the association between health antecedents, specifically disease severity (according to the Kellgren–Lawrence Scale), bilaterality, and type of OA (knee, hip, or both), the level of physical activity reported by Chilean individuals with OA (assessed using the IPAQ-SF), level of pain measured with VAS, and level of functionality problems (measured by the Lequesne Index), a bivariate analysis was performed. Kendall’s τ coefficient was used to analyze the relationships between these variables as it is suitable for ordinal variables [35], such as the physical activity levels measured by the IPAQ.
For categorical factors related to health antecedents (bilaterality and type of OA: knee, hip, or both), mean IPAQ-SF and Lequesne Index scores were compared using the Student’s t-test (for comparing two independent means, such as in the case of bilaterality and use of medication) or ANOVA (for comparing more than two independent means, such as in the case of the type of OA). Post-hoc pairwise comparisons were conducted using the Bonferroni test. Effect sizes were interpreted using Cohen’s d and eta-squared. The categories for bilaterality were classified as (1) unilateral and (2) bilateral; and (1) whether the patient does not use medication and (2) uses medication. The categories for the type of OA were classified as (1) hip, (2) knee, and (3) both.
Additionally, a linear regression model with interaction terms was utilized to explain functionality problems as assessed by the Lequesne Index. The analysis incorporated all pertinent exogenous variables, including health antecedents (such as the severity level, bilaterality, and use of medication) and the level of physical activity measured by the IPAQ-SF. All statistical analyses were conducted using IBM SPSS version 28 for Windows.

3. Results

Table 1 presents the sociodemographic and health history characteristics derived from the patients’ profile and background, encompassing variables such as sex, date of birth, education level, monthly income, and respective socioeconomic status following the criteria of the Chilean Association of Market Researchers [36]. Regarding clinical details for osteoarthritis (OA) participants, the recorded medical information included the specific diagnosis, severity level as determined by the Kellgren–Lawrence Scale, and whether the condition affected joints unilaterally or bilaterally.

3.1. First Research Question: What Is the Relationship between Health Antecedents (Such as Disease Severity, Bilaterality, Type of OA, and Medication Use) and Levels of Functionality in Chilean Individuals with OA?

Table 2 presents the results of Kendall’s correlation analysis. Significant associations were found between higher levels of functionality problems, as measured by the Lequesne Index, and greater severity of osteoarthritis (OA) according to the Kellgren–Lawrence Scale (p < 0.001). Additionally, there were strong correlations with higher pain levels assessed using the Visual Analog Scale (VAS) (p < 0.001) and with physical activity levels evaluated by the IPAQ-SF (p = 0.030). Likewise, greater OA severity was consistently linked to higher functionality problems (p < 0.001).
Moreover, the findings of this research indicate that individuals who suffer from bilateral OA present higher levels of functionality problems (p = 0.030) and higher levels of pain (p = 0.049) than individuals with unilateral OA. Likewise, individuals with higher levels of pain used medication (p = 0.011). Finally, higher levels of severity were present in those who presented both knee and hip OA, in contrast with individuals who suffered from only knee OA (p = 0.048), while individuals who presented both knee and hip OA suffered from higher levels of functionality problems than those who suffered from only hip OA (p = 0.032). Using Cohen’s benchmarks [37] for interpreting effect sizes, the effect of laterality on functionality problems and pain can be considered small. However, the effect of the use of medication on pain was moderate. The effect sizes of the type of OA on functionality problems and levels of severity were medium (see Table 3).

3.2. Second Research Question: Can the Functionality of Individuals with OA Be Explained through a Multivariate Model Based on Self-Reported Physical Activity, Health Antecedents, and Medication Use?

Table 4 indicates that higher levels of functionality problems measured by the Lequesne Index can be predicted by a linear combination of the coexistence of both pathologies of OA (knee and hip) over only hip affection, (95% CI = [−0.611; 1.353]), greater severity disease (95% CI = [0.675; 3.176]), and pain level (95% CI = [0.118; 0.179]). Specifically, the Lequesne Index score was higher in individuals who suffered higher levels of severity when they performed lower levels of physical activity (95% CI = [−0.735; −0.097]). The final regression model accounted for 65.4% of the variance in the levels of functionality problems based on the Lequesne Index.

4. Discussion

In the current study, we explored the relationships between health antecedents such as disease severity, bilaterality, type of osteoarthritis (knee, hip, or both), medication use, and levels of physical activity and how these factors, along with their interactions, could explain the functionality reported by Chilean individuals with OA.

4.1. Association between Age, Health Antecedents, Levels of Physical Activity, and Functionality Problems in Individuals with OA

The results related to health antecedents referring to disease severity, bilaterality, type of osteoarthritis (knee, hip, or both), and medication use were evaluated in association with levels of physical activity and functionality problems. Previous research has shown that individuals who suffer from OA show higher levels of pain and lower levels of physical activity, and it may affect the functionality in this group of people [38], which is consistent with our results. Our findings showed that individuals with OA who suffered from higher levels of functionality problems performed lower levels of physical activity and had higher levels of pain and severity. Our results also revealed a significant relationship between greater impairment in functionality and elevated pain levels, which is in line with the existing literature. Previous studies have shown that a higher score on the Lequesne Index is associated with increased pain levels [39]. Furthermore, physical functionality, measured by the Lequesne Index, has been shown to be related to OA severity, assessed by the Kellgren–Lawrence Scale [40]. In turn, OA severity, according to this scale, shows a significant association with pain levels measured by the VAS scale [41]. In this context, our findings confirm that people with OA experience greater functionality problems when they have higher levels of severity and pain, which is characteristic of the disease [42,43,44].
However, surprisingly, physical activity levels did not correlate with severity or pain. This aspect deserves a detailed discussion since it is well documented that people with a higher degree of OA severity tend to move less, which negatively impacts their quality of life [45]. It has been shown that performing light exercise is associated with a reduction in pain and stiffness levels [46,47]. On the other hand, it has been found that an intense level of physical activity in people with higher disease severity can affect functionality and increase pain [48]. From this perspective, it is striking that in our results, the levels of physical activity do not vary in people with OA according to laterality, the use of medication, or the coexistence of OA in the knee and hip.
In a previous study by Oka et al. [49], people with bilateral OA were found to perform less intense and moderate physical activity and were also more sedentary. It is possible that our results differed from their findings because they assessed different levels of physical activity whereas, in our sample, the level of general physical activity was measured. In this regard, it is essential that different levels of physical activity are considered in future research since some low-impact activities, such as walking or swimming, may be recommended for people suffering from OA because they reduce the load on the affected joints [12].
Also, as noted in the introduction, medication use in individuals with OA is associated with lower levels of physical activity as they have higher levels of pain, which makes movement difficult [28,29,30]. Although our results did not find a significant association between medication use and physical activity levels, a relationship was observed between medication use and pain level. This was expected, given that medication often relieves pain in people suffering from chronic pain [50]. Furthermore, the level of pain was higher in those with bilateral OA, which was also expected since scientific evidence has shown that people with bilateral OA have a lower quality of health compared to those with unilateral OA and lower levels of pain [51]. However, it is interesting to note that in our results, the involvement of multiple body parts, as in the case of bilaterality, did not show the same relationship with pain when considering the coexistence of OA in both joints, hip, and knee.
Individuals with both hip and knee OA often experience heightened fatigue, which can significantly impair their physical functionality and restrict daily activities [52,53]. The combined effects of fatigue and pain in those with concurrent hip and knee OA likely exacerbate the decline in physical function. Although our study did not find a significant link between the coexistence of hip and knee OA and pain, previous research highlights that knee OA pain is generally persistent and associated with overall movement, while hip OA pain is typically more intense, localized, and emotionally draining [54,55]. Despite these differences in pain characteristics, the overall pain levels between the two conditions might not differ significantly. Research has shown that pain in individuals with knee OA [56] and hip OA [57] is related to the severity of the disease. However, Iidaka et al. [57] observed that pain levels were correlated with severity mainly in individuals with advanced stages, rather than those with milder forms of the disease. The coexistence of both types of OA could place an additional burden on affected joints, particularly in individuals with excess weight [58,59], increasing the likelihood of reaching greater severity levels and further compromising physical functionality. A deeper understanding of the specific pain profiles in individuals with both hip and knee OA is necessary to better grasp how these conditions interact and impact disease severity and physical function, a factor not examined in this study. This could explain why the presence of both conditions is associated with greater severity and reduced functionality in those with OA in both affected areas. Future research should, therefore, investigate limb alterations in more detail, particularly considering the coexistence of multiple pathologies and bilateral OA as bilateral involvement has also been linked to functional impairments.
We also examined whether the age of individuals with osteoarthritis (OA) was related to health antecedents, levels of physical activity, and functionality problems. Interestingly, our results indicated that these variables were not affected by age. As mentioned previously, OA can also affect younger adults due to various factors such as joint injuries, genetic predispositions, and lifestyle choices [11]. Moreover, it has been shown that COVID-19 may disrupt endothelial and adipose tissue, potentially accelerating aging processes similar to early osteoarthritis, with joint and muscle pain reflecting characteristics of age-related musculoskeletal decline [19]. The fact that this study was conducted after the COVID-19 pandemic may explain why individuals who contracted the virus could present OA symptoms at a younger age. This situation may lead to multiple pathologies affecting functionality and physical activity levels in individuals with OA, regardless of age [60,61,62]. However, these variables were not considered in this research. Nonetheless, our findings contribute to the literature by highlighting the importance of further investigating the relationship between health antecedents, physical activity levels, and functionality issues in individuals with OA across different age groups.

4.2. Regression Model to Explain Problems in the Functionality of Individuals with OA

Regarding the association of health antecedents (such as disease severity, bilaterality, type of OA (knee, hip, or both), medication use, and physical activity levels), the higher scores in functionality problems in individuals with OA could be explained by the coexistence of OA in both the hip and the knee in comparison to individuals who only suffered from hip OA and had higher levels of pain and higher severity of the disease (the latter was observed when levels of physical activity were low).
A study by Jackson et al. [63] found that individuals with the coexistence of knee and hip OA suffered from higher pain levels than those with only knee OA or hip OA. Although our results did not find a significant difference in pain in relation to the coexistence of both affected areas, we did find that the severity was more significant in this group of people. In an investigation by Allen et al. [64], it was found that the severity among people with coexisting hip and knee OA was different according to ethnicity; particularly, there was greater severity in the African American group versus the Caucasian group. Although the ethnic differences in this OA symptomatology are not apparent, it is thought that there may be an influence of genetic predisposition, environmental and behavioral differences, and sociocultural aspects [65].
It should also be noted that in the analyses of comparisons in Table 3, it can be seen that people with bilaterality and the coexistence of knee and hip OA have a more significant functionality problem, but in the linear regressions, this variable did not explain the functionality problem. In a previous study, it was found that bilaterality was related to lower physical capacity [49], whereas in this study, bilaterality was related to the coexistence of both pathologies; this could be because in their study, bilaterality was associated with severity, and in our study, coexistence was related to higher levels of severity. The regression model shown in Table 4 indicated that, although in the global regression model, the coexistence of hip and knee OA was one of the variables that explained functionality, the variable by itself was not significant. However, the levels of pain and severity were significant in explaining functionality problems, as has been documented in different studies that have shown that OA affects the patients’ quality of life, independence, functional capacity, and ability to mobilize [66,67,68,69].
An interesting finding of this research is that severity explains the functionality problems in individuals with OA when they perform lower physical activity levels. It has been shown that intense physical activity can worsen the severity of OA; however, if the physical activity is moderate, it does not have a negative impact on severity, as demonstrated by the Kellgren–Lawrence Scale [70]. As noted above, milder physical activities may contribute to improving the symptomatology of people suffering from OA [41], and in cases where the severity of OA is not advanced, it is recommended that they perform moderate physical activity to avoid functionality problems [71].
The COVID-19 pandemic continues to have a significant impact on patients’ quality of life, especially those with noncommunicable diseases [72]. OA, which is a noncommunicable disease, is expensive to treat in Latin America due to the variability in the health systems and the lack of resources that hinder the implementation of effective policies and access to diagnosis and adequate treatment [73,74,75,76]. Moreover, it has been shown that the pandemic has left older adults with chronic OA in a more precarious situation than before, causing their health to deteriorate and resulting in a higher risk of recurrent infections or new variants of the coronavirus [77]. Therefore, it is possible that more people with COVID-19 will show persistent symptoms, which will not only affect people’s quality of life but also have a socioeconomic cost worldwide [19]. Specifically, in the Chilean context, there is a higher age-standardized prevalence rate of musculoskeletal diseases, with a significant predominance of years lived with disability, and there is a high burden of disability due to these disorders [78]. In this sense, it is essential to prioritize the development and implementation of targeted health policies that address this vulnerable population’s needs, particularly after the COVID-19 pandemic [79]. Therefore, ensuring better access to care and resources will be essential to improve their overall well-being and reduce the long-term impact of osteoarthritis and the consequences of the pandemic, making it a challenge for people with OA to follow the minimum recommendations for physical activity [80].
Nevertheless, in Chile and other countries, the COVID-19 pandemic has led to lower physical activity levels even after confinement measures ended [81,82,83]. However, the findings of Gallardo-Rodriguez et al. [84] and Katewongsa et al. [81] showed that older adults did not decrease their physical activity levels as abruptly as younger people did. Therefore, based on our research findings, we suggest that certain Chilean public institutions, such as the National Service for the Elderly (SENAMA) [83], continue designing initiatives that promote physical activity in older adults. As noted previously, older adults are the most likely to develop OA [9,10]. Therefore, encouraging older adults to engage in physical activity could improve their symptomatology, slowing the progression of OA severity and preventing functionality problems [50,72,85].

5. Limitations and Future Directions for Research

This study contributes to the existing scientific literature on functionality problems in individuals with OA, examining their relationship with health antecedents, including disease severity, bilaterality, OA type (knee, hip, or both), medication use, and physical activity levels. However, several limitations should be noted. Given that the sample size is small, with only 80 participants, the results of this study cannot be generalized.
Furthermore, it is essential to note that correlations do not imply causation. In this descriptive cross-sectional study, “explain” refers to estimating functionality problems based on Lequesne Index scores concerning health antecedents and physical activity levels, which are considered predictor variables rather than suggesting direct causality. The lack of a longitudinal design is a limitation as functionality problems may vary with changes in muscle strength, mental health, self-efficacy, social support, and aerobic exercise [86].
Another limitation to consider is that the IPAQ-SF is a self-reported tool rather than an objective measurement method like accelerometers or job-specific physical activity questionnaires used in other research [87,88]. Its limitations include potential biases or inaccuracies compared to objective measurements. Nevertheless, the IPAQ-SF is a well-regarded and widely recommended instrument for evaluating perceived physical activity as it is one of the most commonly employed self-report questionnaires for assessing physical activity across various countries [88].
Finally, the current study did not account for other comorbidities. Our results showed that functionality was more impaired when both hip and knee OA coexisted, particularly when the condition was bilateral. Although only the coexistence of hip and knee OA was considered in the regression model and was found to be non-significant, it appears to have some connection to functionality in OA patients. Our findings could have been more comprehensive had we examined the impact of other coexisting diseases, similar to previous studies [61,62,63]. This is particularly important because the likelihood of developing OA increases with age, and older adults often have additional health conditions, which can further diminish functionality levels [9,10].
Despite the limitations mentioned above, this study offers notable strengths that deepen our understanding of the factors influencing functionality problems in individuals with osteoarthritis (OA), underscoring the need for tailored clinical interventions, as highlighted in previous research [89,90]. Given the prevalence of OA among aging populations, this research addresses a critical public health issue, providing insights into how to enhance the daily lives of those affected by OA and improve their overall quality of life. Our study shows that while physical activity levels do not correlate with OA severity or pain, they significantly enhance physical function, particularly in individuals with low severity. This challenges existing views and emphasizes the need for personalized exercise recommendations. The findings advocate for improved support for older adults and those with comorbidities, setting the stage for future research to refine OA management strategies.

6. Conclusions

This study’s findings suggest that osteoarthritis (OA) has a significant impact on functionality, particularly in cases where both hip and knee joints are affected and when the condition is bilateral. This study also highlights the intricate relationships between disease severity, pain levels, and physical activity, which are crucial factors influencing the functionality of individuals with OA. These insights are particularly relevant for institutions like SENAMA and the Ministry of Women in Chile as they can inform targeted interventions to improve the quality of life for older adults and women disproportionately affected by OA as well as develop strategies tailored to the needs of these vulnerable groups. Thus, these institutions can play a critical role in mitigating the progression of OA, reducing pain, and enhancing overall functionality. Moreover, given that the impact of COVID-19 exacerbates aging processes and may accelerate osteoarthritis symptoms, our findings underscore the importance of addressing this issue through targeted physical activity programs and personalized care. Adopting this comprehensive approach can significantly enhance functionality and improve the overall quality of life for those affected by OA.
To enhance the impact of these findings, we recommend specific interventions, such as community-based exercise programs designed for older adults with OA, which can facilitate safe and effective physical activity. Additionally, healthcare providers should be trained to offer personalized exercise plans and pain management strategies, encouraging patients to engage in regular physical activity. By integrating these recommendations into policy and practice, we can better address the needs of those affected by OA and improve their overall health outcomes, whose results could be used in longitudinal studies to confirm the benefits of physical activity in slowing OA progression.

Author Contributions

Conceptualization, R.G.-R.; methodology, R.G.-R. and J.P.V.-B.; software, R.G.-R.; validation, R.G.-R., F.P.-V., V.R.-K., and J.P.V.-B.; formal analysis, R.G.-R.; investigation, R.G.-R.; resources, R.G.-R.; data curation, R.G.-R.; writing—original draft preparation, R.G.-R.; writing—review and editing, R.G.-R. and J.P.V.-B.; visualization, F.P.-V. and V.R.-K.; supervision, R.G.-R. and J.P.V.-B.; and funding acquisition, R.G.-R. All authors have read and agreed to the published version of the manuscript.

Funding

This research was funded by Becas Chile de Doctorado en el Extranjero, provided by the National Agency for Research and Development (ANID), grant number 72190317.

Institutional Review Board Statement

This study was conducted in accordance with the Declaration of Helsinki and approved by the Ethics Committee of the Universidad Católica de la Santísima Concepción (2022/50 October 2022) for studies involving humans.

Informed Consent Statement

Informed consent was obtained from all subjects involved in this study.

Data Availability Statement

The data supporting this study can be requested from the corresponding author. The data are not publicly accessible because they contain sensitive information. An anonymized version of the database, including the relevant variables for reproducing the analyses, has been created and is available upon request.

Acknowledgments

This research was also possible thanks to the immeasurable help of Laura Léniz-Maturana, who contributed to all phases of this research. We also thank all the participants who answered the questionnaires.

Conflicts of Interest

The authors declare no conflicts of interest. The funders had no role in the design of this study; the collection, analyses, or interpretation of data; the writing of the manuscript; or the decision to publish the results.

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Table 1. Sociodemographic and health history characteristics.
Table 1. Sociodemographic and health history characteristics.
CharacteristicFrequency (n)Percentage (%)MinMaxMeanSD
Sex
Men1316.2
Women6783.8
Age (years) 389266.611.2
Marital Status
Single22.5
Divorced1316.3
Widowed1316.3
Married5265.0
Employment Status
Retired3442.5
Employed2430.0
Houseworkers2025.0
Unemployed22.5
Educational Level
Not completed high school1518.8
Completed high school3138.8
Professionals2632.5
Postgraduates810.0
Monthly Income (USD) 13214,4001956.22766.6
Socioeconomic Status (AIM, 2019)
Upper class67.5
Affluent middle class1215.0
Emerging middle class810.0
Typical middle class45.0
Lower middle class78.8
Vulnerable middle class2227.5
Poor2126.2
Laterality
Unilateral3138.8
Bilateral4961.2
Type of OA
Hip 2835.0
Knee 2632.5
Both2632.5
Severity 143.040.75
Level of Pain 0105.392.77
Use of Medication
Yes5568.7
No2531.3
Min: Minimal value; Max: Maximum value; and SD: Standard deviation.
Table 2. Kendall’s correlations between the Lequesne Index score, physical activity level, and severity of disease.
Table 2. Kendall’s correlations between the Lequesne Index score, physical activity level, and severity of disease.
12345
1. Functionality --−0.19 *0.32 **0.626 **0.116
2. Physical Activity Level----−0.04−0.074−0.037
3. Severity disease------0.299 **0.147
4. Levels of Pain--------0.087
5. Age----------
* p < 0.05 and ** p < 0.01.
Table 3. Descriptive summary of the Lequesne Index and IPAQ scores based on health history characteristics derived from the patients’ profile and background.
Table 3. Descriptive summary of the Lequesne Index and IPAQ scores based on health history characteristics derived from the patients’ profile and background.
Severity Disease ScoresLequesne Index ScoresIPAQ-SFVASAge
M ± SD
(Min–Max)		M ± SD
(Min–Max)		M ± SD
(Min–Max)		M ± SD
(Min–Max)		M ± SD
(Min–Max)
Laterality
Unilateral (n = 31)2.87 ± 0.85
(1–4)		9.63 ± 5.97 (1–23.00)1.87 ± 0.81
(1–3)		46.58 ± 25.98
(0–10)		66.58 ± 9.99
(47–85)
Bilateral (n = 49)3.14 ± 0.68
(2–4)		11.86 ± 5.69 (1–21.50)1.65 ± 0.81
(1–3)		58.47 ± 27.98
(0–10)		66.53 ± 11.96
(38–92)
Statistical testt = −1.59t = −1.67t = 1.18t = −1.90t = 0.019
Effect sized = 0.36d = 0.38 *d = 0.27d = 0.44 *d = 0.01
Use of Medication
Yes (n = 55)3.04 ± 0.72
(2–4)		11.54 ± 6.39 (1–21.00)1.84 ± 0.81
(1–3)		58.62 ± 24.41
(5–10)		65.96 ± 9.91
(48–85)
No (n = 25)3.04 ± 0.84
(1–4)		9.80 ± 5.69 (1–23.00)1.52 ± 0.77
(1–3)		43.40 ± 31.84
(0–10)		66.82 ± 11.78
(38–92)
Statistical testt = 0.20t = −1.23t = −1.64t = −2.34t = −0.317
Effect sized = 0.01d = 0.30d = 0.40d = 0.57 *d = 0.08
Type of OA
Hip (n = 28)2.93 ± 0.86
(1–4)		9.50 ± 6.39 (1–23)1.82 ± 0.82
(1–3)		47.32 ± 28.52
(0–10)		63.57 ± 12.16
(38–89)
Knee (n = 26)2.85 ± 0.68
(2–4)		10.06 ± 5.16 (2.50–21.50)1.85 ± 0.83
(1–3)		50.50 ± 27.35
(0–10)		67.35 ± 11.46
(47–92)
Both (n = 26)3.35 ± 0.63
(2–4)		13.54 ± 5.27 (2–21)1.54 ± 0.76
(1–3)		64.27 ± 24.92
(0–10)		68.96 ± 9.31
(55–88)
Statistical testF = 3.52F = 3.96F = 1.18F = 2.95F = 1.70
Effect sizeη2 = 0.08 *η2 = 0.09 *η2 = 0.03η2 = 0.07η2 = 0.04
* p < 0.05.
Table 4. Summary of the regression model using the Lequesne Index scores (n = 80) as the dependent variable. The categorical factors include comparisons between each category and the reference category (indicated in parentheses).
Table 4. Summary of the regression model using the Lequesne Index scores (n = 80) as the dependent variable. The categorical factors include comparisons between each category and the reference category (indicated in parentheses).
VariableEstimateSEStandardized Betatp
Intercept−1.3981.723--−0.8110.420
Type of OA (both)0.3710.4930.0520.7530.454
Severity disease1.9250.6280.2473.0680.003
Pain level0.1480.0150.6999.701<0.001
Severity disease × physical activity level−0.4160.160−0.195−2.5970.011
Adj. R2 = 0.654; SE: Standard error
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Gallardo-Rodríguez, R.; Poblete-Valderrama, F.; Rodas-Kürten, V.; Vilas-Boas, J.P. The Role of Disease Severity, Affected Joints, and Physical Activity Levels on Functional Impairment in Osteoarthritis after the COVID-19 Pandemic. Appl. Sci. 2024, 14, 9205. https://doi.org/10.3390/app14209205

AMA Style

Gallardo-Rodríguez R, Poblete-Valderrama F, Rodas-Kürten V, Vilas-Boas JP. The Role of Disease Severity, Affected Joints, and Physical Activity Levels on Functional Impairment in Osteoarthritis after the COVID-19 Pandemic. Applied Sciences. 2024; 14(20):9205. https://doi.org/10.3390/app14209205

Chicago/Turabian Style

Gallardo-Rodríguez, Rodrigo, Felipe Poblete-Valderrama, Viviana Rodas-Kürten, and João Paulo Vilas-Boas. 2024. "The Role of Disease Severity, Affected Joints, and Physical Activity Levels on Functional Impairment in Osteoarthritis after the COVID-19 Pandemic" Applied Sciences 14, no. 20: 9205. https://doi.org/10.3390/app14209205

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