Impact of lower limb osteoarthritis on health-related quality of life: A cross-sectional study to estimate the expressed loss of utility in the Spanish population

Autoři: Jesús Martín-Fernández aff001;  Roberto García -Maroto aff004;  Amaia Bilbao aff003;  Lidia García-Pérez aff003;  Blanca Gutiérrez-Teira aff009;  Antonio Molina-Siguero aff010;  Juan Carlos Arenaza aff003;  Vanesa Ramos-García aff008;  Gemma Rodríguez-Martínez aff012;  Fco Javier Sánchez-Jiménez aff013;  Gloria Ariza-Cardiel aff001
Působiště autorů: Unidad Docente Multiprofesional de Atención Familiar y Comunitaria Oeste, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain aff001;  Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Madrid, Spain aff002;  Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC), Spain aff003;  Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Clínico San Carlos, Servicio Madrileño de Salud, Madrid, Spain aff004;  Doctorando en el Programa de Investigación en Ciencias Médico Quirúrgicas, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain aff005;  Osakidetza, Hospital Universitario Basurto, Unidad de Investigación, Bilbao, Spain aff006;  Instituto de Investigación en Servicios de Salud Kronikgune, Barakaldo, Spain aff007;  Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), Las Palmas de Gran Canaria, Spain aff008;  Centro de Salud El Soto, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain aff009;  Centro de Salud Presentación Sabio, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain aff010;  Osakidetza, Hospital Universitario Basurto, Servicio de Traumatología y Cirugía Ortopédica, Bilbao, Spain aff011;  Centro de Salud Infante Don Luis, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain aff012;  Centro de Salud Gregorio Marañón, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain aff013
Vyšlo v časopise: PLoS ONE 15(1)
Kategorie: Research Article
doi: 10.1371/journal.pone.0228398



Osteoarthritis of the lower limb (OALL) worsens health-related quality of life (HRQL), but this impact has not been quantified with standardized measures. We intend to evaluate the impact of OALL on HRQL through measures based on individual preferences in comparison to the general population.


A cross-sectional study was designed. A total of 6234 subjects aged 50 years or older without OALL were selected from the Spanish general population (National Health Survey 2011–12). An opportunistic sample of patients aged 50 years or older diagnosed with hip (n = 331) or knee osteoarthritis (n = 393), using the American Rheumatism Association criteria, was recruited from six hospitals and 21 primary care centers in Vizcaya, Madrid and Tenerife between January and December 2015. HRQL was measured with the EQ-5D-5L, and the results were transformed into utility scores. Sociodemographic variables (age, sex, social group, cohabitation), number of chronic diseases, and body mass index were considered. The clinical stage of OALL was collected using the Western Ontario and McMaster Universities Osteoarthritis Index and the Oxford hip score and Oxford knee score. Generalized linear models were constructed using the utility index as the dependent variable.


HRQL expressed by OALL patients was significantly worse than this of the general population. After adjustment for sociodemographic and clinical characteristics, the mean utility loss was -0.347 (95% CI: -0.390, -0.303) for osteoarthritis of the hip and -0.295 (95% CI: -0.336, -0.255) for osteoarthritis of the knee. OALL patients who were treated at a hospital had an additional utility loss of -0.112 (95% CI: -0.158, -0.065).


OALL has a great impact on HRQL. People with OALL perceive a utility loss of approximately 0.3 points compared to the general population without osteoarthritis, which is very high in relation to the utility loss reported for other chronic diseases and for arthritis in general.

Klíčová slova:

Body limbs – Body mass index – Hip – Knee joints – Knees – Obesity – Osteoarthritis – Spain


1. World Health Organization. Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19–22 June, 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into the force on 7 April 1948.

2. Urzúa A. Calidad de vida relacionada con la salud: Elementos conceptuales. Rev Med Chile. 2010;138: 358–365.

3. Wailoo AJ, Hernandez-Alava M, Manca A, Mejia A, Ray J, Crawford B, et al. Mapping to estimate health-state utility from non-preference-based outcome measures: An ISPOR good practices for outcomes research task force report. Value Health. 2017;20: 18–27. doi: 10.1016/j.jval.2016.11.006 28212961

4. Group EuroQol. EuroQol—a new facility for the measurement of health-related quality of life. Health Policy. 1990;16: 199–208. doi: 10.1016/0168-8510(90)90421-9 10109801

5. Ramos-Goñi JM, Pinto-Prades JL, Oppe M, Cabases JM, Serrano-Aguilar P, Rivero-Arias O. Valuation and modeling of EQ-5D-5L health states using a hybrid approach. Med Care. 2017;55: e51–e58.6. doi: 10.1097/MLR.0000000000000283 25521503

6. NICE National Institute for Health and Care Excellence. Guide to the methods of technology appraisal 2013. London; 2013.

7. Dakin H. Review of studies mapping from quality of life or clinical measures to EQ-5D: an online database. Health Qual Life Outcomes. 2013;11: 151. doi: 10.1186/1477-7525-11-151 24010873

8. Ramos-Goñi JM, Craig BM, Oppe M, Ramallo-Farina Y, Pinto-Prades JL, Luo N, et al. Handling data quality issues to estimate the Spanish EQ-5D-5L value set using a hybrid interval regression approach. Value Health. 2018;21: 596–604. doi: 10.1016/j.jval.2017.10.023 29753358

9. Vos T, Allen C, Arora M, Barber RM, Bhutta ZA, Brown A, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388: 1545–1602. doi: 10.1016/S0140-6736(16)31678-6 27733282

10. van der Pas S, Castell MV, Cooper C, Denkinger M, Dennison EM, Edwards MH, et al. European project on osteoarthritis: Design of a six-cohort study on the personal and societal burden of osteoarthritis in an older European population. BMC Musculoskelet Disord. 2013;14: 138. doi: 10.1186/1471-2474-14-138 23597054

11. Loza E, Lopez-Gomez JM, Abasolo L, Maese J, Carmona L, Batlle-Gualda E. Economic burden of knee and hip osteoarthritis in Spain. Arthritis Rheum. 2009;61: 158–165. doi: 10.1002/art.24214 19177521

12. Salmon JH, Rat AC, Sellam J, Michel M, Eschard JP, Guillemin F, et al. Economic impact of lower-limb osteoarthritis worldwide: A systematic review of cost-of-illness studies. Osteoarthritis Cartilage. 2016;24: 1500–1508. doi: 10.1016/j.joca.2016.03.012 27034093

13. Puig-Junoy J, Zamora AR. Socio-economic costs of osteoarthritis: A systematic review of cost-of-illness studies. Semin Arthritis Rheum. 2015;44: 531–541. doi: 10.1016/j.semarthrit.2014.10.012 25511476

14. Prieto-Alhambra D, Judge A, Javaid MK, Cooper C, Diez-Perez A, Arden NK. Incidence and risk factors for clinically diagnosed knee, hip and hand osteoarthritis: Influences of age, gender and osteoarthritis affecting other joints. Ann Rheum Dis. 2014;73: 1659–1664. doi: 10.1136/annrheumdis-2013-203355 23744977

15. Reyes C, Leyland KM, Peat G, Cooper C, Arden NK, Prieto-Alhambra D. Association between overweight and obesity and risk of clinically diagnosed knee, hip, and hand osteoarthritis: A population-based cohort study. Arthritis Rheumatol. 2016;68: 1869–1875. doi: 10.1002/art.39707 27059260

16. Ackerman IN, Busija L, Tacey MA, Bohensky MA, Ademi Z, Brand CA, et al. Performance of the assessment of quality of life measure in people with hip and knee joint disease and implications for research and clinical use. Arthritis Care Res (Hoboken). 2014;66: 481–488.

17. Busija L, Osborne RH, Roberts C, Buchbinder R. Systematic review showed measures of individual burden of osteoarthritis poorly capture the patient experience. J Clin Epidemiol. 2013;66: 826–837. doi: 10.1016/j.jclinepi.2013.03.011 23810023

18. Bernad-Pineda M, de las Heras-Sotos J, Garcés-Puentes MV. Calidad de vida en pacientes con artrosis de rodilla y/o cadera. Rev Esp Cir Ortop Traumatol. 2014;58: 283–289. doi: 10.1016/j.recot.2014.04.005 25022212

19. van Schoor NM, Zambon S, Castell MV, Cooper C, Denkinger M, Dennison EM, et al. Impact of clinical osteoarthritis of the hip, knee and hand on self-rated health in six European countries: The European project on OSteoArthritis. Qual Life Res. 2016;25: 1423–1432. doi: 10.1007/s11136-015-1171-8 26547441

20. Instituto Nacional de Estadistica. Ministerio de Sanidad Servicios Sociales e Igualdad. Metodología de la Encuesta Nacional de Salud 2011–2012. [Internet]. 2013 pp. 1–2. Available from:

21. Altman RD. Criteria for classification of clinical osteoarthritis. J Rheumatol Suppl. 1991;27: 10–12. 2027107

22. Altman R, Asch E, Bloch D, Bole G, Borenstein D, Brandt K, et al. Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Diagnostic and therapeutic criteria committee of the American rheumatism association. Arthritis Rheum. 1986;29: 1039–1049. doi: 10.1002/art.1780290816 3741515

23. Green SB. How many subjects does it take to do a regression analysis. Multivariate Behav Res. 1991;26: 499–510. doi: 10.1207/s15327906mbr2603_7 26776715

24. Herdman M, Gudex C, Lloyd A, Janssen M, Kind P, Parkin D, et al. Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L). Qual Life Res. 2011;20: 1727–1736. doi: 10.1007/s11136-011-9903-x 21479777

25. Bilbao A, Garcia-Perez L, Arenaza JC, Garcia I, Ariza-Cardiel G, Trujillo-Martin E, et al. Psychometric properties of the EQ-5D-5L in patients with hip or knee osteoarthritis: Reliability, validity and responsiveness. Qual Life Res. 2018;27: 2897–2908. doi: 10.1007/s11136-018-1929-x 29978346

26. Domingo SA, Marcos AJ. Proposal of an indicator of "social class" based on the occupation. Gac Sanit. 1989;3: 320–326. doi: 10.1016/s0213-9111(89)70948-1 2498222

27. Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol. 1988;15: 1833–1840. 3068365

28. Dawson J, Fitzpatrick R, Murray D, Carr A. Questionnaire on the perceptions of patients about total knee replacement. J Bone Joint Surg Br. 1998;80: 63–69. doi: 10.1302/0301-620x.80b1.7859 9460955

29. Dawson J, Fitzpatrick R, Carr A, Murray D. Questionnaire on the perceptions of patients about total hip replacement. J Bone Joint Surg Br. 1996;78: 185–190. 8666621

30. Escobar A, Quintana JM, Bilbao A, Azkarate J, Guenaga JI. Validation of the Spanish version of the WOMAC questionnaire for patients with hip or knee osteoarthritis. Western Ontario and McMaster universities osteoarthritis index. Clin Rheumatol. 2002;21: 466–471. doi: 10.1007/s100670200117 12447629

31. Murray DW, Fitzpatrick R, Rogers K, Pandit H, Beard DJ, Carr AJ, et al. The use of the Oxford hip and knee scores. J Bone Joint Surg Br. 2007;89: 1010–1014. doi: 10.1302/0301-620X.89B8.19424 17785736

32. Martín-Fernández J, Garcia-Maroto R, Sanchez-Jimenez FJ, Bau-Gonzalez A, Valencia-Garcia H, Gutierrez-Teira B, et al. Validation of the Spanish version of the Oxford knee score and assessment of its utility to characterize quality of life of patients suffering from knee osteoarthritis: A multicentric study. Health Qual Life Outcomes. 2017;15: 186. doi: 10.1186/s12955-017-0761-2 28962613

33. Martín-Fernández J, Gray-Laymon P, Molina-Siguero A, Martinez-Martin J, Garcia-Maroto R, Garcia-Sanchez I, et al. Cross-cultural adaptation and validation of the Spanish version of the Oxford hip score in patients with hip osteoarthritis. BMC Musculoskelet Disord. 2017;18: 205. doi: 10.1186/s12891-017-1568-3 28532445

34. Long JS, Ervin LH. Using heteroscedasticity consistent standard errors in the linear regression model. Am Stat. 2000;54: 217–224.

35. Fabozzi F, Focardi S, Rachev S, Arshanapalli B. Appendix E: Model selection criterion: AIC and BIC. In: Fabozzi F, Focardi S, Rachev S, Arshanapalli B, editors. The basics of financial econometrics: Tools, concepts, and asset management applications. Hoboken, NJ, USA: John Wiley & Sons, Inc.; 2014. pp. 399–430.

36. Kass RE, Raftery AE. Bayes factors. J Am Stat Assoc. 1995;90: 773–795.

37. Wu M, Brazier JE, Kearns B, Relton C, Smith C, Cooper CL. Examining the impact of 11 long-standing health conditions on health-related quality of life using the EQ-5D in a general population sample. Eur J Health Econ. 2015;16: 141–151. doi: 10.1007/s10198-013-0559-z 24408476

38. Tsiplova K, Pullenayegum E, Cooke T, Xie F. EQ-5D-derived health utilities and minimally important differences for chronic health conditions: 2011 commonwealth fund survey of sicker adults in Canada. Qual Life Res. 2016;25: 3009–3016. doi: 10.1007/s11136-016-1336-0 27307010

39. Oliva-Moreno J, Lopez-Bastida J, Worbes-Cerezo M, Serrano-Aguilar P. Health related quality of life of Canary Island citizens. BMC Public Health. 2010;10: 675. doi: 10.1186/1471-2458-10-675 21054832

40. Salaffi F, Di Carlo M, Carotti M, Farah S, Ciapetti A, Gutierrez M. The impact of different rheumatic diseases on health-related quality of life: A comparison with a selected sample of healthy individuals using SF-36 questionnaire, EQ-5D and SF-6D utility values. Acta Biomed. 2019;89: 541–557. doi: 10.23750/abm.v89i4.7298 30657123

41. Ministerio de Sanidad, Servicios Sociales e Igualdad. Estrategia en enfermedades reumáticas y musculoesqueléticas del Sistema Nacional de Salud. Madrid, Spain: Ministerio de Sanidad, Servicios Sociales e Igualdad; 2013.

42. Carlesso LC, Hawker GA, Waugh EJ, Davis AM. Disease-specific pain and function predict future pain impact in hip and knee osteoarthritis. Clin Rheumatol. 2016;35: 2999–3005. doi: 10.1007/s10067-016-3401-z 27601231

43. Veronese N, Stubbs B, Solmi M, Smith TO, Noale M, Cooper C, et al. Association between lower limb osteoarthritis and incidence of depressive symptoms: Data from the osteoarthritis initiative. Age Ageing. 2017;46: 470–476. doi: 10.1093/ageing/afw216 27932358

44. Serra-Sutton V, Allepuz A, Martínez O, Espallargues M. Factores relacionados con la calidad de vida al año de la artroplastia total de cadera y rodilla: Estudio multicéntrico en Cataluña. Rev Esp Cir Ortop Traumatol. 2013;57: 254–262. doi: 10.1016/j.recot.2013.04.002 23885650

45. Martín-Fernández J, Ariza-Cardiel G, Polentinos-Castro E, Sanz-Cuesta T, Sarria-Santamera A, Del Cura-Gonzalez I. Explaining differences in perceived health-related quality of life: A study within the Spanish population. Gac Sanit. 2018;32: 447–453. doi: 10.1016/j.gaceta.2017.05.016 28958573

46. Arrospide A, Machon M, Ramos-Goni JM, Ibarrondo O, Mar J. Inequalities in health-related quality of life according to age, gender, educational level, social class, body mass index and chronic diseases using the Spanish value set for Euroquol 5D-5L questionnaire. Health Qual Life Outcomes. 2019;17: 69. doi: 10.1186/s12955-019-1134-9 30999899

47. Carou AC, Fernandez SP, Diaz SP, Santos FJD. Clinical profile, level of affection and therapeutic management of patients with osteoarthritis in primary care: The Spanish multicenter study EVALUA. Reumatol Clin. 2015;11: 353–360. doi: 10.1016/j.reuma.2014.12.005 25648903

48. García-Pérez L, Ramos-García V, Serrano-Aguilar P, Pais-Brito JL, Aciego de Mendoza M, Martín-Fernández J, et al. EQ-5D-5L utilities per health states in Spanish population with knee or hip osteoarthritis. Health Qual Life Outcomes. 2019;17: 164. doi: 10.1186/s12955-019-1230-x 31666071

49. Torre JA, Puigdomenech E, Valderas JM, Evans JP, Martin V, Molina AJ, et al. Availability of specific tools to assess patient reported outcomes in hip arthroplasty in Spain. Identifying the best candidates to incorporate in an arthroplasty register. A systematic review and standardized assessment. PLoS One. 2019;14: e0214746. doi: 10.1371/journal.pone.0214746 30934024

Článek vyšel v časopise


2020 Číslo 1