Physical activity in people with osteoarthritis and comorbidity: a multi-method study

Abstract

Osteoarthritis (OA) is common and associated with one of the highest comorbidity rates. OA clinical guidelines recommend physical activity (PA) as core treatment, irrespective of comorbidity. However, no current synthesis of the effectiveness of PA for people with OA and comorbidity exists. The impact of comorbidity on the uptake and experience of PA in this population is unknown and how to successfully implement PA interventions within primary care for people with OA and comorbidity remains unclear. This thesis addressed these three research gaps.

A systematic review examining the effectiveness of PA interventions in people with OA and comorbidity found the evidence to be limited and heterogeneous (n=14 studies, of which 10 were OA and obesity studies). Trends suggest PA interventions may improve clinical outcomes of pain and function, although uncertainty remains.

Secondary data analysis of two large randomised controlled trials for older adults with knee (n=514) and joint (knee, hip, hand and foot) OA (n=525) found an association between comorbidity presence and lower PA levels. A potential dose response relationship exists between comorbidity frequency and lower PA levels, and the presence of specific comorbidity types (e.g. cardiovascular disease) were associated with decreased PA levels.

Qualitative semi-structured interviews in 17 older adults with OA and comorbidity found barriers to PA were multiple and dynamic. OA was often prioritised as more important over other health conditions based on the disruption it caused to QOL. Participants reported; a lack of knowledge about how best to manage their conditions, and the role of PA; negative perceptions regarding the role of PA in managing their conditions, which appeared to impact self-efficacy for self-management of conditions and PA. Healthcare professionals and social support were found to facilitate PA.

This multi-method thesis has contributed to a better understanding of PA in the context of OA and comorbidity.