Determinants of Health-Related Quality of Life in Patients with Knee and Hip Osteoarthritis under Rehabilitation Care


  • Universiti Sultan Zainal Abidin, School of Nutrition and Dietetics, Faculty of Health Sciences, Terengganu, 21300, Malaysia
  • Universiti Sultan Zainal Abidin, Faculty of Medicine, Kuala Terengganu, Terengganu, 20400, Malaysia


The World Health Organization estimated Osteo-Arthritis (OA) to cause 80% sufferers to have movement limitation and 25% unable to perform major daily activities, which result in quality of life deterioration. This study aims to determine the factors associated with Health-Related Quality Of Life (HRQOL). A total of 131 OA patients were involved in a crosssectional study which were recruited from the Rehabilitation Health Organization, Terengganu. Socio-demographic, clinical and lifestyle histories, and 24-hour dietary intake were assessed by using structured questionnaire while HRQOL was measured by using the Malay version of the Osteo-Arthritis Knee and Hip Quality Of Life (OAKHQOL) questionnaire. OAKHQOL questionnaire was evaluated via Likert scales in the items range from 0 (best) to 10 (worst). In each domain, the mean score of the items was calculated, yielding a score for each domain. The score is the standardized on a scale from 0 (best possible QOL) to 100 (worst possible QOL) scale. Anthropometric measurement was measured by using Tanita Body Fat Monitor and Seca height scale and Body Mass Index (BMI) was calculated. Multiple linear regression was performed. Age was positively associated with social functioning (p=0.005). Meanwhile, disease duration was positively associated with physical domain (p=0.043). Among the anthropometric measurement, only BMI was positively associated with physical domain (p=0.040). Higher vitamins C and D intake was associated with lower mental health. Next, better social functioning was observed in low vitamin K consumption. Patients who exercise were associated with better physical and mental health, lower pain, and greater social support. Monthly income, body mass index, waist circumference, and other nutrients intake were not associated with HRQOL. In summary, exercise was the best predictor for better HRQOL.


Clinical, Health-Related Quality Of Life (HRQOL), Lifestyle, Nutritional Status, Osteoarthritis, Socioeconomic

Subject Discipline


Full Text:


Bijlsma JWJ, Berenbaum F, Lafeber FPJG. Osteoarthritis: An update with relevance for clinical practice. Lancet. 2011; 377(9783): 2115-26.

Conaghan P, Porcheret M, Kingsbury SR, et al. Impact and therapy of osteoarthritis: The Arthritis care OA Nation 2012 survey. Clin. Rheumatol. 2014. s10067-014-2692-1. PMid: 24889403.

March L, Cross M, Arden N, Hawker G. Osteoarthritis: A Serious Disease, Submitted to the U.S. Food and Drug Administration; 2016.

Kamaruzaman H. CPG Management of Osteoarthritis (2nd Ed). Vol 2, Ministry of Health Malaysia; 2013. https:// Management_of_Osteoarthritis_2nd_Edition,

Woolf AD, Pfleger B. Burden of major musculoskeletal conditions. Bull World Health Organ. 2003; 81(9): 646-56.

Allen KD, Golightly YM. Epidemiology of osteoarthritis: State of the evidence. Curr Opin Rheumatol. 2015; 27(3): 276-83. PMid: 25775186 PMCid: PMC4405030.

Fransen M, Bridgett L, March L, Hoy D, Penserga E, Brooks P. The epidemiology of osteoarthritis in Asia. Int. J. Rheum. Dis. 2011; 14(2): 113-21. PMid: 24792942.

Kawano MM, Araújo ILA, Castro MC, Matos MA. Assessment of quality of life in patients with knee osteoarthritis. Acta. Ortop. Bras. 2015; 23(6): 307-10. PMid: 27057143, PMCid: PMC4775507.

Mahmoud GA, Moghazy A, Fathy S, Niazy MH. Osteoarthritis knee hip quality of life questionnaire assessment in Egyptian primary knee osteoarthritis patients: Relation to clinical and radiographic parameters. Egypt Rheumatol. 2019; 41(1): 65-69.

Abdul Kadir A, Mohd Arif MF, Ishak A, Hassan II, Mohd Noor N. Adaptation and validation of the Malay version of the Osteoarthritis Knee and Hip Quality of Life (OAKHQOL) questionnaire among Knee Osteoarthritis Patients. Biomed. Res. Int. 2018; 2018: 1-32. https://doi. org/10.1155/2018/4329751. PMid: 29955601, PMCid: PMC6000845.

Ngoh HJ, Sakinah H, Harsa Amylia MS. Development of demi-span equations for predicting height among the Malaysian elderly. Malays. J. Nutr. 2012; 18(2): 149-59.

Zakaria ZF, Bakar AA, Hasmoni HM, Rani FA, Kadir SA. Health-related quality of life in patients with knee osteoarthritis attending two primary care clinics in Malaysia: A cross-sectional study. Asia Pac. Fam. Med. 2009; 8(1): 10. PMid: 20084190, PMCid: PMC2807850.

Shrestha R. Quality of life of patients with knee osteoarthritis. J. Patan. Acad. Heal. Sci. 2018; 5(2): 81-84.

Jhun HJ, Sung NJ, Kim SY. Knee pain and its severity in elderly Koreans: Prevalence, risk factors and impact on quality of life. J. Korean Med. Sci. 2013; 28(12): 1807-13. PMid: 24339713, PMCid: PMC3857379.

Vitaloni M, Botto-Van Bemden A, Sciortino Contreras RM, et al. Global management of patients with knee osteoarthritis begins with quality of life assessment: A systematic review. BMC Musculoskelet Disord. 2019; 20(1). PMid: 31656197, PMCid: PMC6815415.

Al-Ahaideb A, Alrushud A, El-Sobkey S, Hafez A. Impact of knee osteoarthritis on the quality of life among Saudi elders: A comparative study. Saudi J. Sport. Med. 2013; 13(1): 10.

Harsha Kumar H, Nagaraj K, Luthra K, et al. Health-related quality of life among osteoarthritis patients attending primary care clinics of Mangalore city. Int. J. Med. Public Heal. 2015; 5(1): 55-58.

Norimatsu T, Osaki M, Tomita M, et al. Factors predicting health-related quality of life in knee osteoarthritis among community-dwelling women in Japan: The Hizen-Oshima study. Orthopedics. 2011; 34(9): e535-40. PMid: 21902153.

Bindawas SM, Vennu V, Al Snih S. Differences in healthrelated quality of life among subjects with frequent bilateral or unilateral knee pain: Data from the osteoarthritis initiative study. J. Orthop. Sports Phys. Ther. 2015; 45(2): 128-36. PMid: 25573010, PMCid: PMC4380178.

Jeong H, Baek SY, Kim SW, et al. Comorbidities and healthrelated quality of life in Koreans with knee osteoarthritis: Data from the Korean National Health and Nutrition Examination Survey (KNHANES). PLoS One. 2017; 12(10): e0186141. PMid: 29045425, PMCid: PMC5646822.

Watanabe H, Urabe K, Takahira N, et al. Quality of life, knee function, and physical activity in Japanese elderly women with early-stage knee osteoarthritis. J Orthop. Surg. (Hong Kong). 2010; 18(1): 31-34. PMid: 20427830.

Zhou M, Hou H, Zou W, et al. Predicting factors of quality of life in Chinese knee osteoarthritis patients with or without knee replacement surgery: Weight loss, physical exercise and patient expectations. Biomed. Res. 2017; 28(12): 5383-87. articles/predicting-factors-of-quality-of-life-in-chinesekneeosteoarthritis-patients-with-or-without-kneereplacementsurgery-weight-loss.html.

van der Kraan PM. Osteoarthritis and a high-fat diet: The full “OA syndrome” in a small animal model. Arthritis Res. Ther. 2010; 12(4): 130. PMid: 20701740, PMCid: PMC2945034.

Hung M, Bounsanga J, Voss MW, Gu Y, Crum AB, Tang P. Dietary and supplemental vitamin C and D on symptom severity and physical function in knee osteoarthritis. J. Nutr. Gerontol Geriatr. 2017; 36(2-3): 121-33. PMid: 28557644, PMCid: PMC6088727.

Jensen NH. Reduced pain from osteoarthritis in hip joint or knee joint during treatment with calcium ascorbate. A randomized, placebo-controlled cross-over trial in general practice. Ugeskr. Laeger. 2003; 165(25): 2563-66.

Wluka AE, Stuckey S, Brand C, Cicuttini FM. Supplementary vitamin E does not affect the loss of cartilage volume in knee osteoarthritis: A 2 year double blind randomized placebo controlled study. J. Rheumatol. 2002; 29(12): 258591.


  • There are currently no refbacks.