무릎 골관절염 환자의 삶의 질과 하지기능 관련 요인 = Health Related Quality of Life and Factors Associated with Lower Limb Function in Patients with Symptomatic Knee Osteoarthritis

다국어 초록 (Multilingual Abstract)

Background: Knee osteoarthritis (OA) is a major cause of disability, particularly in the elderly. The factors determining disability remain unclear and have not been defined in Korea. The aim of this study was to assess the various aspects of the quality of life, and to define the determinant factors of disability in patients with knee OA.
Methods: The Korean version of AIMS2 (K-AIMS2) and CMCHS (Catholic Medical Center Health Survey) were administered to a cohort of 239 outpatients with symptomatic OA of the knee who attended 7 participating University Hospitals in Seoul, Ilsan and Taejon. The scores of K-AIMS2 12 subscales by demographic variables and body mass index were compared using Student t-test. And the determinant factors of the lower extremity disability were analysed by stepwise multiple regression method.
Results: The study subjects (n=239) were 61.6±9.1 years old, comprised of 197 (82.4%) females and 42 (17.6%) males, had been sick with knee osteoarthritis for 6.2±6.5 years, and had 24.7±3.1 kg/m2 BMI. Among K-AIMS2 12 subscales ‘Walking and bending’ (5.82±2.17), ‘Arthritis pain’ (5.19±1.98), ‘Social activities’ (3.97±2.04), and ‘Mobility level’ (3.61±1.74) showed high scores, while subscales related with upper extremities function showed low scores, reflecting the costruct validity of K-AIMS2 in patients with symptomatic knee OA. After adjustment for the presence of sociodemographic variables, we found bodily pain (P＜0.001), age (P＜0.001), emotional function (P=0.033), and education level (P=0.099) as determinant factors of K-AIMS2 lower limb function.
Conclusion: It is recommendable that the knee OA patients should be treated properly in the emotional aspect as well as the bodily pain aspect. In addition, it is suggested that education level be considered as an important factor when teaching the OA patients about coping with knee disabilities.

국문 초록 (Abstract)

연구배경: 관절염 환자의 삶의 질, 특히 관절 기능을 평가하는 것은 환자 관리에 매우 중요한 부분이다. 외국에서의 연구결과에 의하면, 무릎 골관절염 환자의 기능장애와 관련 있는 요인들로는 무릎 통증, 고령, 저학력, 비만, 여성, 동반질환 유무 등을 들 수 있지만, 정신사회적 요인들, 특히 우울과 불안의 역할은 덜 명확한 것으로 나타났다. 국내에서는 무릎 골관절염 환자의 삶의 질의 제 측면 중 기능장애에 영향을 미치는 요인을 밝히고자 한 연구가 아직 보고된 바 없다. 본 연구에서는 최근에 타당도가 검증된 한국형 Arthritis Impact Measurement Scale 2(AIMS2)를 이용하여, 무릎 골관절염 환자의 삶의 질과 관련 있는 요인을 조사하고 특히 하지기능 관련요인을 밝히고자 하였다.
방법: 2001년 10월부터 2001년 12월까지 7개 대학병원 외래(가정의학과 5, 정형외과 2)를 방문해 무릎 통증을 호소하는 골관절염 초진환자 239명을 대상으로 한국형 AIMS2와 삶의 질의 전반적 평가 도구인 Catholic Medical Center Health Survey(CMCHS)로 조사하였다. 한국형 AIMS2 12척도 점수를 인구학적 특성, 체질량지수, 유병기간에 따라 Student's t-검정으로 비교하였다. 하지의 기능을 의미하는 ‘이동성’ 및 ‘걷기와 구부리기’ 척도 점수 합을 종속변수로 하고, 연령, 성, 학력(고졸 미만 또는 이상), 월수입(2백만원 미만 또는 이상), 체질량지수, CMCHS의 ‘정서적 기능’, ‘신체 통증’ 등을 독립변수로 하는 다중 회귀분석을 시행하였다.
결과: 연구 대상자 239명의 연령은 61.6±9.1세였으며, 여성이 197(82.4%)명으로 다수를 차지했다. 관절염을 앓아온 기간은 6.2±6.5년이었다. 체질량 지수는 24.7±3.1 kg/m2로 나타났다. 한국형 AIMS2 12척도들 중 ‘걷기와 구부리기’(5.82±2.17), ‘관절염 통증’(5.19±1.98), ‘사회적 활동’(3.97±2.04), ‘이동성’(3.61±1.74) 등은 높은 점수(낮은 삶의 질)를 보였고, 상지기능과 관련 척도들은 낮은 점수(높은 삶의 질)를 나타냈다. 무릎 골관절염 환자의 하지기능에 영향을 미치는 요인으로는 ‘신체통증’(P＜0.001), 연령(P＜0.001), 교육수준(P=0.099)으로 나타났으며, ‘정서적 기능’은 하지기능과의 인과관계를 확인할 수는 없었지만 유의한(P=0.033) 상관관계가 있었다.
결론: 무릎 골관절염 환자의 하지기능을 개선시키기 위해서는 관절염으로 인한 통증을 관리하는 것이 중요하고, 정서적 문제를 인지하고 관리해야 하며, 교육수준과 이로 인한 사회경제적인 어려움 등을 감안할 필요가 있다.

참고문헌 (Reference)

1 신호철, "한국형 건강상태 평가도구의 개발 - CMCHS V1.0." 19 (19): 1998

2 이재호, "한국형 AIMS2의 타당도와 신뢰도." 24 (24): 19-44, 2003

3 임영택, "비만환자에서 체중감소가 삶의 질에 미치는 영향." 22 (22): 556-564, 2001

4 이재호, "관절염/비만 건강상태 평가도구." 24 (24): 376-385, 2003

5 박용우, "과체중 및 체지방 분포와 건강관련 삶의 질." 21 : 753-761, 2000

6 Dekker J, "pain and disability in osteoarthritis patients the mediating role of muscle weakness. Behav Res ther 1993" 203-6,

7 Altman R, "et al. Development of criteria for the classification of osteoarthritis of the knee. Arthritis Rheum 1986" 1039-49,

8 Badley EM, "Wood PHN. The prevalence and severity of major disabling conditions. Int J Epidemiol 1978" 145-51,

9 Gonarthrosis and Quality of Life Assessment (GOQOLA) Study Group, "Validation of an Italian version of the arthritis impact measurement scales 2 (ITALIAN-AIMS2) for patients with osteoarthritis of the knee." 39 (39): 720-727, 2000

10 Meenan RF, "The content and properties of a revised and expanded Arthritis Impact Measurement Scales health status questionnaire. Arthritis Rheum 1992" 1-10,

11 Sharma L, "Studying how osteoarthritis causes disability: nothing is simple (editorial)." 25 : 1-4, 1998

12 Jordan JM, "Self reported functional status in osteoarthritis of the knee in a rural Southern community: the role of sociodemographic factors, obesity and knee pain." 9 : 27-, 1996

13 Hopman-Rock M,, "Physical and psychosocial disability in elderly subjects in relation to pain in the hip and/or knee." 23 : 1037-1044, 1996

14 van Baar ME,, "Pain and disability in patients with osteoarthritis of hip or knee: the relationship with articular, kinesiological and psychological characteristics." 25 : 125-133, 1998

15 Kushner RF, "Obesity and Quality of Life." 16 : 947-952, 2000

16 Jinks C, "Measuring the population impact of knee pain and disability with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)." 100 (100): 55- 64, 2002

17 Meenan RF, "Mason JH. Measuring health status in arthritis" 146-52,

18 Ettinger WH, "Mallon KP. Long- term physical functioning in persons with knee osterarthritis from NHANES. I Effcts of comorbid medical conditions. J Clin Epidemiol 1994" 809-15,

19 Jordan JM, "Knee pain and knee osterarthritis severity in self reported task specific disability: the Johnstone County Osteoarthritis Project." 24 : 1344-1349, 1997

20 Gates DM, "Ike RW. Risk Factors for disability among U.S. adults with arthritis. J Clin Epidemiol 1991" 167-82,

21 "Ferraccioli G. Analysis of disability in knee osteoarthritis. Relationship with age and psychological variables but not with radiographic score. J Rheumatol 1991" (lli m) : 1581-6,

22 Creamer P, "Factors associated with functional impairment in symptomatic knee osteoarthritis." 39 (39): 490-496, 2000

23 Lawrence RC, "Estimates of the prevalence of arthritis and selected musculoskeletal disorders in the United States." 41 : 778-799, 1998

24 McAlindon TE, "Dieppe PA. Determinants of disability in osteoarthritis of the knee. Ann Rheum Dis 1993" 258-62,

25 Creamer P, "Determinants of pain severity in knee osteoarthritis effect of demographic and psychosocial variables using 3 pain measures." 26 (26): 1785-1792, 1999

26 Wolfe F, "Determinants of WOMAC function, pain and stiffness scores: evidence for the role of low back pain, symptom counts, fatigue and depression in osteoarthritis, rheumatoid arthritis and fibromyalgia." 38 : 355-361, 1999

27 Bombardier C, "Beaton D. Cross-cultural adaptation of health-related quality of life measures" 1417-32,

28 Guccione AA, "Anderson JJ. Defining arthritis and measuring functional status in elders methodological issues in the study of disease and physical disability. Am J Public Health 1990" 945-9,

29 "American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition" 317-50, 1994

30 Summers M, "Alarcon GS. Radiographic assessment and psychological variables as predictors of pain and funtional impairment in osteoarthritis of the knee or hip. Arthritis Rheum 1988" 204-9,