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Title: The risk factors associated with the prevalence of pain and self-reported physician-diagnosed osteoarthritis in Great Britain's Olympians
Author: Cooper, Dale
ISNI:       0000 0004 6060 8202
Awarding Body: University of Nottingham
Current Institution: University of Nottingham
Date of Award: 2016
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Background: Affecting approximately one in four adults over the age of 50 years in the UK, knee pain is a leading cause of disability in the elderly and bears a significant economic cost. Despite the plethora of studies that have investigated the factors associated with the onset of knee pain and osteoarthritis (OA) in the sedentary population, relatively little is known about the prevalence and factors associated with musculoskeletal pain and OA in an athletic sporting population. Objectives: This study aimed to: (1) describe the injury patterns, the prevalence of pain, and OA in Great Britain’s (GB) Olympians; (2) determine in GB Olympians aged 40 years and older the risk of pain and OA at three joints - the hip, knee and the lumbar spine; and (3) identify the individual risk factors associated with joint pain and OA in GB Olympians aged 40 years and older. Methods: This was a cross-sectional study design with an internal nested-case control study. A web-based and / or paper questionnaire was distributed by email and / or post to 2742 GB Olympians living in 30 different countries. The questionnaire was used to collect data on risk factors associated with the onset of pain and OA. The presence of OA was defined by a self-reported physician-diagnosis. Pain was self-reported using a body manikin, and defined as pain in or around the selected joint on most days for at least one month. The most severe limb was selected as the index joint for data analysis, if bilateral. Three separate models of binary logistic regression were constructed to examine the covariates that were associated with pain at the hip, knee, and the lumbar spine. A further three models were constructed to examine the covariates associated with OA at the aforementioned joints. Covariates were identified for analysis, and those that were associated with pain or OA (P < 0.25) were purposefully fitted into a multivariable regression model. The final regression models were constructed by refitting, one at a time, the covariates that had previously been excluded until all of the covariates and interactions that were clinically relevant or significant at traditional levels (P < 0.05) were included. Relative risk (RR) was estimated using odds ratio (OR), and confounding factors were adjusted (aOR) using logistic regression. The Faculty of Medicine and Health Sciences Research Ethics Committee at the University of Nottingham approved the study. Results: The response rate was 26%, with 714 returns achieved between the 22nd of May 2014 and the 31st of January 2015. The questionnaires were returned from GB Olympians living in 15 different countries, including the UK. The age of the GB Olympians recruited ranged from 19 to 97 years, with a mean age of 58.76 + 16.79 years. Fifty-seven per cent of those recruited were male (n = 405) and 43% were female (n = 309). The age of male GB Olympians recruited ranged from 22 to 97 years, with a mean age of 63.00 + 16.30 years. The age range of female GB Olympians recruited ranged from 19 to 93 years, with a mean age of 53.20 + 15.78 years. A total of 821 significant injuries were reported, resulting in an injury rate of 1150 significant injuries per 1000 registered GB Olympians, with 62% reporting they had sustained at least one significant injury (n = 441). Cartilage injuries, joint sprain (injury of joint and / or ligaments), and ligament ruptures were prominent in those with knee pain and knee OA. Intervertebral disc injuries, contusions and joint related injury were common in those with pain and OA at the lumbar spine. Pain was most prevalent at the lumbar spine (32.7%), knee (25.6%), hip (23.0%), and the ankle (14.1%). Osteoarthritis was most prevalent at the knee (14.2%), hip (11.1%), lumbar spine (5.0%), and the ankle (1.3%). Female gender and older age were significantly associated with lumbar spine OA, and older age and a previous significant hip injury were significantly associated with the prevalence of hip OA. Ageing and body mass index (BMI) (kg/m2), a previous significant knee injury and early-life (20-29 years) generalised joint hypermobility (GJH) (Beighton > 4/9) were found to be significantly associated with the prevalence of knee OA. The strongest factors associated with knee pain were a prior significant knee injury, early-life (20-29 years) varus knee alignment, competing in weight-bearing loading sports, widespread pain, and a higher body mass index (kg/m2). Factors associated with hip pain included a previous significant hip injury and competing in weight-bearing loading sports. A one-unit increase in age and BMI (kg/m2), and a prior significant lumbar spine injury were significantly associated with lumbar spine pain. A one-unit increase in physical well-being was significantly associated with a lower prevalence of pain at the hip and knee. Conclusion: This study found that: 1) injury appeared to be constantly the strongest risk factor for pain at the knee, hip and the lumbar spine, as well as OA at the hip and knee; 2) in GB Olympians aged 40 years and older, the knee was most likely affected by OA, and the lumbar spine by pain; 3) participation in weight-bearing loading sports was associated with hip and knee pain, but not hip and knee OA; and 3) generalised joint hypermobility (Beighton > 4/9) appeared to be not a risk factor for injury, and nor was it a risk factor for all joint pain/OA, except OA at the knee joint. Female GB Olympians with early-life GJH were more vulnerable to knee OA than their male counterparts. Future research is needed to help determine whether or not GJH is a risk factor associated with the onset of knee OA in the general population, particularly among females. As one of the few modifiable risk factors, joint injury prevention should be part of the future initiatives to reduce the risk of OA, along with maintaining a healthy body weight.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available