Observational Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 16, 2023; 11(29): 7043-7052
Published online Oct 16, 2023. doi: 10.12998/wjcc.v11.i29.7043
Self-management of osteoarthritis while waiting for total knee arthroplasty during the COVID-19 pandemic among older Malaysians
Ahmad Nabil Khairi Mahdzir, Sumaiyah Mat, Shi Rui Seow, Rizal Abdul Rani, Muhammad Kamil Che Hasan, Nor Hamdan Mohamad Yahaya
Ahmad Nabil Khairi Mahdzir, Physiotherapy Programme, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Kuala Lumpur, Malaysia
Sumaiyah Mat, Shi Rui Seow, Center for Healthy Ageing and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Kuala Lumpur, Malaysia
Rizal Abdul Rani, Nor Hamdan Mohamad Yahaya, Department of Orthopedic & Traumatology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Kuala Lumpur, Malaysia
Muhammad Kamil Che Hasan, Department of Medical Surgical Nursing, Kulliyyah of Nursing, International Islamic University Malaysia, Kuantan 25200, Pahang, Malaysia
Author contributions: Mat S, Abdul Rani R, Mohamad Yahaya NH, and Che Hasan MK designed and coordinated the study; Mahdzir ANK, Abdul Rani R, Mohamad Yahaya NH, and Che Hasan MK performed the experiments, acquired, and analyzed data; Mahdzir ANK and Mat S interpreted the data; Mahdzir ANK and Seow SR wrote the manuscript; and all authors approved the final version of the article.
Supported by Fundamental Research Grant Scheme grant from the Malaysia’s Minister of Higher Education, FRGS/1/2021/SKK0/UKM/02/15.
Institutional review board statement: Ethical approval for this study was obtained from the UKM ethics committee (reference number: JEP-2022-105).
Informed consent statement: Informed consent of participants was obtained prior to the interview.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data is available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sumaiyah Mat, PhD, Lecturer, Researcher, Center for Healthy Ageing and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Kuala Lumpur, Malaysia. sumaiyah.mat@ukm.edu.my
Received: June 27, 2023
Peer-review started: June 27, 2023
First decision: August 4, 2023
Revised: September 11, 2023
Accepted: September 22, 2023
Article in press: September 22, 2023
Published online: October 16, 2023
Processing time: 107 Days and 17.8 Hours
Abstract
BACKGROUND

The study sought to understand the self-management strategies used by patients during the postponement of their total knee arthroplasty (TKA) procedure, as well as the associations between the length of waiting time, pain, and physical frailty and function. The study focused on individuals aged 50 years and above, as they are known to be more vulnerable to the negative impacts of delayed elective surgery and rehabilitation. This study hypothesizes that delayed TKR due to coronavirus disease 2019 (COVID-19) will bear negative effect in self-management, pain, and physical frailty and function in older adults.

AIM

To investigate the effects of COVID-19 pandemic on self-management, pain, and physical function in older adults awaiting TKA in Malaysia.

METHODS

This cross-sectional study has the data of participants, who matched the criteria and scheduled for TKA for the first time, extracted from the TKA registry in the Department of Orthopaedics and Traumatology, Hospital Canselor Tuanku Mukhriz. Data on pain status, and self-management, physical frailty, and instrumental activities daily living were also collected. Multiple linear regression analysis with a significant level of 0.05 was used to identify the association between waiting time and pain on physical frailty and functional performance.

RESULTS

Out of 180 had deferred TKA, 50% of them aged 50 years old and above, 80% were women with ethnic distribution Malay (66%), Chinese (22%), Indian (10%), and others (2%) respectively. Ninety-two percent of the participants took medication to manage their pain during the waiting time, while 10% used herbs and traditional supplements, and 68% did exercises as part of their osteoarthritis (OA) self-management. Thirty-six participants were found to have physical frailty (strength, assistance with walking, rising from a chair, climbing stairs, and falls questionnaire score > 4) which accounted for 72%. Increased pain was associated with physical frailty with odds ratio, odds ratio (95% confidence interval): 1.46 (1.04-2.05). This association remained significant even after the adjustment according to age and self-management.

CONCLUSION

While deferring TKA during a pandemic is unavoidable, patient monitoring for OA treatment during the waiting period is important in reducing physical frailty, ensuring the older patients’ independence.

Keywords: Osteoarthritis; Total knee arthroplasty; Aged; COVID-19; Pain; Functional performance

Core Tip: Prevalence of osteoarthritis (OA) increases with age and contributes to pain, physical inactivity, and mental distress, eventually resulting in high disease burden and low quality of life. As the last resort for late knee OA, total knee arthroplasty (TKA) aims to relieve knee pain by replacing knee joints’ articular surfaces. The emergence of the coronavirus disease 2019 pandemic had interrupted elective surgery and rehabilitation, including TKA for OA patients. The self-management strategies and impacts of delayed TKA may bring interesting insight. This study aimed to determine the associations of TKA waiting time and pain status with physical frailty and function among older patients.