身体锻炼对轻中度膝骨性关节炎生活质量的影响

Effect of physical exercise on quality of life and clinical presentations of mild to moderate knee osteoarthritis

[目的]评估身体锻炼对轻中度膝骨性关节炎(knee osteoarthritis,KOA)生活质量与临床表现的影响。[方法]2022年9月—2022年12月在本院关节外科门诊就诊的76例Kellgren-Lawrence分级为I~II级的KOA患者纳入本研究。采集患者一般资料,采用世界卫生组织生活质量简表(World Health Organization Quality-of-Life Scale,WHOQOL-Brief)、HSS、KOOS、WOMAC评分以及患者膝关节伸屈活动度(range of motion,ROM)评价患者生活质量和临床表现。采用单项因素比较,Pearson相关分析和逻辑回归分析资料。[结果]本研究76例患者中,29例列入锻炼组,占38.2%;其余47例列入不锻炼组,占61.8%。锻炼组的BMI[(23.8±1.3)vs(25.0±1.7),P=0.002],以及糖尿病(62.0%vs 91.8%,P<0.001)、高血压(75.9%vs 91.8%,P=0.010)、冠心病(65.5%vs 87.2%,P<0.001)的发病率均显著低于不锻炼组,而锻炼组文化程度和个人收入均显著高于不锻炼组(P<0.05)。两组在年龄、性别、病程、症状膝侧数和影像K-L分级的差异均无统计学意义(P>0.05)。锻炼组的WHOQOLBrief的生理健康[(63.8±4.8)vs(54.6±3.4),P<0.001]、心理健康[(62.6±5.3)vs(53.7±3.4),P<0.001]、社会关系[(60.9±5.0)vs(53.6±3.1),P<0.001]和周围环境[(61.6±4.5)vs(54.0±4.8),P<0.001],以及HSS评分[(74.1±4.2)vs(68.3±2.5),P<0.001]、KOOS评分[(73.7±4.1)vs(68.4±3.3),P<0.001]和膝屈-伸ROM[(139.3±9.2)°vs(129.4±13.3)°,P=0.001]均显著大于不锻炼组,而前者的WOMAC评分显著低于后者[(31.2±5.8)vs(43.3±3.0),P<0.001]。WHOQOL-Brief评分均与HSS、KOOS和膝ROM呈显著正相关(P<0.05),均与WOMAC评分呈显著负相关(P<0.05)。逻辑回归表明:社会关系评分高是参与锻炼的积极因素(OR=0.664,P=0.026),而WOMAC高是不参与锻炼的危险因素(OR=1.681,P=0.001)。[结论]身体锻炼可以控制轻中度KOA患者的BMI,减少慢性疾病的发病率,改善生活质量和临床表现。WHOQOL-Brief评分与临床评分存在相关性,WOMAC评分可较好体现患者情况。

[Objective]To evaluate the effects of physical exercise on quality of life and clinical manifestations of mild to moderate knee osteoarthritis(KOA).[Methods]A total of 76 patients who visited Outpatients Department of Joint Surgery of our hospital for Kell⁃gren-Lawrence grade I to II KOA from September 2022 to December 2022 were included in this study.The general data of patients were collected,and the World Health Organization Quality-of-Life Scale(WHOQOL-Brief),as well as HSS,KOOS,WOMAC scores and knee flexion-extension range of motion(ROM)were measured for evaluating the quality of life and clinical manifestations.Univariate compari⁃son,Pearson correlation analysis and logistic regression analysis were conducted on the data.[Results]Of the 76 patients included into this study,29 patients fall into the exercise group,accounting for 38.2%,while the remaining 47 patients were classified as the non-exercise group,accounting for 61.8%.The exercise group proved significantly lower than the non-exercise group in terms of BMI[(23.8±1.3)vs(25.0±1.7),P=0.002],as well as incidence of diabetes(62.0%vs 91.8%,P<0.001),hypertension(75.9%vs 91.8%,P=0.010)and coronary heart disease(65.5%vs 87.2%,P<0.001),while the former had significantly higher levels of education and personal income than the latter(P<0.05).However,there were no significant differences between the two groups in age,sex,course of disease,number of knee side in⁃volved,and imaging K-L grade(P>0.05).The exercise groups was significantly greater than the non-exercise group in terms of WHOQOLBrief scores,including physical health[(63.8±4.8)vs(54.6±3.4),P<0.001],mental health[(62.6±5.3)vs(53.7±3.4),P<0.001],social rela⁃tions(60.9±5.0)vs(53.6±3.1),P<0.001]and the surrounding environment[(61.6±4.5)vs(54.0±4.8),P<0.001],as well as the HSS score[(74.1±4.2)vs(68.3±2.5),P<0.001],KOOS score[(73.7±4.1)vs(68.4±3.3),P<0.001]and knee ROM[(139.3±9.2)°vs(129.4±13.3)°,P=0.001],while the former got significantly lower WOMAC score than the latter[(31.2±5.8)vs(43.3±3.0),P<0.001].The WHOQOL-Brief scores were significantly positively correlated with HSS,KOOS and knee ROM(P<0.05),whereas significantly negatively correlated with WOMAC score(P<0.05).As results of logistic regression the high social relationship score was a positive factor for exercise participation(OR=0.664,P=0.026),while high WOMAC was a risk factor for non-exercise participation(OR=1.681,P=0.001).[Conclusion]Physical exercise does control BMI,reduce the incidences of chronic diseases,and improve quality of life and clinical manifestations in patients with mild to moderate KOA.There is a correlation between WHOQOL-Brief score and clinical score,and WOMAC score could better reflect the situation of the patients.