Call Girls Tirupati Just Call 8250077686 Top Class Call Girl Service Available
Impact of arthritis on health related quality of life
1. A PROJECT SEMINAR
ON
IMPACT OF ARTHRITIS ON HEALTH RELATED
QUALITY OF LIFE
BY
SOOBIYA MAJEED
M.Pharm, II/II semester, PHARMACOLOGY
Under the guidance of
Dr. K. Abedulla Khan,
M.Pharm, Ph.D.
Professor,
Dept. of Pharmacology
SULTAN UL ULOOM COLLEGE OF PHARMACY
(Recognised by AICTE & Pharmacy Council of India)
B. Pharm Programme Accredited by NBI)
Mount Pleasant, 8-2-249, Road No. 3, Banjara Hills,
Hyderabad - 500034
4. What is Arthritis
• The term Arthritis
is from the Greek,
“arthro” meaning
joint and “itis”
meaning
inflammation.
• Arthritis is a joint
disorder featuring
Inflammation and
pain.
4
5. Types of Arthritis
There are more than 100 types of
Arthritis and most common types of
them are:
Osteoarthritis
Rheumatoid Arthritis
Gout
Infectious Arthritis
Fibromyalgia
Ankylosing Spondylitis
5
6. Osteoarthritis
• It is the most common type of
arthritis.
• Degenerative joint disease.
• Occurs in hands and weight bearing
joints including knee, spine.
• Occurs because of breakdown of
cartilage.
6
17. AIM: The aim of this study was to assess HRQoL and to
determine which factors contribute to the prediction of
HRQoL among persons with Arthritis in India.
OBJECTIVE:
• To Compare the different Scales Of AIMS2 in different
age groups. The various Scales measured in different age
groups were as follows:
• Mobility Level, Walking and Bending, Arm Function, Self
Care Task, Social Activity, Support from Family & Friends,
Arthritis Pain, Work, Level Of Tension & Mood.
17
19. The data was collected through Patient
Counselling forms, Patient Profile forms
made available by the institution and
the tertiary care hospital unit and
Arthritis Impact Measurement Scale
(AIMS/AIMS2) developed by Robert F.
Meenan, dean, Boston University School
of Public Health,715 Albany St., T-C-
306, Boston,MA 02118.
19
20. AIMS2
• The current AIMS2 instrument is a 78 item
questionnaire.
• The first 57 items are broken down into 12
scales:
• Mobility level, Walking and Bending, Hand and
Finger Function, Arm Function, Self Care
Tasks, Household Tasks, Social Activity,
Support from Family and Friends, Arthritis
Pain, Work, Level of Tension and Mood.
• The number of items in each scale is either 4
or 5.
20
21. • Item 58 concerns respondent satisfaction
with each of the 12 health status scales.
• Item 59 ask respondents to report how
much of their problem with any of these
twelve areas is attributable to arthritis.
• Item 67 and 68 allow the patients to
identify the type and duration of her/his
arthritis.
• Item 69 provides an estimate of
medication usage.
• Item 70-72 explores for comorbidity, and
items 73-78 deal with demographics.
21
22. FIVE COMPONENT MODEL
• PHYSICAL = (MOBILITY LEVEL +
WALKING AND BENDING + HAND AND
FINGER FUNCTION + ARM FUNCTION +
SELF CARE + HOUSEHOLD TASKS ) ÷ 6
• AFFECT = (LEVEL OF TENSION + MOOD)
÷ 2
• SYMPTOMS = ARTHRITIS PAIN
• SOCIAL INTERACTION = (SOCIAL
ACTIVITY + SUPPORT FROM FAMILY) ÷ 2
• ROLE = WORK
22
24. 101
46
0
100
200
Urban Non Urban
No.Of
Patients
DISTRIBUTION OF POPULATIONS INTO
URBAN & RURAL
24
2 4
9
41
30
12
2 11 3 3
12
19
7
1 0
0
10
20
30
40
50
No.OfPatients
Age Group
URBAN & RURAL POPULATION DISTRIBUTION
ACCORDING TO AGE-WISE
Urban Patients
Non Urban
Patients
25. 3 7
12
53 49
19
3 1
0
20
40
60
21-30 31-40 41-50 51-60 61-70 71-80 81-90 91-100
No.OfPatients
Age Group
AGE GROUP WISE DISTRIBUTION OF NO. OF
PATIENTS
25
1 2 7
19 22
12
2 12 5 3
34 27
7 1 0
0
20
40
No.ofMales&
Females
Age Group
GENDER WISE DISTRIBUTION OF NO. OF PATIENTS
Males
Females
26. 5
36
62
44
0
20
40
60
80
Underweight Normal Overweight Obese
No.OfPatients
Category Of BMI
BODY MASS INDEX
26
4
58
42
24
17
0
20
40
60
80
Hypotension Normal Pre
Hypertension
Stage I Stage II
No-OfPatients
CLASSIFICATION OF HYPERTENSION
28. 2 8
19
78
0
50
100
Grade I Grade II Grade III Grade IV
No.OfPatients
GRADES OF OSTEOARTHRITIS
28
10 11
17
0
5
10
15
20
Grade II Grade III Grade IV
No.OfPatients
GRADES OF RHEUMATOID ARTHRITIS
30. MOBILITY
1. How often were you physically
able to drive a car or use public
transportation?
2. How often were you out of the
house
for at least part of the day?
4. How often were you able to do
errands
in the neighborhood?
5. How often were you in a bed or
chair
for most or all of the day?
3. How often did someone have to
assist
you to get around outside your
home?
30
3.1 3.9 4.5 3.7 4.6 5.2
8.7
0
5
10
21-30 31-40 41-50 51-60 61-70 71-80 81-90
SCORE
Age Groups
MOBILITY LEVEL
31. WALKING & BENDING
6. Did you have trouble doing vigorous
activities such as running, lifting heavy
objects, or participating in sports?
7. Did you have trouble either
walking several blocks or
climbing a few flights of stairs
9. Did you have trouble either
walking one block or climbing one
flight of stairs?
10. Were you unable to walk unless
assisted by another person or by a
cane, crutches, or walker?
8. Did you have trouble bending,
lifting or stooping?
31
3.2
5.3 6.3
7.5 7.9 8.3 9.2
0
5
10
21-30 31-40 41-50 51-60 61-70 71-80 81-90
score
Age Groups
WALKING & BENDING
32. HAND & FINGER FUNCTION
11. Could you
easily write with
a pen or pencil?
12. Could you
easily button a
shirt or blouse?
13. Could you
easily turn a key
in a lock?
14. Could you
easily tie a knot
or a bow?
15. Could you
easily open a
new jar of food?
32
3.2
4.7
5.8 6.4
8.7 8.9 9.7
0
5
10
15
21-30 31-40 41-50 51-60 61-70 71-80 81-90
Score
HAND & FINGER FUNCTION
33. ARM FUNCTION
16. Could you
easily wipe
your mouth
with a napkin?
17. Could you
easily put on a
pullover
sweater?
18. Could you
easily comb
or brush your
hair?
19. Could you
easily scratch
your low back
with your hand?
20. Could you
easily reach
shelves that
were above your
head?
33
3.1
5.0 6.4 6.4
7.9 8.6 9.7
0.0
5.0
10.0
15.0
21-30 31-40 41-50 51-60 61-70 71-80 81-90
Score
Age Group
ARM FUNCTION
34. 21. Did you need help to take a
bath or shower?
22. Did you need help to get
dressed?
23. Did you need help to use the
toilet?
24. Did you need help to get in
or out of bed?
SELF CARE TASK
34
3.1
5 6.4 6.4 7.9 8.6 9.8
0
5
10
15
21-30 31-40 41-50 51-60 61-70 71-80 81-90
Score
Age Group
SELF CARE TASK
35. 25. If you had the necessary
transportation, could you go
shopping for groceries without
help?
26. If you had kitchen facilities,
could you prepare your own
meals without help?
27. If you had household tools
and appliances, could you do your
own housework without help?
28. If you had laundry facilities,
could you do your own laundry
without help?
HOUSEHOLD TASKS
35
4
5.2 5.8 6.4
7.4
8.9 9.5
0
5
10
21-30 31-40 41-50 51-60 61-70 71-80 81-90
Score
Age Groups
HOUSEHOLD TASKS
36. SOCIAL ACTIVITY
29. How often did you get
together with friends or
relatives?
30. How often did you have
friends or relatives over to your
home?
32. How often were you on the
telephone with close friends or
relatives?
33. How often did you go to a
meeting of a church, club, team or
other group?
31. How often did you visit friends or
relatives at their homes?
36
3 3.9
4.9 5.7
7.7 8.6 9.3
0
5
10
21-30 31-40 41-50 51-60 61-70 71-80 81-90
Score
Age Group
SOCIAL ACTIVITY
37. 34. Did you feel that your family
or friends would be around if you
needed assistance?
35. Did you feel that your family
or friends were sensitive to your
personal needs?
36. Did you feel that your family
or friends were interested in
helping you solve problems?
37. Did you feel that your family
or friends understood the
effects of your arthritis?
SUPPORT FROM
FAMILY & FRIENDS
37
2.2
3.7
2.8
3.3
1.5
4.4
5
0
2
4
6
21-30 31-40 41-50 51-60 61-70 71-80 81-90
Score
Age Group
SUPPORT FROM FAMILY & FRIENDS
38. ARTHRITIS PAIN
38. How would you describe the
arthritis pain you usually had?
39. How often did you have
severe pain from your arthritis?
41. How often did your morning
stiffness last more than one hour
from the time you woke up?
42. How often did your pain make
it difficult for you to sleep?
40. How often did you have pain in two
or more joints at the same time?
38
5.3 4.7
6.4 5.7
7.6
8.7 9.4
0
5
10
21-30 31-40 41-50 51-60 61-70 71-80 81-90
Score
Age Groups
ARTHRITIS PAIN
39. 44. How often were you unable to
do any paid work, housework or
school work?
45. On the days that you did work,
how often did you have to work a
shorter day?
46. On the days that you did work,
how often were you unable to do
your work as carefully and
accurately as you would like?
47. On the days that you did work,
how often did you have to change
the way your paid work, housework
or school work is usually done?
WORK
39
3.4
5 5.2 5.9
7.6
8.6 9.1
0
5
10
21-30 31-40 41-50 51-60 61-70 71-80 81-90
Score
Age Group
WORK
40. LEVEL OF TENSION
48. How often have you felt tense
or high strung?
49. How often have you been
bothered by nervousness or your
nerves?
51. How often have you felt relaxed
and free of tension?
52. How often have you felt calm
and peaceful?
50. How often were you able to
relax without difficulty?
40
3.5
5.8 5.3 5.4
7.4
8.7 9.6
0
5
10
15
21-30 31-40 41-50 51-60 61-70 71-80 81-90
Score
Age Group
LEVEL OF TENSION
41. MOOD
53. How often have you enjoyed the
things you do?
54. How often have you been in low
or very low spirits?
56. How often did you feel that
others would be better off if you
were dead?
57. How often did you feel so down
in the dumps that nothing would
cheer you up?
55. How often did you feel that nothing turned out
the way you wanted it to?
41
3.2
4.8 5.7 6.4
8.2 8.3
9.7
0
5
10
15
21-30 31-40 41-50 51-60 61-70 71-80 81-90
Score
Age Group
MOOD
47. STATISTICAL ANALYSIS
RESULT FOR CHI SQUARE TEST
• NULL HYPOTHESIS: There is no association of age
and deviation of life style factors in prevalence of
Arthritis.
• ALTERNATIVE HYPOTHESIS: ‘There is an
association of age and deviation of life style factors
in prevalence of Arthritis.
• DEGREE OF FREEDOM: = No of variables-1
= 12-1 = 11
• For degree of freedom 11, Chi-Square value (5% level)
is 19.67 (as per the Chi-Square table).
• INFERENCE: The calculated value of Chi.Square
(20.04) is higher than the table value (19.67).
Therefore we reject the null hypothesis and accept
the alternative hypothesis.
47
49. • It was found out that total Urban patients (n=101) were
more when compared to Rural patients (n=46).
• The urban patients age group ranging between 51-60 (n=53)
are most prone to Osteoarthritis and Rheumatoid Arthritis
followed by 61-70(n=49) age groups.
• The majority of the patients belonged to 51-60 age group
categories and next followed by 61-70 age groups.
• The patients under this study were, female patients (n=81)
and male patients were found to be n=66.
• The average age of the patients getting affected with
Arthritis was found to be 59.62±0.98 years.
49
50. • Out of 147 patients included in the study:
• The age group ranging from 81-90 had the systolic pressure
136.66 ± 12.01 (Mean ± SEM) was found to be more when
compared with other age groups.
• The diastolic pressure was found to be more in age groups
ranging from 71-80 and the Mean ± SEM was found to be
85.78± 3.27.
• Most of the population involved in the study were found to
have normal blood pressure range as they are undergoing
therapy.(n=58).
50
No. Of patients Category BMI range
36 Normal 18.8 to 24
62 Over weight 25 to 29.9
44 obese 30 to 40
5 underweight 18.5
51. 51
Category No. Of Subjects
Pre hypertensive 42
Stage I 24
Stage II 17
Category No. Of Patients Average age
OA 107 59.5±1.15yrs
RA 38 59.3±2.09yrs
Gout 2 45.5±0.5yrs
KL grading system for OA No. Of Patients
Grade I 2
Grade II 8
Grade III 19
Grade IV 78
Larson Grading System for RA No. Of Patients
Grade II 10
Grade III 11
Grade IV 17
52. • Out of 147 patients surveyed in the study, 103 patients
were operated for replacement of a joint whereas only
44 were not operated as they were not in advanced
stage of the disease. They were treated using
medicines and other alternatives.
• The average of 5 comonents of AIMS2 was
determined.
52
5 components Average Score
Physical 6.15±0.16
Affect 6.44±0.15
Symptoms 6.86±0.15
Social Interaction 5.52±0.1
Role 7.08±0.36
54. • 147 patients were enrolled between November 2015 to
June 2016 out of which
101 (68.7%)- urban population
46 (31.3%)-rural areas
81(55.1%) - females
66 (44.8%) were males.
• Majority of subjects in our study were found to be between
51-60 years- 53 cases (36%)
• 61-70-years 49 cases (33.3%)
• Females were more commonly affected in all age groups.
• 85 cases (57.8%) - moderate workers
• 53 cases (36%) - sedentary workers
• 9 cases (6.1%) -heavy workers.
• This disproportion can be because of more number of
housewives enrolled in the study.
•
54
BMI Category Max no. Of Cases
Overweight 62 cases (42.2%)
Obese 44 cases (29.9%)
55. • Out of 147 patients 103 patients were operated for
replacement of a joint.
• Statistical Analysis Chi-Square test was performed to
compare the observed data with data we would expect to
obtain according to a specific hypothesis.
• The Chi.Square value was found to be 20.04 which is
slightly greater than Chi-square table value.(19.67).
55
No. Of Cases Category
78 cases (72.89%) Grade IV of Osteoarthritis
17 cases (44.7%) grade IV of Rheumatoid
Arthritis
Category No. Of Cases
OA 107 cases (72.7%)
RA 38 cases (25.8%)
Gout 2 cases (1.36%)
57. • QoL has become an important outcome measure in clinical
trials as well as in clinical practice.
• The internationally well-known AIMS2 is one of the most
important assessment instruments for QoL of patients
suffering from rheumatoid arthritis as well as OA.
• It is clearly understood that Arthritis has a significant
effect on mental health and health-related quality of life
and impacts on the ability to take part in physical, mental
and emotional tasks.
• The impact on mental health was noted in all age groups
but in particular in younger age groups, who may be less
accepting of their functional limitations.
• Evaluation of these factors is an important part of health
promotion and treatment of chronic musculoskeletal
conditions.
57
58. • To counter act to this situation the health care team i.e.
Physicians, Pharmacists, Nurses & other health care
professions should work as a team.
• More effective guidelines to control the disease should
be formulated.
• The awareness programs should be conducted frequently
by the government and the non profitable organizations.
• The Obese population was more prone to arthritis
because of behavioral changes like stress, food eating
habits (junk foods), environmental changes, sedentary
life style etc.
• Where as in Non-Obese population less people were
affected with Arthritis. This might be because of the
healthy habits, which increased their resistance towards
the diseases.
58
59. BIBLIOGRAPHY
– Atlas of Osteoarthritis. Springer. 2015.
– "Osteoarthritis". National Institute of Arthritis and Musculoskeletal
and Skin Diseases. April 2015. Retrieved 13 May 2015
– Glyn-Jones, S; Palmer, AJ; Agricola, R; Price, AJ; Vincent, TL; Weinans,
H; Carr, AJ "Osteoarthritis.". Lancet. 386: 376–87. (3 March 2015).
– Berenbaum F "Osteoarthritis as an inflammatory disease
(osteoarthritis is not osteoarthrosis!)". Osteoarthritis and
Cartilage. 21 (1): 16–21. doi: (2013).
– Conaghan P (2014). "Osteoarthritis — Care and management in
adults" (PDF).
– Bartlett, C; Doyal, L; Ebrahim, S; Davey, P; Bachmann, M; Egger, M;
Dieppe, P "The causes and effects of socio-demographic exclusions
from clinical trials.". Health technology assessment (Winchester,
England). 9(38): iii–iv, ix–x, 1–152. (October 2005).
59
