Background/Purpose: Osteoarthritis (OA) is associated with functional limitations, including difficulty walking. However, comorbid disease is common in people with OA and may also be associated with functional limitations; this includes chronic conditions such as obesity, stroke, angina, heart failure, diabetic neuropathy, and intermittent claudication. Previous studies have demonstrated that walking disability is associated with cardiovascular (CV) events and all-cause mortality. Our aim was to examine the extent to which knee and hip OA contribute to walking disability. 

Methods: A population cohort aged ≥55 years was recruited from one urban and one rural community from 1996-98. Age, sex, height and weight, joint complaints, functional limitations and self-reported medical comorbidities known to be associated with walking disability were collected by questionnaire. Subjects with inflammatory arthritis, rheumatic disease, amputation and/or reported use of a wheelchair were excluded. OA was defined as (1) swelling, pain, or stiffness in any joint lasting 6 weeks in the past 3 months; and (2) indication on the homunculus that a knee and/or hip was “troublesome”. Walking disability was defined as self-reported difficulty standing or walking in the last 3 months. Participants were classified into 4 mutually exclusive joint groups based on the presence/absence of knee and hip OA. Using logistic regression, we assessed the independent correlates of walking disability. Covariates of interest were: combined knee and hip OA, knee OA only, hip OA only, neurological disease, CV disease, diabetes and peripheral vascular disease. 

Results: 20,644 participants were included: mean age 68.2±8.5 years, 58.5% female, 51.8% rural-dwelling and mean body mass index (BMI) of 25.9±4.5 kg/m².  Self-reported walking disability was present in 5,667 (27.5%) subjects. In bivariate analysis, presence of walking disability was associated with increased age, female sex, higher BMI and all covariates of interest (p<0.01). In the final regression analysis, walking disability was significantly associated with older age (odds ration [OR] 1.04, 1.04 – 1.05, p<0.01), sex (OR 0.83, 0.77 – 0.89, p<0.01), BMI (OR 1.07, 1.07 – 1.08, p<0.01), presence of CV disease (OR 2.12, 1.88 – 2.36, p<0.01), diabetes (OR 1.48, 1.28 – 1.71, p<0.01), peripheral vascular disease (OR 6.98, 3.46 – 14.06, p<0.01) and neurological diseases (OR 3.67, 2.58 – 5.20, p<0.01). Controlling for all of these factors, knee and hip OA remained significantly associated with walking disability: knee and hip OA (OR 17.50, 15.33 – 19.97, p<0.01), knee OA only (OR 6.66, 6.03 – 7.37, p<0.01) and hip OA only (OR 7.13, 6.15 – 8.27, p<0.01). 

Conclusion: In a large population cohort aged ≥55 years, the greatest independent contributor to walking disability was the presence of symptomatic knee and hip OA. Given the previously documented relationship between walking disability and mortality, addressing OA-associated functional limitations is important in the management of other common chronic conditions.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/contributors-to-walking-disability-in-people-with-osteoarthritis-results-from-a-population-based-cohort/