Factors associated with fatigue in hip and/or knee osteoarthritis: a systematic review and best evidence synthesis

Henrietta O Fawole; Opeyemi A Idowu; Ukachukwu O Abaraogu; Andrea Dell'Isola; Jody L Riskowski; Kayode I Oke; Ade F Adeniyi; Chidozie E Mbada; Martijn P Steultjens; Sebastien F M Chastin

doi:10.1093/rap/rkab013

Factors associated with fatigue in hip and/or knee osteoarthritis: a systematic review and best evidence synthesis

Rheumatol Adv Pract. 2021 Feb 26;5(1):rkab013. doi: 10.1093/rap/rkab013. eCollection 2021.

Authors

Affiliations

¹ Centre for Living, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.
² Department of Physiotherapy, College of Medical Sciences, University of Benin, Benin-city.
³ Department of Medical Rehabilitation, University of Nigeria, Enugu, Nigeria.
⁴ Department of Clinical Sciences, Orthopaedics, Clinical Epidemiology Unit, Faculty of Medicine, Lund University, Lund, Sweden.
⁵ Department of Physiotherapy, University of Ibadan, Oyo State.
⁶ Department of Medical Rehabilitation, Obafemi Awolowo University, Osun State, Nigeria.
⁷ Department of Movement and Sports Science, Ghent University, Ghent, Belgium.

Abstract

Objective: The aim was systematically to identify and evaluate factors related to fatigue in individuals with hip and/or knee OA.

Methods: A systematic literature search was conducted using AMED, CINAHL, MEDLINE, ProQuest and Web of Science Core Collections databases. Inclusion criteria comprised cross-sectional, case-control or longitudinal studies on patients with a diagnosis of hip and/or knee OA that included self-reported fatigue measures. Study quality was assessed using the National Heart, Lung and Blood Institute quality appraisal tool, and factors were synthesized within a bio-behavioural framework. Study designs and quality were combined to determine current evidence levels using best evidence synthesis grading. The full review protocol is available from PROSPERO (PROSPERO 2019: CRD42019138571).

Results: Twenty-four studies were included, of which 19 were high, 4 moderate and 1 low quality. There was strong evidence of an association between poor self-reported physical function and high depressive symptoms with higher fatigue. Moderate evidence of an association was found between severe pain, high numbers of co-morbidities and low physical activity levels with higher fatigue. There was moderate or limited evidence of no association between most sociodemographic factors and radiographic OA severity with fatigue.

Conclusion: Targets for fatigue management might include improving physical function, reducing depressive symptoms, pain and co-morbidities, and increasing physical activity levels. There is a need for more rigorous longitudinal studies to understand the causal effect of fatigue determinants within the hip and knee OA populations.

Keywords: correlates; factors; fatigue; osteoarthritis; predictors; systematic review.