Background Identifying the predictors of health-related quality of life (HRQoL) is essential for improving patient outcomes in chronic conditions like knee osteoarthritis (KOA). However, research exploring the structural pathways within this context remains limited. This study aims to examine the structural relationships of symptoms, functional status, and depressive symptoms on both physical and mental HRQoL using Structural Equation Modeling (SEM). Methods This study included 174 patients with KOA. For the assessment of patients, symptoms were measured by Numeric Pain Rating Scale, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) (pain and stiffness); functional status by the Lower Extremity Functional Scale and WOMAC physical function; depressive symptoms by the Beck Depression Inventory. HRQoL physical and mental component were assessed using the Short-Form Health Survey (SF-36). SEM was used to examine the structural relationships of symptoms, functional status and depressive symptoms on HRQoL (physical and mental). Results The final model exhibited the following fit indices (x2/df = 2.254, CFI = 0.941, IFI = 0.942, NNFI (TLI) = 0.918, RMSEA = 0.085, SRMR = 0.0802). This study revealed that symptoms were significantly associated with functional status (standardized coefficient = 0.978; p < 0.001), functional status with depressive symptoms (0.377; p < 0.001), and depressive symptoms with HRQoL-Mental (-0.773; p < 0.001). The findings showed that HRQoL-Mental was significantly associated with HRQoL-Physical (0.746; p < 0.05). However, neither symptoms nor functional status demonstrated a statistically significant association with HRQoL-Mental. Additionally, symptoms, functional status, and depressive symptoms showed no significant associations with HRQoL-Physical. Conclusions The results of this study demonstrate the pathways associated with HRQoL in patients with KOA. Through a sequential pathway, symptoms and functional impairments are associated with higher depressive symptoms and lower HRQoL-Mental. This subsequent decline in HRQoL-Mental is associated with HRQoL-Physical. From a clinical perspective, this mediating relationship should be considered when patients show no improvement in their quality of life despite conventional or surgical treatments. Ultimately, to achieve a comprehensive improvement in quality of life in patients with KOA, it is essential to integrate symptom relief, the management of functional impairment, and the treatment of accompanying depressive symptoms into a holistic treatment plan. Trial registration The study was registered at ClinicalTrials.gov on January 6, 2025 (Registration number: NCT06760338).

Predictors of health-related quality of life in patients with knee osteoarthritis

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2026年8月1日

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Emrah Afsar,
Zeynep Sena Namaz

摘要

Background

Identifying the predictors of health-related quality of life (HRQoL) is essential for improving patient outcomes in chronic conditions like knee osteoarthritis (KOA). However, research exploring the structural pathways within this context remains limited. This study aims to examine the structural relationships of symptoms, functional status, and depressive symptoms on both physical and mental HRQoL using Structural Equation Modeling (SEM).

Methods

This study included 174 patients with KOA. For the assessment of patients, symptoms were measured by Numeric Pain Rating Scale, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) (pain and stiffness); functional status by the Lower Extremity Functional Scale and WOMAC physical function; depressive symptoms by the Beck Depression Inventory. HRQoL physical and mental component were assessed using the Short-Form Health Survey (SF-36). SEM was used to examine the structural relationships of symptoms, functional status and depressive symptoms on HRQoL (physical and mental).

Results

The final model exhibited the following fit indices (x²/df = 2.254, CFI = 0.941, IFI = 0.942, NNFI (TLI) = 0.918, RMSEA = 0.085, SRMR = 0.0802). This study revealed that symptoms were significantly associated with functional status (standardized coefficient = 0.978; p < 0.001), functional status with depressive symptoms (0.377; p < 0.001), and depressive symptoms with HRQoL-Mental (-0.773; p < 0.001). The findings showed that HRQoL-Mental was significantly associated with HRQoL-Physical (0.746; p < 0.05). However, neither symptoms nor functional status demonstrated a statistically significant association with HRQoL-Mental. Additionally, symptoms, functional status, and depressive symptoms showed no significant associations with HRQoL-Physical.

Conclusions

The results of this study demonstrate the pathways associated with HRQoL in patients with KOA. Through a sequential pathway, symptoms and functional impairments are associated with higher depressive symptoms and lower HRQoL-Mental. This subsequent decline in HRQoL-Mental is associated with HRQoL-Physical. From a clinical perspective, this mediating relationship should be considered when patients show no improvement in their quality of life despite conventional or surgical treatments. Ultimately, to achieve a comprehensive improvement in quality of life in patients with KOA, it is essential to integrate symptom relief, the management of functional impairment, and the treatment of accompanying depressive symptoms into a holistic treatment plan.

Trial registration

The study was registered at ClinicalTrials.gov on January 6, 2025 (Registration number: NCT06760338).