Perception, Attitude, And Practice Of Patients With Osteoarthritis In Sudair Area-Saudi Arabia

Introduction

Osteoarthritis (OA) is defined as a progressive joint disorder that has been linked to many factors such as genetic, biomechanical and environmental, that contribute to causing physical, psychological and social consequences[1].In many countries, prevalence of OA can exceed the prevalence of other common medical diseases such as diabetes mellitus, hypertension, and ischemic heart disease[2].

OA is characterized by degeneration and damage of articular cartilage [3] and whole joint, including the subchondral bone and synovium[4].It consist of vary clinical manifestation from mild to severe pain and stiffness of joints till chronically health problems and long term disability [5].OA can be primary or secondary, depending on its aetiology.

Multiple risk factors have been linked to OA and can be categorised as non-modifiable (age, gender and genetics) and modifiable (obesity, previous joint injury and malalignment) [1].It can occur in various joints and the most commonly affected are the knees, hands, and hips joints [6].The diagnosis of OA is mainly depend on clinical impression and radiographic findings [1].

Currently, OA management is mainly consists of two types: the first type is non-surgical intervention includes exercise, physiotherapy, weight loss, pharmacological therapy and intra-articular injections. The second type is surgical intervention, which is considered when first type fails [7].

More importantly, improving the patients’ knowledge is acquired and transmitted by physician with efficiency and practice and blended with measures of wisdom, ethics, and attitude [8].However, no study has been carried out to explore perception, attitude and practice among patients with osteoarthritis in Sudair region-Saudi Arabia. Furthermore, a study reported that patients could achieve greater satisfaction when they received more information regarding their management [9].Hence, this review aimed to explore in detail about the perception, attitude and practice among patients with osteoarthritis in Sudair region-Saudi Arabia to enhance their knowledge with improve the community medical services.

Materials and Methods

A cross-sectional study involving the patients with osteoarthritis in Sudair was conducted to assess perception, attitude and practice. The following regions were included: Almajmaah,HautatSudair,Tumair,Alghat,Al-Zulfi, and Jalajil. The sample size was taken as 165 and data were collected over a period of 6 months from June to December 2020.Adults over the age of 18 were invited to participate in the study through an online survey. The study proposal was approved by the research ethics committee of Majmaah University. The responses to the online questionnaires were collected in an Excel spreadsheet and exported to the Statistical Package for the Social Sciences (SPSS) file.

The questionnaire contained items about perception, attitude and practice, based on previous studies and theories. It also included questions on socio-demographic features, such as sex, age, education level, monthly income, occupation. Some questions had answer options of always, mostly, sometimes and no, it didn’t affect.

Questionnaire scoring

The criteria for the perception, attitude and practice toward osteoarthritis were drawn from 9 questions (table 2) where 4-point Liker t scale categories were the answer options such as; “No” coded as 1, “sometimes” coded as 2, “mostly” coded as 3 and “always” coded as 4. The total score has been calculated by adding all questions related to perception, attitude and practices, each 3 questions, respectively which generally means that the higher the score, the greater perception, attitude and practices toward osteoarthritis. By using 50% and 75% to determine the levels of perception, attitude and practices. Participants were considered as poor/negative, levels by the score range of 3 – 6 points, 7 – 9 were considered as moderate/neutral and 10 – 12 were considered as good/positive levels.

Table 2: Assessment of perception, attitude and practices toward osteoarthritis(n=165)
Perception statement	N (%)
Do you think that osteoarthritis may affect the nature of your normal life?
Always	45 (27.3%)
Mostly	36 (21.8%)
Sometimes	60 (36.4%)
No, it didn’t affect	24 (14.5%)
Have you ever had a feeling of depression due to osteoarthritis?
Always	22 (13.3%)
Mostly	34 (20.6%)
Sometimes	42 (25.5%)
No, I didn’t feel depressed	67 (40.6%)
Have you suffered from sleep disturbance due to osteoarthritis?
Always	24 (14.5%)
Mostly	33 (20.0%)
Sometimes	66 (40.0%)
No, I didn’t suffered sleep disturbance	42 (25.5%)
Attitude statement
Are you committed using the treatment or the treatment plan?
Always	18 (10.9%)
Mostly	46 (27.9%)
Sometimes	52 (31.5%)
No, I’m not committed	49 (29.7%)
If you use medications, intra-articular injections, or have joint replacement surgery, have you been informed in advance of the possible side effects of the treatment method?
Always	16 (09.7%)
Mostly	19 (11.5%)
Sometimes	21 (12.7%)
No, I didn’t	109 (66.1%)
Do you follow a healthy diet to maintain your weight?
Always	07 (04.2%)
Mostly	28 (17.0%)
Sometimes	64 (38.8%)
I don’t follow a diet	66 (40.0%)
Practices statement
Do you keep on doing exercises to strengthen muscles surrounding the joints?
Always	07 (04.2%)
Mostly	23 (13.9%)
Sometimes	58 (35.2%)
I don’t keep doing exercise	77 (46.7%)
Do you have used one of the therapeutic methods of complementary and alternative medicine such as herbal remedies or acupuncture or cupping for treatment of osteoarthritis?
Always	05 (03.0%)
Mostly	16 (09.7%)
Sometimes	34 (20.6%)
No, I didn't use alternative and complementary medicine	110 (66.7%)
Do you used the method of cauterization for the treatment of osteoarthritis?
Always	02 (01.2%)
Mostly	05 (03.0%)
Sometimes	09 (05.5%)
I didn’t use cauterization	149 (90.3%)

Statistical Analysis

Descriptive statistics are demonstrated using numbers, percentages, minimum, maximum, mean and standard deviation, whenever appropriate. Between comparisons, Mann Whitney U test and Kruskal Wallis test were applied. P-value of <0.05 was considered statistically significant. Normality tests were conducted using Shapiro Wilk, Kolmogorov and Smirnov tests. Data follows abnormal distribution. Therefore, non-parametric tests were applied between comparisons of variables. Correlation procedures were also conducted to evaluate the linear agreement between perception, attitude and practices score. All statistical analyses were carried out using Statistical Packages for Software Sciences (SPSS) version 21 Armonk, New York, IBM Corporation.

Results

We enrolled 165 Saudi patients who were diagnosed with osteoarthritis to evaluate their perception, attitude and practices toward the disease. As seen in table 1, nearly all patients (81.2%) were living inside Al Majmaah city with nearly (80%) were in the younger age group (18 – 50 years) and mostly were females (60.6%). With respect to their education, approximately (60%) were college degree with more than a half (55.2%) earned less than 5,000 SAR per month. With regards to occupational status, (43%) were unemployed and (42.4%) were employed. When asked the nature of their work, (30.3%) reported that their work depends on lifting heavy weights or requiring too much movement. Furthermore, more than two third (67.9%) indicated a duration of osteoarthritis of less than 5 years. The prevalence of smokers in this study was (9.7%).

Table 1: Socio demographic characteristics of the patients(n=165)
Study variables	N (%)
Residence location
Inside Al Majmaahcity	134 (81.2%)
Outside Al Mamaah city	31 (18.8%)
Age group
18 – 50 years	130 (78.8%)
>50 years	35 (21.2%)
Gender
Male	65 (39.4%)
Female	100 (60.6%)
Educational level
High school or below	67 (40.6%)
College degree	98 (59.4%)
Monthly income level (SAR)
<5,000	91 (55.2%)
5,000 – 10,000	29 (17.6%)
>10,000	45 (27.3%)
Occupational status
Unemployed	71 (43.0%)
Student	24 (14.5%)
Employed	70 (42.4%)
Does the nature of your work depend on lifting heavy weights or requiring movement too much?
Yes	50 (30.3%)
No	115 (69.7%)
Duration of osteoarthritis
<5 years	112 (67.9%)
5 – 10 years	42 (25.5%)
>10 years	11 (06.7%)
Smoking
Yes	16 (09.7%)
No	149 (90.3%)

Table 2 described the assessment of perception, attitude and practices toward osteoarthritis. In the assessment of perception, in question 1, it was found that (36.4%) of the patients sometimes believe that osteoarthritis may affect the nature of normal life, (27.3%) rated always and (21.8%) mostly believe. In question 2, (40.6%) stated that osteoarthritis did not affect their mental health; others said they sometimes feeling depressed (25.5%) or mostly depressed (20%). In question 3, (40%) stated that they sometimes had sleep disturbance due to osteoarthritis, (20%) stated mostly and (14.5%) stated always. For attitude, in question 1, (31.5%) were sometimes committed with treatment or treatment plan recommended by the doctor, (27.9%) said they mostly committed and only (10.9%) stated that they had always committed to the treatment plan. In question 2, majority of the patients (66.1%) said that they did not receive information in advance of the possible side effects of medications, intra-articular injections, or joint replacement surgery. In question 3, (38.8%) were sometimes followed healthy diet to maintain weight, (17%) mostly followed while (40%) reported that they did not follow a healthy diet.For practices, in question 1, (35.2%) stated that they sometimes doing exercises to strengthen muscles surrounding joints, (13.9%) said that they mostly doing exercises while (46.7%) said they don’t keep doing exercise. In question 2, two-third of the patients stated that they did not use alternative and complementary medicine for the treatment of osteoarthritis and (20.6%) said sometimes. In question 3, most of them (90.3%) stated that they did not use cauterization.

The descriptive statistics of the perception, attitude and practices toward osteoarthritis has been described at table 3. Based on the results, it was observed that the overall mean perception score was 8.32 (SD 1.46) out of 12 points. Based on the given criteria, the proportion of patients with poor, moderate and good perception were (12.7%), (67.3%) and (20%), respectively. For attitude, the mean score was 5.70 (SD 1.99) with (66.1%) were classified as negative attitude, (28.5%) were in neutral and only (5.5%) were classified as positive attitude level. For practices, the mean score was 9.12 (SD 1.23) with poor, moderate and good practices were detected among (3.6%), (64.2%) and (32.1%), respectively.

Table 3: Descriptive statistics for the perception, attitude and practices(n=165)
Variables	N (%)
Perception total score (mean ± SD)	8.32 ± 1.46
Level of perception
Poor	21 (12.7%)
Moderate	111 (67.3%)
Good	33 (20.0%)
Attitude Total score (mean ± SD)	5.70 ± 1.99
Level of attitude
Negative	109 (66.1%)
Neutral	47 (28.5%)
Positive	09 (05.5%)
Practices total score (mean ± SD)	9.12 ± 1.23
Level of practices
Poor	06 (03.6%)
Moderate	106 (64.2%)
Good	53 (32.1%)

Figure 1: Correlation between the perception and attitude score

In figure 1, there was an inverse correlation between perception and attitude score (r=-0.180; p=0.021).

Figure 2: Correlation between the perception and practices score

In figure 2, the correlation between perception and practices score was not statistically significant (r=0.092; p=0.241).

Figure 3: Correlation between the attitude and practices score

In figure 3, there was negative correlation between attitude and practices score, however statistical test revealed that it did not reach statistical significant (r=-0.026; p=0.742).

When comparing the perception, attitude and practices in relation to the socio demographic characteristics of the patients, it was found that those in the older age group (>50 years) showed significantly better attitude than their counterparts (T=-1.871; p=0.027) but in practices, younger age group (18 – 50 years) showed significantly better practices (T=2.356; p=0.014). Furthermore, patients with higher monthly income level (>10,000 SAR) exhibited with better attitude than the other groups (F=5.156; p=0.004) while those unemployed patients observed to have significantly lower practices compared to either students or employed (F=4.602; p=0.040). In addition, patients with less than 5 years’ duration of the disease showed significantly higher practices than their counterparts (F=8.278; p=0.004). Other socio demographic characteristics including; residence location, gender, educational level, the nature of work and smoking status did not show significant difference when compared to perception, attitude and practices score (All p>0.05) (Table 4).

Table 4: Comparison between the mean perception, attitude and practices score in relation to the socio demographic characteristics of the patients(n=165)
Factor	Perception Score (12)Mean ± SD	AttitudeScore (12)Mean ± SD	PracticesScore (12)Mean ± SD
Residence locationa
Inside Al Majmaah City	8.31 ± 1.38	5.67 ± 1.98	9.11 ± 1.29
Outside Al Majmaah	8.32 ± 1.78	5.84 ± 2.07	9.13 ± 0.92
T-test	-0.031	-0.421	-0.069
P-value	0.935	0.777	0.758
Age group a
18 – 50 years	8.28 ± 1.45	5.55 ± 2.02	9.23 ± 1.16
>50 years	8.43 ± 1.50	6.26 ± 1.80	8.69 ± 1.41
T-test	-0.519	-1.871	2.356
P-value	0.654	0.027 **	0.014 **
Gendera
Male	8.55 ± 1.51	5.82 ± 1.96	9.28 ± 1.17
Female	8.16 ± 1.41	5.63 ± 2.01	9.01 ± 1.27
T-test	1.708	0.584	1.364
P-value	0.056	0.445	0.279
Educational levela
High school or below	8.31 ± 1.59	5.63 ± 1.94	9.03 ± 1.36
College degree	8.62 ± 1.37	5.76 ± 2.03	9.18 ± 1.14
T-test	-0.012	-0.406	-0.735
P-value	0.981	0.768	0.571
Monthly income level (SAR)b
<5,000	8.19 ± 1.55	5.90 ± 2.11	9.02 ± 1.29
5,000 – 10,000	8.52 ± 1.24	4.66 ± 1.56	9.34 ± 1.20
>10,000	8.44 ± 1.39	5.98 ± 1.79	9.16 ± 1.13
F-test	0.809	5.156	0.787
P-value	0.386	0.004 **	243
Occupational statusb
Unemployed	8.14 ± 1.61	6.04 ± 1.98	8.79 ± 1.44
Student	8.33 ± 1.40	5.79 ± 2.08	9.42 ± 1.18
Employed	8.49 ± 1.30	5.33 ± 1.92	9.34 ± 0.92
F-test	0.991	2.336	4.602
P-value	0.286	0.095	0.040 **
Does the nature of your work depend on lifting heavy weights or requiring movement too much?a
Yes	8.04 ± 1.52	5.78 ± 2.14	9.04 ± 1.14
No	8.43 ± 1.42	5.67 ± 1.93	9.15 ± 1.27
T-test	-1.608	0.327	-0.516
P-value	0.128	0.845	0.357
Duration of osteoarthritisb
<5 years	8.21 ± 1.42	5.69 ± 2.01	9.32 ± 1.16
5 – 10 years	8.64 ± 1.62	5.62 ± 1.96	8.88 ± 1.13
>10 years	8.18 ± 0.98	6.18 ± 1.94	7.91 ± 1.58
F-test	1.436	0.357	8.278
P-value	0.111	0.683	0.004 **

.

Smokinga
Yes	8.00 ± 1.79	5.13 ± 1.93	9.25 ± 0.93
No	8.35 ± 1.42	5.77 ± 1.99	9.10 ± 1.26
T-test	-0.911	-1.225	0.460
P-value	0.612	0.236	0.551

a P-value has been calculated using Mann Whitney U test.

b P-value has been calculated using Kruskal Wallis test.

** Significant at p<0.05 level

Discussion

Worldwide, OA is the one of the most common musculoskeletal disorder associated with disability and reduced quality of life resulting in psychological distress and decreased social functioning [10, 11]. According to Wolf et al, patients aged 60 and above were (18.0%) woman and (9.6%) men suffer from symptomatic OA, with (25%) of them unable to perform a routine activity daily living [7].

In our study, persons aged between 18 and 50 years and those with college degree were the main respondents and this could be attributed to the method of data collection using an electronic survey. Obviously, (67.3%) of the participants had a moderate perception about osteoarthritis and third of them mentioned sometimes OA reduced quality of life.

Several studies have evaluated the relationship between OA and depression; this concluded that depression adversely impact the quality of life of patients with OA [12]. (40.6%) participants in our study had never felt depressed. OA known to increases the risk of sleep disturbance, and that both pain and sleep problems may lead to functional disability and depression [13].It was found only (40 %) of participants had sometimes sleep disturbance due to osteoarthritis.

Attitude is considered as one of the most important component to improve medical knowledge; it has a positive impact on the value of ethical conduct in raising the application of the component in real life to a peak[8].However, our results showed that the majority of participants’ attitude about OA were (66.1%) negative.

A study reported that medical professionals who fail to provide clear information on pharmacological properties of the medications may causes patients not to adhere to drug therapy [14].In the present study (66.1%) of participants have not been informed in advance of the possible side effects of the treatment method of OA. Good practice is an art that is linked to the progress of knowledge and technology and is executed in an ethical manner [8].

Campbell et al. reported that long-term physiotherapy exercise adherence was affected by a positive attitude to exercise, perceived exercise effectiveness, perceived causes of OA, and perceived symptoms severity [15]. Our results reported that level of practices in majority of participant's were (64.2%) moderate.

Figures 1, 2 and 3 shows correlation between the perception, attitude and practices score.

There was an apparent relationship between the perception, attitude and practices with socio demographic features; participant with older age group (>50 years) and higher monthly income level (>10,000 SAR) exhibited with better attitude than the other groups, and these findings were consistent with reported data by Gecht [16].

Moreover, younger age group (18 – 50 years) of participant showed significantly better practices than their counterparts. This could be because the older age group may need to take extra precautions and seek medical advice before striving to achieve the recommended levels of physical activity for older people [17].

To the best of our knowledge, this is the first review assessing the perception, attitude and practices among patients with osteoarthritis in Sudair region-Saudi Arabia. Therefore, it can shed light regarding better perception, attitude and practices understanding and ensuring more fruitful and desirable outcomes among OA patients.

Conclusion

Overall, perception and practices appear to be moderately pervasive among the majority of patients with osteoarthritis in Sudair region-Saudi Arabia. On the other hand negative attitude was obviously observed among the participants. Further studies are also required to confirm our findings.

Conflict of interest

The authors declare no conflicts of interest.

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