Objectives To investigate the association of diabetes, hypertension and overweight/obesity with physical activity (PA), self-efficacy for pain and self-efficacy for other symptoms before and after a 6- week exercise and education intervention for knee and hip osteoarthritis (OA), and to assess outcome disparities based on metabolic health. Methods Register-based cohort study using the Swedish Osteoarthritis and Diabetes cohort. We used Body Mass Index, medical records and medication dispensation to define overweight/obesity, hypertension and diabetes at baseline (exposures). PA was self-reported (weekly minutes), and self-efficacy was measured using the ‘Arthritis Self-Efficacy Scale’ (ASES) (score 10–100) (outcomes). We used linear mixed-effect models to estimate associations between exposures and outcomes, adjusted for confounders. Results We included 80 893 individuals with knee or hip OA. Those with metabolic conditions consistently showed lower PA and self-efficacy, with baseline disparities persisting after the intervention, particularly when all three conditions coexisted (PA difference: baseline 107 min 95% CI: 97; 118, 3-month 97 86; 108, 12-month 109 95; 123; ASES-pain difference: baseline 5.6 3.9; 7.3, 3-month 5.9 4.1; 7.7, 12-month 8.2 6.1; 10.4; ASES-other symptoms difference: baseline 6.1 4.6; 7.7, 3-month 6.4 4.8; 8.0, 12-month 8.2 6.3; 10.1). Conclusions Metabolic conditions were associated with lower PA and self-efficacy, with differences increasing with the number of co-existing conditions. The baseline disparities associated with metabolic conditions persisted after the intervention, with both groups showing improvement at 3 months but reverting to baseline by 12 months. This suggests that current guideline-based interventions for OA may not reduce long-term disparities related to metabolic conditions.
Recenti et al. (Tue,) studied this question.