The impact of osteoarthritis on difficulty walking: a population-based study

Objective — To assess the relationship of hip and knee osteoarthritis (OA) to walking difficulty.

Methods — A population cohort aged ≥55 years recruited from 1996-98 (n=28,451) completed a standardized questionnaire assessing demographics, health conditions, joint complaints and functional limitations, including difficulty walking in the past 3 months. Survey data were linked to health administrative databases; self-report and administrative data were used to identify health conditions. Hip/knee OA was defined as self-reported swelling, pain, or stiffness in a hip or knee lasting ≥6 weeks in the past 3 months without an inflammatory arthritis diagnosis. Using multivariable logistic regression, we examined the determinants of walking difficulty and constructed a clinical nomogram.

Results — 18,490 cohort participants were eligible (mean age 68 years, 60% female). 25% reported difficulty walking. Difficulty walking was significantly and independently associated with older age, female sex, body mass index, and several health conditions; of the conditions examined, the likelihood of walking difficulty was greatest with hip and knee OA and increased with number of hips/knees joints affected. The predicted probability of difficulty walking for a 60-year-old middle-income, normal-weight woman was 5-10% with no health conditions, 10-20% with diabetes and CV disease, 40% with OA in two hips/knees, 60-70% with diabetes, CV disease and OA in two hips/knees, and 80% with diabetes, CV disease and OA in all hips/knees.

Conclusion — In a population cohort, symptomatic hip/knee OA was the strongest contributor to walking difficulty. Given the importance of walking to engagement in physical activity for chronic disease management, greater attention to OA is warranted.