Ancient descriptions often referred to musculoskeletal pain and dysfunction as “rheumatism” [
Symptomatic knee OA is currently the fourth leading cause of disability worldwide, [
The diagnosis of knee OA lies in both clinical and radiological terms. It is a clinical disease consisting of subjective symptoms of joint pain on loading and bony swelling, objective physical examination of knee stiffness, and deformity or crepitations, along with supplementary radiographic findings [
The Framingham Knee Osteoarthritis Study called knee OA a “disease of the older age” [
Pathognomonic of knee OA includes significant pain over knee joints associated with varying degrees of functional limitation and reduced quality of life [
A major threat to full employment at older ages is the incapacity arising from symptomatic knee OA [
A sample of 254 patients with knee OA from Italy reported as 2.4% for discontinuing work, 2% changed the type of work, and 22% with regular knee OA-related sick leave [
The OA Research Society International (OARSI) reported that treatments like acetaminophen, nonselective and selective oral nonsteroidal anti-inflammatory drugs (NSAIDs), topical NSAIDs and capsaicin, intra-articular injections of corticosteroids or hyaluronans, glucosamine, and/or chondroitin sulphate may be used for symptom relief, while glucosamine sulphate, chondroitin sulphate, and/or diacerein are administered for structure-modifying effects, and weak opioids or narcotic analgesics are used for the relief of refractory pain [
Rising prevalence rates and longer lifespan indicate a pending global public health crisis, yet only sparse information for identifying and preparing for it still exists in most developed and developing nations. Despite detailed published accounts of self-management techniques and knee OA prevention, for example, the NICE Guidelines and the Arthritis Foundations’ National Public Health Agenda, misconceptions, lack of preventive knowledge, and maladaptive sociocultural beliefs among caregivers and general population in different regions pose substantial barriers towards preventive efforts [
To the best of our knowledge, this study was the first population-based study that assessed knowledge of symptomatic knee OA among railway workers. Data on prevalence rates of knee OA among railway workers was rather scarce from both developed and developing countries. Railway workers with diverse occupational traits from both manual and administrative sectors involving locomotive engine pilots or drivers, railroad yardworkers, trackmen, maintenance workers, signalers, station masters, shunters, and office workers were predominantly classified as high strained workers because of their prolonged exposure to rigid protocols and limited rests [
Occupational health in Malaysia is regulated mainly by the Occupational Safety and Health Act 1994. The responsibilities of safety and health at the workplace lie with those who create the risk and with those who work with the risk. It stresses on self-regulation and participation and cooperation of workers. The Department of Occupational Safety and Health (DOSH) is a department under the Ministry of Human Resources which is responsible for standard setting of relevant legislation and code of practice and guidelines as well as enforcement through the regional branch office in each state in the country [
This study complied with the guidelines in the Declaration of Helsinki. Study protocol was approved by the affiliated institutional ethical committee. Following institutional review board, the Cooperative Society
This descriptive cross-sectional study was conducted in the month of April 2012 among all workers from “
We designed a 36-item self-administered questionnaire regarding knowledge of knee OA from literatures and proven hypotheses. Validated items on risk factors [
Analysis was performed using Statistical Package of Social Sciences (SPSS) (version 16.0, IBM, Armonk, NY). For each item in the knowledge part, the correct answer was coded (1), while the incorrect answer or “I do not know” was coded (0). Scores of knowledge items were summed to obtain the total knowledge score on knee OA (minimum = 0 and maximum = 36). A higher score represents better knowledge. A high knowledge level was classified based on median cut-off point of the total score (≥21). Descriptive analysis was performed for all variables in this study. Knowledge scores were expressed as mean and standard deviations. Test of normality was performed for the total knowledge score.
A total of 513 railway workers with a response rate of (70.3%) consented to participate in the survey. The mean (±SD) age of respondents was 41.4 (±10.7) years and the majority aged 50 years or older (34.9%). The majority of respondents were males (74.9%), white-collar workers (52.0%), and secondary educated (69.1%). Less than half (40.2%) of the entire sample had an immediate family member with the condition. One hundred five (20.5%) of total respondents reported having knee OA diagnosed clinically by a doctor (Table
Sociodemographic characteristics of the respondents (
Characteristic |
|
% |
---|---|---|
Gender | ||
Male | 384 | 74.9 |
Female | 129 | 25.1 |
Age group (years) | ||
20–34 | 157 | 30.6 |
35–49 | 177 | 34.5 |
≥50 | 179 | 34.9 |
Education level | ||
Primary | 11 | 2.1 |
Secondary | 354 | 69.1 |
Tertiary | 148 | 28.8 |
Occupation | ||
Blue-collar | 246 | 48.0 |
White-collar | 267 | 52.0 |
Awareness of knee osteoarthritis as a disease entity | ||
Yes | 309 | 60.2 |
No | 204 | 39.8 |
Immediate family members with knee osteoarthritis | ||
Yes | 207 | 40.4 |
No | 306 | 59.6 |
Diagnosed clinically to have knee osteoarthritis | ||
Yes | 105 | 20.5 |
No | 408 | 79.5 |
Most of the respondents expressed awareness of knee OA as a disease entity (60.2%). Based on median cut-off points of knowledge score, 53.6% of the respondents had low levels of knowledge. Table
Knowledge of knee osteoarthritis among respondents (
Statement | Correct answer |
|
---|---|---|
Risk factors | ||
Female gender | Yes | 164 (32.0) |
Postmenopausal women are more likely to have osteoporosis, not osteoarthritis | No | 346 (67.4) |
Age 50 years or older | Yes | 236 (46.0) |
Obesity is not a risk factor | No | 303 (59.1) |
Previous knee injury | Yes | 325 (63.4) |
Sports and leisure time physical activities | Yes | 262 (51.1) |
Repetitive strain injury | Yes | 214 (41.7) |
Working in a kneeling or squatting position | Yes | 267 (52.0) |
Climate change has no risks | Yes | 162 (31.6) |
Sitting improperly for long time | Yes | 196 (38.2) |
Standing improperly for long time | Yes | 217 (42.3) |
Signs and symptoms | ||
Knee pain | Yes | 370 (72.1) |
Stiffness of the knee during the night | No | 265 (51.7) |
Feeling of increased warmth in the knee | Yes | 208 (40.5) |
Redness of the knee | Yes | 190 (37.0) |
“Clicking” or “catching” of the knee | Yes | 256 (49.9) |
“Locking” of the knee or unable to fully straighten | Yes | 271 (52.8) |
Weakness of muscles of the thigh | Yes | 249 (48.5) |
No swelling of the knee | No | 281 (54.8) |
Numbness or tingling sensation of the knee | Yes | 232 (45.2) |
Pain when touched or pressed the knee | Yes | 272 (53.0) |
Disabilities | ||
Bed ridden rather than difficulty rising from bed | No | 303 (59.1) |
Difficulty putting on stockings | Yes | 255 (49.7) |
Difficulty rising from sitting | Yes | 328 (63.9) |
Difficulty bending to the floor involves osteoarthritis of the hip, not knee | No | 326 (63.5) |
Difficulty kneeling | Yes | 334 (65.1) |
Difficulty squatting | Yes | 332 (64.7) |
Movements are totally impaired | No | 186 (36.3) |
Prevention | ||
Regular exercises | Yes | 255 (49.7) |
Optimal body weight is not necessary for prevention | No | 343 (66.9) |
Avoiding excessive and prolonged weight bearing to the knees during work | Yes | 347 (67.6) |
Supportive footwear | Yes | 222 (43.3) |
Management | ||
Pain killers and anti-inflammatory drugs help to relieve osteoarthritis pain temporarily | Yes | 269 (52.4) |
Intra-articular steroid injections help to relieve severe symptoms temporarily | Yes | 212 (41.3) |
Knee replacement surgery is indicated for severe osteoarthritis | Yes | 97 (18.9) |
Hot or cold packs to the knees help to resolve osteoarthritis symptoms temporarily | Yes | 95 (18.5) |
Table
Association between knowledge of knee osteoarthritis and socio-demographic variables among respondents (
Characteristic | Mean (SD) |
|
---|---|---|
Gender | ||
Male | 18.8 (10.5) | |
Female | 15.0 (11.4) | <0.001 |
Age group (years) | ||
20–34 | 13.3 (10.9) | |
35–49 | 18.2 (10.9) | |
≥50 | 21.7 (9.1) | <0.001 |
Education level | ||
Primary | 13.4 (8.3) | |
Secondary | 16.8 (11.5) | |
Tertiary | 20.8 (8.8) | <0.001 |
Occupation | ||
Blue-collar | 19.8 (10.3) | |
White-collar | 16.2 (11.1) | <0.001 |
Awareness of knee osteoarthritis as a disease entity | ||
Yes | 24.5 (6.2) | |
No | 7.9 (8.5) | <0.001 |
Immediate family members with knee osteoarthritis | ||
Yes | 25.5 (5.7) | |
No | 12.8 (10.5) | <0.001 |
Diagnosed clinically to have knee osteoarthritis | ||
Yes | 25.7 (5.6) | |
No | 15.9 (11.0) | <0.001 |
Table
Factors associated with knowledge of symptomatic knee osteoarthritis among respondents by multiple linear regression (
B | SE | Beta |
|
95% CI | ||
---|---|---|---|---|---|---|
Lower | Upper | |||||
Age (35–49 years) | 1.3 | 0.7 | 0.1 | 0.078 | −0.1 | 2.8 |
Age (≥50 years) | 1.7 | 0.8 | 0.1 | 0.035 | 0.1 | 3.2 |
Education (tertiary) | 1.3 | 0.7 | 0.1 | 0.056 | 0.0 | 2.6 |
Type of work (blue-collar) | 1.0 | 0.6 | 0.1 | 0.083 | −0.1 | 2.2 |
Awareness of knee osteoarthritis as a disease entity | 12.5 | 0.7 | 0.6 | <0.001 | 11.0 | 13.9 |
Having family members with knee osteoarthritis | 5.5 | 0.7 | 0.2 | <0.001 | 4.1 | 6.9 |
Diagnosed clinically to have knee osteoarthritis | 2.1 | 0.8 | 0.1 | 0.011 | 0.5 | 3.7 |
This cross-sectional study was aimed at determining factors affecting knowledge of symptomatic knee OA among Malaysian railway workers. Of the 513 railway men surveyed, 53.6% reported low levels of knowledge. Our final regression model yielded four variables significantly influencing knee OA knowledge in this group: respondents over 50 years old, respondents previously aware of knee OA, immediate family members with knee OA, and respondents with knee OA diagnosed clinically by a doctor.
Data on risk factors, clinical manifestations, and available treatment options was well documented in numerous epidemiological studies and clinical trials [
Our sample demonstrated a broad spectrum of preventive knowledge, including self-management techniques for symptomatic relief. A majority reported that avoidance of excessive and prolonged knee weight bearing activities and optimal body weight are the gold standards for prevention. However, the notion that exercise accelerates quadriceps muscle strength and helps to prevent knee OA [
Female gender and ages greater than 50 years old were at higher risk for developing knee OA [
Educational attainment was linked to pain and disability in osteoarthritis [
Repetitive strain at tibiofemoral or patellofemoral joints during work is associated with an increased risk of knee OA [
Family history reflects a higher genetic susceptibility and shares environmental or behavioral factors of disease [
The following limitations should be acknowledged in this study. This is the first population-based study to measure and self-report knowledge of symptomatic knee OA among workers. Exclusive reliance upon knowledge scales used here may pose correlation inflations. The cross-sectional nature of this study could not establish the causal relationships. The issue of measurement variation could be another limitation in this study.
This study initiated in-depth insights of symptomatic knee OA knowledge among the general population, stimulating a national public health agenda for prevention of knee OA and related problems. Access to information, education, and social support is vital [
The results from this cross-sectional study impact important public health decisions, given that respondents over 50 years, with a family history, self-awareness, and a knee OA diagnosis, showed better knowledge of symptomatic knee OA as shown in the multivariate analysis. In general, Malaysian railway workers projected low levels of knowledge regarding symptomatic knee OA, demonstrating an alarming ignorance on the subject, suggesting the need for more and better information to be disseminated among the railway workers.
Osteoarthritis
Rheumatoid arthritis
Standard deviation.
The authors declare that there is no conflict of interests regarding the publication of this paper.
The authors of this study expressed their sincere gratitude to Mr. Mohamed Faid Bin Musa, President of Cooperative Society,