Health Related Quality of Life and Treatment Regimens in Patients With Musculoskeletal Disorders at Kenyatta National Hospital

Abstract

Background: Globally, musculoskeletal disorders are one of the most neglected diseases despite showing a prevalence that is on the rise and a leading cause of disability. Various regimens have been identified and are used in the management of these conditions. The impact of its treatment from the patient’s perspective should be a very important indicator of the desired outcome other than relying on clinical judgment alone from the healthcare provider’s perspective. Such an impact is measured by determining the health related quality of life (HRQoL) which can also be used to pick out other issues in the course of treatment. Objective: To determine the most common musculoskeletal disorder, evaluate the health related quality of life and impact of various treatment regimens in patients who attend the rheumatology clinic at Kenyatta National Hospital for their routine management. Methodology: A cross - sectional descriptive study was conducted at Kenyatta National Hospital, Rheumatology clinic, targeting adult patients with a diagnosis of a musculoskeletal disorder and on treatment at the facility. Simple random sampling was used to obtain a representative sample of 71 consented participants. Data on HRQoL was collected through a self-administered questionnaire using the EQ-5D-5L questionnaire. This tool has been validated and is used worldwide for assessing HRQoL. Data analysis was carried out using STATA version 13.0 software, with level of significance set at P value < 0.05. Categorical variables such as pattern of HRQoL and treatment regimens were summarized as frequencies and percentages while

continuous variables such as age were represented as mean (± standard deviation). Bivariate analysis was carried out using the chi squared test (Χ2) to determine any statistically significant association between treatment regimens and HRQoL. Results The most common musculoskeletal disorder in this population was rheumatoid arthritis that accounted for 59.1% of all the cases, followed closely by systemic lupus erythematosus which accounted for 23.9% of the cases and osteoarthritis that was reported in 5.6% of the participants. The mean health related quality of life was 10 (3.64) with the physical and mental domain being the one participants complained of the most. Most of the participants (80.1%) in this study were prescribed non-biologic Disease Modifying Anti-Rheumatic Drug (DMARDs) therapy as either monotherapy (35.2%), dual therapy (38%) or triple therapy (7%). The remaining fourteen (19.7%) participants were on analgesics from the Non-steroidal anti-inflammatory (NSAID) group. Conclusion Analysis of the data obtained showed that rheumatoid arthritis was the most common musculoskeletal disorder. Majority of the patients had a health related quality of life score that was below the mean. The physical domain which was described in terms of pain and difficulty in walking was the most affected followed by the mental domain that was described in terms of number of patients that reported depression. Increasing the number of drugs in management of MSDs doesn’t necessarily improve patients’

quality of life. The different treatment regimens did not seem to improve the patients’ quality of life. Recommendations

1. Mandatory assimilation of HRQoL measure as an important tool in determining therapeutic outcomes should be encouraged. This will improve the holistic and multidimensional management of patients with musculoskeletal disorders.

2. Embracement of community based hospital support groups that will offer counselling and psychological care to assist patients cope with their new diagnosis and share their experiences.

3. Insurance cover policies that will cater for the different treatment modalities that is both pharmacological management such as biologic DMARDs, non-biologic DMARDs and non-pharmacological management such as aculaser and physiotherapy. The insurance policy should cater for all populations irrespective of employment status.