Osteoarthritis of the hip or knee and work participation: a systematic review

All stakeholders should be involved using a worker support approach

Osteoarthritis (OA) of the hip or knee joints is a very common condition amongst the elderly; however, what is often forgotten is that its onset is often while people are still in paid employment, which may lead to perceived difficulties in performing work tasks. We Elves are very hard-working individuals, so I asked myself, in reality, would having hip or knee OA  affect my work participation, and would it lead to early retirement?

Therefore, I was delighted to find a systematic review by Bieleman et al (2011) in the Journal of Rheumatology that seemed to be able to provide some answers to these questions.

Here’s what they did

A search strategy was conducted in Medline, Embase, CINAHL and PsycInfo (up until June 2009) that included studies that examined the effect of OA on work participation, i.e. work productivity, sick leave, and early retirement.

Here’s what they found

1861 articles were identified; after the inclusion criteria were applied 53 studies were examined thoroughly. Finally, 14 articles were included in the review from which data were extracted and analysed. The articles included: 4 surveys; 2 prospective cohort studies; and 8 cross-sectional studies.

The author’s concluded that

Lower limbs x-ray

OA of the hip or knee could not be proven to be a strong reason for leaving the work force through sick leave or early retirement.

“The effect of OA of the hip or knee on work participation is varied. Despite the functional limitations of OA many people had paid employment and managed to stay at work. In many cases there was a mild negative effect of OA on work participation; however, only a small proportion of workers required early retirement. To summarise, OA of the hip or knee could not be proven to be a strong reason for leaving the work force through sick leave or early retirement.”

The Musculoskeletal Elf’s views

The Msk ElfWhat was interesting (and rather disappointing) when reading this review is the fact that, although 1861 titles were found, after applying the search strategy only 14 could be included. This primarily was because most studies only reported on ‘work’ as a secondary or tertiary outcome measure. Is this because researchers have preconceived ideas that if a person has osteoarthritis then it is unlikely that they are in employment? Or is it because many researchers are still working within a biomedical rather than biopsychosocial model of care, therefore, have not really shifted in their thinking to consider the effects of a condition on ‘participation’ (to use the terminology from the World Health Organisation’s International Classification of Functioning).

On a recent visit to the Arthritis Research UK website I noted that, in a list of daily life topics related to osteoarthritis, ‘work’ was the 20th topic on a list of 23 related to the disease, coming after information on stairlifts and splints. Is this the right message to be putting out to people?

There is strong evidence that work is generally good for physical and mental health and well-being, and worklessness is associated with poorer physical and mental health and well-being (Waddell & Burton, 2006). Therefore, I strongly urge all healthcare professionals to do their utmost to provide accurate information to people with osteoarthritis to support and facilitate their future work participation.

As for my Elf colleagues and me, we will endeavour to work away to a merry old age, whether in shoe mending, toy making or providing tours of Lapland.

Do you recommend continued work participation for your patients with osteoarthritis? What is your view on this review, will it change your clinical practice? Send us your views on this blog and become part of the Musculoskeletal Elf community.


Bieleman, HJ, Bierma-Zeinstra, SMA, Oosterveld, FGJ, Reneman, MF, Verhagen, AP, Groothoff, JW The effects of osteoarthritis of the hip or knee on work participation, 2011, Journal of Rheumatology, 38, 9, 1835-1843 [Pubmed abstract]

World Health Organisation International Classification of Functioning, 2001, available from http://www.who.int/classifications/icf/en/ [accessed 1-8-12]

Arthritis Research UK  – http://www.arthritisresearchuk.org/ [accessed 1-8-12]

Waddell, G, Burton, K Is work good for your health and well-being? 2006, The Stationary Office, Norwich, ISBN 0-11-703694-3 [Link to PDF]


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Heather Gray

I am currently the Head of Physiotherapy & Paramedicine at Glasgow Caledonian University and Chair of the Chartered Society of Physiotherapy's Professional Committee. I have worked at the University of Glasgow in several research positions. I am on the Editorial Board of the Journal of Physical Therapy Education. Other work in which I have been involved is as an Educational Consultant with NHS Education for Scotland. Prior to moving into academia I worked in the National Health Service (NHS) in Scotland as a physiotherapist for 11 years.

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