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Facteurs pronostiques de l’évolution de la santé perçue dans l’arthrose symptomatique de hanche et de genou : analyses de la cohorte KHOALA

Abstract : Knee and hip osteoarthritis (OA) is a public health problem because of its high prevalence, its consequences in terms of impaired quality of life and disability. Despite this, knowledge about its clinical evolution, its consequences on quality of life and the prognostic factors for its evolution remain limited. The objectives of this thesis were therefore to describe the evolution and types of progression of subjects with hip and/or knee OA over 5 years in terms of self-perceived health and to identify the prognostic factors of the evolution of these patients. In a first part, we conducted and published a systematic literature review on the use of trajectory analysis of clinical outcomes to define phenotypes in lower-limb OA. The multiplicity of factors examined in the different studies did not allow us to perform a quantitative synthesis of their respective prognostic roles. Despite this heterogeneity, we could observe that the prognostic factors of the course of pain and physical function (PF) were not exactly identical. In a second part, we therefore simultaneously modelled the evolution of these 2 dimensions of perceived health to better understand the patients' overall experience during the course of their disease and the interrelationships between these 2 concepts. To do this, we used data from the French KHOALA cohort. We highlighted the prognostic role of the physical activity (PA) intensity but we did not highlight the prognostic role of its weekly duration. In a second study, the prognostic roles of the intensity and type of PA on belonging to a particular PF trajectory and the weekly duration of the PA on belonging to a mental health trajectory could be highlighted. Based on these results, we hypothesized that the association between the baseline PA components and PF at 5 years could be mediated by body composition variables at 3 years. In this last part, the causal mediation analysis did not reveal a mediating role of body composition variables in this relationship. In conclusion, our thesis work synthesized the literature on the variability of lower-limb OA and the existence of distinct longitudinal phenotypes. We highlighted the existence of different phenotypes in our French study population and identify predictive characteristics of belonging to a severe symptom trajectory.
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Submitted on : Wednesday, March 25, 2020 - 10:06:36 AM
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Maud Wieczorek. Facteurs pronostiques de l’évolution de la santé perçue dans l’arthrose symptomatique de hanche et de genou : analyses de la cohorte KHOALA. Santé publique et épidémiologie. Université de Lorraine, 2019. Français. ⟨NNT : 2019LORR0182⟩. ⟨tel-02518244⟩



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