ASSESSMENT OF FATIGUE AND ITS CORRELATION WITH QUALITY OF LIFE AND FUNCTION DISABILITY IN OSTEOARTHRITIC PATIENTS

ASSESSMENT OF FATIGUE AND ITS CORRELATION
WITH QUALITY OF LIFE AND FUNCTION
DISABILITY IN OSTEOARTHRITIC PATIENTS
Naira K.R. Mohamed1 ; Magda R. Zahran2 and Abeer A. Yamny3*
1 BSc physical therapy, Faculty of Physical Therapy, Misr University For Science and
Technology, Egypt
2- Professor of Physical Therapy, Basic Sciences Department, Faculty of Physical
Therapy, Cairo University, Egypt.
3- Professor of Physical Therapy, Basic Sciences Department, Faculty of Physical
Therapy, Cairo University, Egypt.
3*Email-abeer.yamany@pt.cu.edu.eg
Key Words: Fatigue, Quality of life, Disability, Knee osteoarthritis,
WOMAC, FSS.
ABSTRACT
Background: Osteoarthritis (OA) is a chronic, degenerative, inflammatory
musculoskeletal dysfunction. It is associated with pain, reduced functional
capacity and deficient quality of life. Fatigue is a frequent complaint in patients
with arthritis, which correlate to tiredness. Purpose of the study: This study
aimed to assess fatigue in knee osteoarthritic patients and to correlate it to
quality-of-life indexes and functional disability. Subjects and Methods: This
cross-sectional study was performed on 200patients of both sex with ages
ranged from 50 to 65 years old and medical diagnoses of knee osteoarthritis
either grade II or grade III. The participants were selected according to the
demographic survey including information on their age, gender, educational
level, height, weight, BMI, disease duration. Fatigue was measured by Arabic
version of fatigue severity scale; quality of life was measured by Arabic version
of SF36 questionnaire and function disability was measured by Arabic version
of The Western Ontario and McMaster Universities osteoarthritis index
(WOMAC). Results: 200 patients were included in the study. Grade II group
consisted of 39 patients (3 male and 36female), grade III consisted of 161
patients (31 male and 131female). The results indicated that there was
significant difference in the fatigue severity scale between both groups with (Uvalue=
2019, Z-value= -3.458, p = 0.001*), this significant increase in grade III
group in compared to grade II group. There was a positive weak correlation
between fatigue severity scale and WOMAC (p=0.0001*). And There was a
negative weak correlation between fatigue and pain domain of SF36
questionnaire (p=0.0001*) and there was a negative weak correlation between
fatigue severity scale and fatigue domain of SF36 questionnaire (p=0.002*).
Conclusion: On the basis of this study, it could be concluded that there is an
association between fatigue and both disability and quality of life in patients
with knee osteoarthritis.
Egypt. J. of Appl. Sci., 36 (5-6) 2021 41-56
INTRODUCTION
Osteoarthritis is the most prevalent form of arthritis. It is a
multifactorial process in which mechanical factors have a central role and is
characterized by changes in the structure and function of the whole
joint(Hunter and Felson, 2006). Rheumatic disease affects older adult
populations worldwide and knees are the most commonly affected joints
(Dawson et al., 2004). These degenerative changes cause pain, stiffness,
and swelling that result in chronic disease and disability with advanced age
and seriously alter the quality of life (QoL) (Alkan et al., 2013).
Some risk factors contribute to the appearance of osteoarthritis
diseases, such as sex, age, trauma, overuse, and genetic conditions. With
disease progression, patients’ complaints of physical limitations, pain, and
functionality restriction increase leading to an important decrease in their
QOL (Kawano et al., 2015)
Fatigue is a common, non-specific, symptom experienced by most
people at some point during their lives. It is the enduring, subjective
sensation of generalized tiredness or exhaustion. It is also conceptualized
variously as weariness, weakness, and depleted energy( Power et al., 2008).
Cultural aspects may play a role in the expression of fatigue
(Mortada et al., 2015). Fatigue in OA is not routinely evaluated and has
only been considered in a limited number of studies ( Power et al., 2008).
Few studies on fatigue in knee osteoarthritis reported marked levels
of fatigue in nearly half of patients (Snijders et al., 2011)( Stebbings et al.,
2010). On the other hand, assessment of fatigue in the provision of OA care
is often neglected (Power et al., 2008).
Health-related quality of life (HRQoL) is a broad concept
representing individual responses to the physical, mental, and social effects
of illness or well-being on daily living, which influence the extent to which
personal satisfaction with life circumstances can be achieved (Perruccio et
al., 2016).
Kawano et al., 2015 showed that patients with knee osteoarthritis
have a low perception of their quality of life, especially in the fields of
functional capacity, functional limitations, and pain.
Araujo et al., 2016 found a correlation between functional
independence and the QOL; the more the functional independence was
impaired, the lower the QOL and the severity of osteoarthritis was not
correlated with significant loss of QOL. The aim of this study was to
investigate the association between fatigue and both functional disability and
quality of life in patients with knee osteoarthritis.
SUBJECTS, MATERIALS AND METHODS
This study was conducted at 6 October Hospital, Health Units and the out
clinic of Faculty of Physical Therapy, Cairo University from January 2019 to
42 Egypt. J. of Appl. Sci., 36 (5-6) 2021
November 2019. The study was approved by ethical comity of Faculty of
Physical Therapy, Cairo University with code number: P.T.REC/012/001930
i. Design of the study:
The study design was a cross sectional study
ii. Subjects:
200 patients according to power analysis participated in this study with
age ranged from 50 to 65 years old of both males and females with a medical
diagnosis of knee osteoarthritis of either grade II and III. All patients singed
data in the informed consent form. Patients were recruited from the outpatient
clinic on 6 October Hospital, Health Units, and the out clinic of Faculty of
Physical Therapy, Cairo University.
Inclusion criteria: patients were included, if they had
 a medical diagnosis of knee osteoarthritis of both side
 Both male and female.
 Aged between 50 and 65 years old.
 BMI: 18.5 to 24.9 kg/m2.
 grade II and III of knee osteoarthritis according to Kellgren and Lawrence
system for classification of osteoarthritis of knee (Kellgren and Lawrence,
1957).
Exclusion criteria:
Patients were excluded if they had:
 Previous orthopedic or neurological disorders of Lower limb, pelvis or spine.
 Previous surgeries of Lower limb, pelvis or spine.
 Other degenerative disease that makes the patient unable to participate in the
study.
 Traumatic conditions of Lower limb, pelvis or spine.
 Deformities of Lower limb, pelvis or spine.
Instruments
1. Demographic survey including information on their age, gender, educational
level, height, weight, and disease duration.
2. Fatigue Severity Scale(Arabic version) to assess fatigue which is valid and
reliable (Al-Sobayel et al., 2016) .The scale includes 9-items with questions
related to how fatigue interferes with certain activities and rates its severity
according to a self-report scale. The items are scored on a 7-point scale with
1 = strongly disagree and 7= strongly agree. The minimum score = 9 and
maximum score possible = 63. Higher the score = greater fatigue severity.
Another way of scoring is taking the mean of all the scores with minimum
score being 1 and maximum score being 7.
3. The SF36 questionnaire(Arabic version) to assess quality of life which is
valid and reliable (Abdulaziz et al., 1998).
SF-36 is a widely applied instrument for measuring health status and
consists of eight scales yielding two summary measures: physical and mental
health. The physical health measure includes four scales of physical functioning
Egypt. J. of Appl. Sci., 36 (5-6) 2021 43
(10 items), role-physical (4 items), bodily pain (2 items), and general health (5
items). The mental health measure is composed of vitality (4 items), social
functioning (2 items), role-emotional (3 items), and mental health (5 items). To
score the SF-36, scales are standardized with a scoring algorithm or by the SF-
36v2 scoring software to obtain a score ranging from 0 to 100. Higher scores
indicate better health status, and a mean score of 50 has been articulated as a
normative value for all scales(Alkan et al., 2014).
4. The Western Ontario and McMaster Universities osteoarthritis index
(WOMAC)(Arabic version) to assess disability which is valid for
assessment of disability (Guermazi et al., 2004) . The WOMAC consists of
9 items to assess physical function: rising from sitting, standing, bending to
floor , walking on flat , shopping, putting on / taking off socks, rising from
bed ,sitting(Guermazi et al., 2004)
Procedures
 The goal of the study and the method was described to all patients and
inform consent were be taken prior to participation in the study. The
potential benefits and inconveniences of all aspects of the study were clearly
stated to participants. A meeting with patients was held to explain the
purpose and protocols of the study; if patients chose to participate, they were
complete the procedure.
 All patients participated in this study suffered from knee osteoarthritis
diagnosed by the orthopedic surgeon through physical examination, X- ray,
and MRI.
 All subjective data were collected and recorded in a specially designed sheet
including Age, sex, weight, height and BMI.
 The three scales were given to the patients to read and answer each question
by themself.
Statistical analysis
Before start of the study and based on the rule of thumb, sample size
was calculated such as 5 to 10 participants per item. The data was collected
by using statistical SPSS Package program version 23 for Windows (SPSS,
Inc., Chicago, IL). The current test involved one independent variable was
the (tested group); between subjects factor which had two levels (grade II of
knee osteoarthritis group and grade III of knee osteoarthritis group). In
addition, this test involved ten tested dependent variables (FSS, WOMAC,
physical function, physical health, emotional problem, fatigue, emotional
well-being, social function, pain and general health).
Prior to final analysis, data were screened for normality assumption,
linearity, and presence of extreme scores. This exploration was done as a
pre-requisite for parametric calculations of the analysis of difference. There
was no a linear relationship between the dependent variables, as assessed by
44 Egypt. J. of Appl. Sci., 36 (5-6) 2021
scatterplot. There were univariate outliers in the data, as assessed by
inspection of a boxplot. Normality test of data using Kolmogorov-Smirnov
test (used when sample size more than 50) was used, that reflect the data
was not normally distributed for all dependent variables (p<0.05) at grade III
group as well as using Shapiro-Wilk test (used when sample size less than
50) reflected that the data was not normally distributed (p<0.05) at grade II
group. All these findings allowed the researchers to conduct non-parametric
analysis. So, “Mann-Whitney U test " was used to compare FSS, WOMAC,
physical function, physical health, emotional problem, fatigue, emotional
well-being, social function, pain and general health between both groups.
The alpha level was set at 0.05. Statistical analysis was conducted using
SPSS for windows, version 23 (SPSS, Inc., Chicago, IL).
RESULTS
1 - General chronological features of the patients:
The mean values of age, body mass and height were 56.6±4.07
years, 84.51±13.49 kg and 160.97±96.32cm respectively as presented at
table (1).
Table (1): Physical characteristics of participants in the study.
Demographic variables Minimum Maximum Mean Std. Deviation
Age 50 65 56.6 4.07
Height 145 175 160.97 6.32
Weight 52 115 84.51 13.49
General Characteristics:
The current study was conducted on 200 patients (166 females and
34 males) suffering from knee osteoarthritis of both sides. They were
assigned according to the grade of OA into two groups. Grade II group
consisted of 39 patients with mean age, body mass, and height values of
54.12±3.57 years, 84.9±11.9 kg, and 162.66±5.19 cm respectively. Grade
III group consisted of 161 patients with mean age, body mass, and height
values of 55.19±3.96 years, 84.4±13.97 kg, and 160.51±6.55 cm
respectively. As indicated by the independent t test, there were no
significant differences (p>0.05) in the mean values of age, body mass,
and height between both tested groups (Table2). The sex distribution of
grade II group revealed that there were 36 females with reported
percentage of 92.3 % and 3 males with reported percentage of 7.7%. The
sex distribution of grade III group revealed that there were 131 females
with reported percentage of 80.7 % and 30 males with reported
percentage of 19.3% as shown in table (2). Chi square revealed there
was no significant differences between both groups in sex distribution
(p>0.05)
Egypt. J. of Appl. Sci., 36 (5-6) 2021 45
Table (2): Physical characteristics of patients in both groups.
Items Grade II Grade III Comparison
Mean ± SD Mean ± SD t-value P-value S
Age (years) 54.12±3.57 55.19±3.96 -0.75 0.460 NS
Body mass (Kg) 84.9±11.9 84.4±13.97 0.149 0.882 NS
Height (cm) 162.66±5.19 160.51±6.55 1.387 0.169 NS
Sex distribution N (%)
Grade II Grade III X2 P-value NS
Female 36 (92.3%) 130 (80.7%) 2.975
0.085
NS
Males 3(7.7%) 31 (19.3%)
*SD: standard deviation, P: probability, S: significance, NS: non-significant.
1. Fatigue severity scale:
As illustrated in figure (1), between groups comparison the median
interquartile range (IQR) of the FSS in the "grade II group" was 36 (15).
While, in the "grade III group" was 43 (10). Mann-Whitney U tests revealed
that there was significant difference in the FSS between both groups with
(U-value=2019, Z-value= -3.458, p = 0.001*) and this significant increase in
favor to grade III group in compared to grade II group.
Figure (1): Median value of FSS between both groups.
2. Correlation study
1. Correlation between the mean value of FSS and WOMAC:
Spearman's correlation coefficient (ρ) between mean value of FSS
(41.86±9.54) and WOMAC (18.83±5.17) was 0.263. The results
indicated that there was a positive weak correlation (p=0.0001*). This
means that increase in the FSS is consistent with increase in WOMAC
(fig 2).
46 Egypt. J. of Appl. Sci., 36 (5-6) 2021
Figure (2). Scatter plot for the bivariate correlation between FSS and WOMAC.
Physical health Domain of SF-36 questioner:
2. Correlation between the mean value of FSS and physical
functioning:
Spearman's correlation coefficient (ρ) between the mean value of
FSS (41.86±9.54) and physical functioning (41.59±14.55) was -0.393.
The results indicated that there was a negative weak correlation
(p=0.0001*). This means that increase in the FSS is consistent with
decrease in physical function (fig 3).
Figure (3). Scatter plot for the bivariate correlation between FSS and physical
function.
3. Correlation between the mean value of FSS and role physical :
Spearman's correlation coefficient (ρ) between mean value of FSS
(41.86±9.54) and role physical (18.5±22.16) was -0.052. The results
indicated that there was no correlation (p=0.468). This means that change
in the FSS is inconsistent with change in role physical (fig 4).
Egypt. J. of Appl. Sci., 36 (5-6) 2021 47
Figure (4). Scatter plot for the bivariate correlation between FSS and role
physical .
4. Correlation between the mean value of FSS and pain domain:
Spearman's correlation coefficient (ρ) between mean value of FSS
(41.86±9.54) and pain domain (39.07±14.08) was -0.437. The results
indicated that there was a negative weak correlation (p=0.0001*). This
means that increase in the FSS is consistent with decrease in pain domain
(fig5).
Figure (5). Scatter plot for the bivariate correlation between FSS and pain
domain.
5. Correlation between the mean value of FSS and general
health:
Spearman's correlation coefficient (ρ) between mean value of FSS
(41.86±9.54) and general health domain (40.49±9.89) was -0.143. The
48 Egypt. J. of Appl. Sci., 36 (5-6) 2021
results indicated that there was a negative weak correlation (p=0.044*).
This means that increase in the FSS is consistent with decrease in general
health (fig6).
Figure (6). Scatter plot for the bivariate correlation between FSS and general
health.
Mental health domain of SF-36 questioner
6. Correlation between the mean value of FSS and vitality
domain:
Spearman's correlation coefficient (ρ) between mean value of FSS
(41.86±9.54) and vitality domain (35.55±14.13) was -0.213. The results
indicated that there was a negative weak correlation (p=0.002*). This means
that increase in the FSS is consistent with decrease in vitality domain (fig7).
Figure (7). Scatter plot for the bivariate correlation between FSS and vitality
domain.
Egypt. J. of Appl. Sci., 36 (5-6) 2021 49
7. Correlation between the mean value of FSS and social
function:
Spearman's correlation coefficient (ρ) between mean value of FSS
(41.86±9.54) and social function (46.11±12.93) was -0.087. The results
indicated that there was no correlation (p=0.223). This means that change
in the FSS is inconsistent with change in social function (fig8).
Figure (8). Scatter plot for the bivariate correlation between FSS and social
function.
8. Correlation between the mean value of FSS and role motional:
Spearman's correlation coefficient (ρ) between mean value of FSS
(41.86±9.54) and role emotional (16.16±22.9) was 0.015. The results
indicated that there was no correlation (p=0.831). This means that change
in the FSS is inconsistent with change in role emotional (fig9).
Figure (9). Scatter plot for the bivariate correlation between FSS and role
emotional.
50 Egypt. J. of Appl. Sci., 36 (5-6) 2021
9. Correlation between the mean value of FSS and Mental
health:
Spearman's correlation coefficient (ρ) between mean value of FSS
(41.86±9.54) and mental health (47.84±16.58 ) was 0.123. The results
indicated that there was no correlation (p=0.083). This means that change
in the FSS is inconsistent with change in mental health (fig10).
Figure (10). Scatter plot for the bivariate correlation between FSS and mental
health.
DISCUSSION
This study was conducted to evaluate the fatigue and its association with
both disability and quality of life in patients with knee osteoarthritis. The
current study was conducted on 200 patients suffering from knee osteoarthritis
of both sides. They were assigned into two studies groups’ according to grade
of OA. Mann-Whitney U tests revealed that there was a significant difference
in the Fatigue severity scale between grade II and III of knee OA and this
significant increase into word grade IIII group in compared to grade II group.
There was a positive weak correlation between the mean value of FSS and
WOMAC and a negative weak correlation between FSS and different domains
of SF-36 included physical functioning, pain, vitality and general health
domain. While there was no correlation between the mean value of FSS and
role physical, role emotional, mental health, and social domain of SF-36.
Fatigue occurs as a result of a complicated interaction of medical,
physical, and psychiatric factors (Doris et al., 2010). Tulay & Fatma,( 2019)
was found that individuals with Knee OA experience more fatigue, insomnia
and depression than in healthy individuals. Also founded that the participants
with Knee OA experienced high levels of fatigue. In Other study, it has been
determined that individuals with OA experience fatigue, sleeping problems and
depression more than healthy individuals (Vitiello et al., 2014). The individuals
Egypt. J. of Appl. Sci., 36 (5-6) 2021 51
in the two studies experienced fatigue; however, the level of fatigue varied from
one study to another, which might be due to differences in the measurement
tools used or due to their cultural characteristics. Snijders et al., 2011 confirms
that fatigue, and even severe fatigue, is highly prevalent among patients with
knee and/or hip OA. Power et al., 2008 found that individual with OA have
significant amounts of fatigue and indicated that it had a substantial impact on
their lives.
This study found that fatigue affect patient with knee OA and there was
significant increase toward grade III group in compared to grade II group.
The study found also that there was a positive correlation between
fatigue and functional disability. this results are similar to Garip et al., (2016)
results which found that intensity and duration of fatigue, and interference with
quality of life subgroups of FSI were found to be positively correlated with
WOMAC A, WOMAC B, WOMAC C, WOMAC total, VAS-pain, BDS, and
pain, energy, and emotional reactions subgroups of NHP (p<0.05). Physical
mobility and sleep subgroups of NHP were only correlated with intensity of
fatigue and duration of fatigue (p<0.05). There was no correlation between FSI
subgroups and social isolation subgroup of NHP (p>0.05) which reported that
the knee osteoarthritic patients were fatigued mostly in the evenings (Garip et
al., 2016).
Similarly, Allen et al., (2013) founded an association between pain
subgroup of WOMAC and VAS-fatigue in the study where 291 patients
with knee and hip OA were assessed. In this study the fatigue evaluated by
using VAS-fatigue, which is inadequate in determining different facets of
fatigue. On the other hand, Stebbings et al., (2010) assessed fatigue of OA
patients in New Zealand by using Multidimensional Assessment of Fatigue-
Global Fatigue Index and reported a statistically significant correlation between
fatigue and physical disability. Also Wolfe et al., (1996) founded that pain was
the strongest predictor of fatigue in OA, explaining 25% of the variance in
fatigue scores in multivariate regression analyses.
This study found a negative weak correlation between fatigue and pain
domains of SF-36 this differently from Tulay & Fatma, (2019) determined that
fatigue affected pain and there was a relationship between them. Similarly
Murphy et al. 2008 found same results. In other study, it was also found that
there was a relationship between pain and fatigue in patients with Knee OA
(Garip et al., 2016).
Allen et al. 2013 used the VAS-fatigue and found a relationship between
fatigue and pain in 348 patients. These results suggest that in the management
of fatigue in individuals with Knee OA, pain is a factor that should be brought
under control.
In the study of Yeşim et al., (2016) fatigue subgroups including intensity
of fatigue and duration of fatigue were found to be associated with QoL in
terms of pain, physical mobility, sleep, energy and psychological functions.
Interference with QoL was correlated with only pain, energy and
52 Egypt. J. of Appl. Sci., 36 (5-6) 2021
psychological functions. Social function domain of QoL was not linked with
fatigue. This might be due to study sample involving mostly women
which is similar to our study and there was no correlation between role
physical, role emotional, mental health , and social domain of SF-36
In the study of Stebbings et al., 2010 that investigated the relationship
between fatigue, sleep, pain and depression in patients with rheumatoid arthritis
and OA, the patients with OA were found to have more fatigue, sleep
disturbance, pain and depression than the patients with rheumatoid arthritis.
Patients with OA have also been shown to exhibit problems related to falling
asleep, sleep care and early morning awakening (Parmelee et al., 2015).
Relevant studies have also shown that there is an important relationship
between fatigue and sleep disturbances (Stebbings et al., 2010)
Similar results obtained from Doris et al., 2010 suggest that application
of therapeutic approaches to sleep disturbances in OA management would be an
appropriate intervention to control fatigue in these patients.
Salaffi et al. 1991, as well as Marks R 2014 found that patients’ pain
experience and disability scores were strongly influenced by the presence of
depressive symptoms. This linkage of pain, depression, and osteoarthritis
disability observed by Salaffi et al. 1991is problematic as it is strongly
associated with activity avoidance, a wide array of emergent cognitive issues,
such as learned helplessness, job dissatisfaction, and an adverse disease
outcome (Okma-Keulen and Hopman, 2001).
That is, Marks R 2014 stated that the bulk of the research on
osteoarthritis research reveals a consistent picture of potentially debilitating
overlapping symptoms, including a low sense of morale, social isolation,
helplessness, further depression, anxiety, sleep disturbances, and disability that
can heighten and prolong the osteoarthritic pain experience with few
comprehensive treatment options. And that fostering a positive, rather than
ignoring any negative affect, may help to attenuate the prevailing degree of
osteoarthritic pain and disability (Keefe et al. 1990)
Zautra and Smith, 2001 stated that this negative series of feedback
responses where depression, anxiety and coping ability are significantly
correlated with the osteoarthritic patient's pain and disability levels potentially
produces a vicious cycle of excess pain and disability, plus varying degrees of
negative affect, regardless of the prevailing degree of osteoarthritic damage.
In this respect, McBeth et al., 2014 founded evidence from the chronic
pain literature strongly suggests central nervous system influences of emotions
and cognitions including individual behavioral characteristics along with
psychosocial factors, and increased sensitivity to pain signals by the brain
should not be ignored as potent factors that can mediate or moderate
osteoarthritis outcomes in older adults.
Predictors of new-onset widespread pain in older adults: results from a
population-based prospective cohort study in the UK. That is, it can be assumed
that the perceptions, interpretations, and reactions of the affected individual to
Egypt. J. of Appl. Sci., 36 (5-6) 2021 53
their impairment will interact with peripheral pain processes to produce or
heighten the painful experience, as well as the extent of prevailing disability,
thus heightening the changes of incurring reactive depression, even if there is
little or no distinctive prevailing painful source that can be demonstrated
objectively (Sofat et al. 2013).
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تقييم الاجهاد وجىدي الحياة والعجس لذي مرض خشىوت الرکبت.
ويري خالذ رمضان *ماجذة رمضان زهران** عبير عبذ الرحمه يمىي***
* تکإن سي طٕ علاج غثيع - کهيح انعلاج انطثيع - خايعح يصشنهعه وٕ أنرک نُٕ خٕيا ، يصش
**يذسط انعلاج انطثيعي ، قغى انعه وٕ الأعاعيح ، کهيح انعلاج انطثيعي ، خايعح اناا شْج ، يصش
***أعرار انعلاج انطثيعي ، قغى انعه وٕ الأعاعيح ، کهيح انعلاج انطثيعي ، خايعح اناا شْج ، يصش
الخلفيت: خش حَٕ انشکثح خهم يضي ، ذ کُغي ، انر آتي في اند آص انععهي ان يٓکهي يشذثػ تالأنى
أ خَفاض اناذسج إن ظيفيح خٔ دٕج انحياج الاخ آد شک يرکشسج في يشظ انر آب ان فًاصم ، أنري
ذشذثػ تانرعة. الغرض مه الذراست: ذْفد زْ انذساعح إن ذاييى الاخ آد نذ يشظ خش إنشکث سٔتط ت ؤًششاخ خ دٕج انحياج ألإعاقح إن ظيفيح الطريقت : أخشيد زْ انذساعح عه 200 يشيط ي 60 عايًا ذٔشخيصاخ غثيح خش حَٕ انشکثح ع إء ي انذسخح کلا اند غُي ذرشا ذٔ أع اًس ىْ تي 00
انثا يَح أ انذسخح انثانثح ذى اخرياس ان شًاسکي فٔاًا نه غًر انذي غًٕشافي ت اً في رنک يعه يإخ ع انع شً
أند ظُ أن غًر إنرعهي يً أنط لٕ إٔن ص ئؤشش کرهح اندغى ئذج ان شًض ذى قياط انرعة ي خلال
SF ان غُخح انعشتيح ي ياياط شذج انرعة ذى قياط خ دٕج انحياج ي خلال ان غُخح انعشتيح ي اعرثيا 36
ذٔى قياط الإعاقح إن ظيفيح تان غُخح انعشتيح ي يؤشش انر آب ان فًاصم في خايعاخ غشب أ رَٔاسي الىتائج: ذى ذع يً 200 يشيط في انذساعح ذرأنف يد عًٕح دسخ )WOMAC( خٔايعح ياک اًعرش
انثا يَ ي 33 يشيعاً ) 3 رک سٕ 36 إ اَز( ، أيا انذسخح انثانثح فررأنف ي 161 يشيعاً ) 31 رک سٕ U = 131 إ اَز( أشاسخ ان رُائح إن خٔ دٕ فشق في ياياط شذج انرعة تي ان دً عًٕري يع )قي حً 2019
0 *( ، زْٔ انضيادج ان عً يُٕح في يد عًٕح انذسخ انثانثح يااس حَ ع = 001 ، Z = - ، قي حً 3.458
ع = ( WOMAC ت دً عًٕح انذسخح انثا يَح کا اُْک اسذثاغ ظعيف ي خٕة تي ياياط شذج انرعة
0 ع = 0001 ( SF 0 *( کٔا اُْک اسذثاغ ظعيف عهثي تي انرعة ئدال الأنى لاعرثيا 36 0001
0 ع = 002 ( SF *( کٔا اُْک اسذثاغ ظعيف عهثي تي ياياط شذج انرعة ئدال انرعة لاعرثيا 36
*( الخلاصت: عه أعاط زْ انذساعح ، ي کً الاعر رُاج أ اُْک علاقح تي انرعة ألإعاقح عَٕٔيح
انحياج في ان شًظ انزي يعإ ي خش إنشکثح
FSS ،WOMAC ، الکلماث المفتاحيت: انرعة ، عَٕيح انحياج ، الإعاقح ، انر آب يفاصم انشکثح
56 Egypt. J. of Appl. Sci., 36 (5-6) 2021