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Observational Study
. 2019 Dec;144(6):e20191399.
doi: 10.1542/peds.2019-1399. Epub 2019 Nov 19.

Musculoskeletal Pain, Physical Function, and Quality of Life After Bariatric Surgery

Sharon Bout-Tabaku  1   2 , Resmi Gupta  3 , Todd M Jenkins  3 , Justin R Ryder  4 , Amy E Baughcum  5 , Rebecca D Jackson  6 , Thomas H Inge  7   8 , John B Dixon  9 , Michael A Helmrath  3 , Anita P Courcoulas  10 , James E Mitchell  11 , Carroll M Harmon  12   13 , Changchun Xie  14 , Marc P Michalsky  5   6 ; TEEN-LABS CONSORTIUM
Affiliations
Observational Study

Musculoskeletal Pain, Physical Function, and Quality of Life After Bariatric Surgery

Sharon Bout-Tabaku et al. Pediatrics. 2019 Dec.

Abstract

Objectives: To evaluate the longitudinal effects of metabolic and bariatric surgery (MBS) on the prevalence of musculoskeletal and lower extremity (LE) pain, physical function, and health-related quality of life.

Methods: The Teen Longitudinal Assessment of Bariatric Surgery study (NCT00474318) prospectively collected data on 242 adolescents undergoing MBS at 5 centers over a 3-year follow-up. Joint pain and physical function outcomes were assessed by using the Health Assessment Questionnaire Disability Index, Impact of Weight on Quality of Life - Kids, and the Short Form 36 Health Survey. Adolescents with Blount disease (n = 9) were excluded.

Results: Prevalent musculoskeletal and LE pain were reduced by 40% within 12 months and persisted over 3 years. Adjusted models revealed a 6% lower odds of having musculoskeletal pain (odds ratio = 0.94, 95% confidence interval: 0.92-0.99) and a 10% lower odds of having LE pain (odds ratio = 0.90, 95% confidence interval: 0.86-0.95) per 10% reduction of BMI. The prevalence of poor physical function (Health Assessment Questionnaire Disability Index score >0) declined from 49% to <20% at 6 months (P < .05), Physical comfort and the physical component scores, measured by the Impact of Weight on Quality of Life - Kids and the Short Form 36 Health Survey, improved at 6 months postsurgery and beyond (P < .01). Poor physical function predicted persistent joint pain after MBS.

Conclusions: Joint pain, impaired physical function, and impaired health-related quality of life significantly improve after MBS. These benefits in patient-reported outcomes support the use of MBS in adolescents with severe obesity and musculoskeletal pain and suggest that MBS in adolescence may reverse and reduce multiple risk factors for future joint disease.

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Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: Dr Inge received honoraria and stock options from Standard Bariatrics and honoraria from UpToDate and Independent Medical Expert Consulting Services and served as a consultant for Zafgen, Inc, BioMedical Insights, and L&E Research, all outside the submitted work. Dr Harmon served on an advisory panel for Stryker Corporation from 1998 to 2015, unrelated to this project. Dr Dixon consulted for Apollo Endosurgery, Covidien, Bariatric Advantage, Nestle Health Science, Inova, and Novo Nordisk; the other authors have indicated they have no potential conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Percentage change in BMI over 36 months.
FIGURE 2
FIGURE 2
Significant reductions in musculoskeletal and LE pain after MBS. Musculoskeletal joint pain was defined as any reported level of lower back, hip, knee, or ankle and/or foot pain. LE joint pain was defined as any reported level of hip, knee, or ankle and/or foot pain.
FIGURE 3
FIGURE 3
Pain intensity by joint-specific site after MBS. The pain was reported per site by using a 0- to 10-point visual analog scale. Pain was categorized as mild (score of 1–3), moderate (score of 4–6), and severe (score of 7–10). Pain scores of 0 are not included.
FIGURE 4
FIGURE 4
Associations between joint pain and MBS. Percent change in BMI indicates a 10% reduction in BMI. Depressive symptoms were defined as clinical-range depressive symptoms by using a suggested total score of >17 as a conservative cut point on the BDI-II. Comorbidities included hypertension, dyslipidemia, fatty liver disease, obstructive sleep apnea, chronic kidney disease, pseudotumor cerebri, polycystic ovary syndrome, asthma, gastroesophageal reflux disease, and stress urinary incontinence; a composite load score was computed from the total number for comorbidities for each participant. Musculoskeletal joint pain was defined as any reported level of lower back, hip, knee, or ankle and/or foot pain. LE joint pain was defined as any reported level of hip, knee, or ankle and/or foot pain.
FIGURE 5
FIGURE 5
Participants reporting poor physical function decreases after MBS. Poor function status was assessed by the HAQ-DI in which poor physical function represents a score of >0 and good physical function represents a score of 0.
FIGURE 6
FIGURE 6
A, Improvement of IWQOL-Kids total and physical scores after metabolic and MBS. B, Improvement of SF-36 physical component summary scores after MBS.
See this image and copyright information in PMC

References

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