Medication Adherence in Orthopaedic Patients: A Comparative Study Using Morisky Medication Adherence Scale in Ortho Care Unit of Tertiary Care Hospital

Abstract

In a fast-developing country like India, the prevalence of osteoporosis and its associated complications is steadily increasing. Poor adherence to prescribed medications, particularly in chronic conditions, significantly raises the risk of adverse outcomes. Inadequate medication adherence can lead to suboptimal clinical results, increased healthcare costs, and accelerated disease progression. Developing focused clinical interventions that promote compliance and improve patient outcomes.The purpose of this study was to evaluate the management and adherence to medication therapy. Settings and Design:A cross-sectional observational study was conducted From October 2024 to November2025 in the outpatient clinic of a tertiary care hospital in Krishnagiri.A study involving orthopaedic patients with postoperative orthopaedic interventions or chronic conditions (such as osteoarthritis or osteoporosis) was carried out at a tertiary care hospital. The Modified Morisky Medication Adherence Scale (MMS), comprising eight items, was administered to all participants to assess their adherence to prescribed medication.Patients were selected, including all age groups, diagnosis of an orthopaedic condition, and current medication use. Demographic data (age, gender, education level) and clinical factors (co-morbidities, laboratory findings) were also collected through structured questionnaires. To ensure objectivity, the author and three co-authors conducted statistical data analysis using Graph Pad Prism version 10 software. Our study identifies a distinct demographic profile of orthopaedic patients, highlighting that married women (79.87%), primarily housewives (33.19%), aged 41–60 years (37.75%), with low literacy levels (39.21%), and residing in rural areas (63.07%) are disproportionately affected by orthopaedic conditions. A strong association was observed between these demographic factors and the presence of comorbidities, with ulcers being particularly prevalent (77.17%). Medication non-adherence emerged as a major concern, largely influenced by fear of side effects, financial constraints, and a lack of awareness regarding the long-term impact of untreated conditions. These findings underscore the urgent need for targeted educational interventions, particularly for housewives, to promote preventive strategies against bone fractures and osteoporosis, ultimately improving overall health outcomes

Keywords

Introduction

NO OF PATIENTS

MMAS-8 -MMAS 4

DISCUSSION:

In a developing country like India, the prevalence of osteoporosis and related musculoskeletal complications is increasing, particularly among middle-aged and rural populations. Our study observed that a significant proportion of orthopaedic patients were married women (79.87%), many of whom were housewives (33.19%) and aged between 41 and 60 years. This demographic profile highlights the influence of social roles, age-related physiological changes, and geographic disparities on musculoskeletal health .^[9,10] Household responsibilities involving repetitive tasks, prolonged standing, and heavy lifting may contribute to physical strain, potentially increasing the risk of musculoskeletal disorders in women managing home and family duties.^[11] These physical demands, combined with declining muscle strength, joint elasticity, and bone mineral density in the 41–60 age group, are further exacerbated by hormonal changes during the menopausal transition ^[12,13] Notably, 89.83% of participants exhibited low medication adherence, with female patients showing particularly high non-adherence rates. This is consistent with previous research linking poor adherence to socioeconomic barriers, fear of side effects, and limited health literacy.Psychosocial and informational barriers, especially in populations with reduced access to healthcare, remain a major challenge .^[14,15] The Morisky Medication Adherence Scale (MMAS) has been widely used to assess adherence levels and identify barriers such as financial burden and concerns about side effects (Morisky et al., 2008). In our study, only a small proportion of patients demonstrated moderate (8.71%) or high (1.45%) adherence. These findings underscore the need for structured counselling, improved health literacy, and enhanced physician-patient communication to support adherence ^[17] A high prevalence of peptic ulcers (77.17%) was also observed, likely due to prolonged NSAID use for orthopaedic pain management. NSAIDs, though effective, are known to compromise gastrointestinal integrity, leading to increased morbidity and reduced medication adherence. Patients experiencing adverse effects may discontinue treatment prematurely, further complicating disease management. ^[12,13] The interplay between comorbidities and medication adherence highlights the importance of individualized care plans. Structured interventions such as counselling, medication reviews, and lifestyle modifications have been shown to improve adherence, particularly among vulnerable groups like housewives and the elderly. ^[20] Tailored education on self-management and disease awareness, along with strengthened communication and community-based health programs, can empower patients and improve outcomes ^[13]. Addressing adherence through comprehensive, patient-centered strategies remains critical in reducing the burden of musculoskeletal disorders and improving the quality of orthopaedic care.^[16] With a particularly high prevalence of peptic ulcers seen in 77.17% of the study population, the current study highlights a strong correlation between patients' social characteristics and comorbid conditions. This result is in line with earlier research that found a direct correlation between long-term nonsteroidal anti-inflammatory drug (NSAID) use and the emergence of gastrointestinal issues, such as peptic ulcers. ^[12,13] Although NSAIDs are frequently prescribed in orthopaedic care to treat pain and inflammation, long-term use of these medications has been linked to gastrointestinal integrity compromise and increased morbidity ^[11]. Patients who experience discomfort or complications may decide to stop taking their medications or follow their prescribed regimens irregularly, which can have a substantial impact on medication adherence ^[16] The study also highlights a high prevalence of medication non-adherence, with 89.83% of participants exhibiting low adherence levels. This finding is consistent with existing literature that identifies factors such as socioeconomic constraints, fear of side effects, and limited health literacy as significant barriers to adherence.^[14,15] Notably, female patients demonstrated higher rates of non-adherence, underscoring the need for gender-sensitive interventions. The relationship between concurrent disorders and adherence emphasises how crucial tailored and focused interventions are. Orthopaedic patients' adherence rates have been shown to increase with the help of structured patient counselling, medication reviews, and lifestyle modification programs. ^[15] For at-risk populations like housewives and older adults, who comprised a significant portion of our sample and are frequently more vulnerable to musculoskeletal disorders and their related complications, these interventions are especially important ^[17] Adherence issues in these populations may be made worse by socioeconomic restrictions, lack of health literacy, and providing care obligations. ^[18] According to Anderson and Lee, tailored educational programs emphasising self-management techniques and disease awareness can dramatically lower these susceptible groups' risk of osteoporosis-related fractures. ^[19] Furthermore, it has been demonstrated that strengthening physician-patient communication and providing community-based health education improve treatment adherence and give patients the confidence to actively participate in their care ^[20-22] Given these results, a key component of successful orthopaedic management continues to be addressing non-adherence through comprehensive, patient-centered approaches. Clinical practice can minimise obstacles, maximise treatment results, and lessen the overall burden of musculoskeletal disorders by implementing routine counselling, adverse effect monitoring, and adherence evaluations.

CONCLUSIONS

Our analysis reveals a unique demographic profile of orthopaedic patients have a distinct demographic profile. We emphasise that married women (79.87%), housewives (33.19%), individuals between the ages of 41 and 60 (37.75%), individuals who have low literacy (39.21%), as well as those living in rural areas (63.07%) are disproportionately affected by orthopaedic conditions.  These demographic characteristics were found to be significantly correlated with the overall incidence of concurrent medical conditions, with ulcers being the most common (77.17%).Fear of side effects, inadequate knowledge about the long-term consequences of untreated conditions, and financial constraints were the main causes of medication non-adherence, which became a major issue. The aforementioned results highlight the critical need for focused on educational interventions, particularly among housewives, for the purpose to enhance general health outcomes as well as promote osteoporosis and fracture early detection.

ACKNOWLEDGEMENT:

We wish to express our heartfelt gratitude to all the orthopaedic patients who willingly participated in this study. Their valuable time, cooperation, and honest responses to the Morisky Medication Adherence Scale have been instrumental in advancing our understanding of medication adherence patterns in the Ortho Care Unit of the tertiary care hospital.

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