Weiss Carlos O, Hoenig Helen M, Fried Linda P
Division of Geriatric Medicine & Gerontology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21224-2734, USA.
Arch Phys Med Rehabil. 2007 Sep;88(9):1217-20. doi: 10.1016/j.apmr.2007.07.007.
Preclinical disability in mobility tasks can be recognized by asking people without overt mobility disability whether they have changed the way, either the manner or the frequency, of doing a mobility task because of a health or physical condition. Like other compensatory strategies, preclinical mobility disability has a dual nature as both a risk marker associated with impairment or limitation and a mediating factor affecting the natural history of disability. The method of ascertaining preclinical disability through self-report has been shown to have construct validity, to be reliable, and to identify people at an elevated risk of developing overt mobility disability over 1 to 2 years. Many worthy research questions in this field remain to be addressed, especially regarding qualitative heterogeneity (doing more vs doing less) and interactions among compensatory strategies. Nonetheless, there is sufficient evidence to apply what is known about preclinical disability to screening in clinical settings. This area of research and practice constitutes an opportunity for physical medicine and rehabilitation and geriatric medicine to jointly make a large beneficial impact on population health through strategies to prevent disability because rapidly growing numbers of older adults will experience this early and potentially malleable stage.
通过询问没有明显行动障碍的人，是否因为健康或身体状况而改变了进行行动任务的方式（无论是方式还是频率），可以识别出行动任务中的临床前残疾。与其他代偿策略一样，临床前行动残疾具有双重性质，既是与损伤或限制相关的风险标志物，也是影响残疾自然史的中介因素。通过自我报告确定临床前残疾的方法已被证明具有结构效度、可靠性，并且能够识别出在1至2年内发生明显行动残疾风险较高的人群。该领域许多有价值的研究问题仍有待解决，特别是关于质性异质性（做得更多与做得更少）以及代偿策略之间的相互作用。尽管如此，有足够的证据将关于临床前残疾的已知知识应用于临床环境中的筛查。这一研究和实践领域为物理医学与康复以及老年医学提供了一个机会，通过预防残疾的策略，共同对人群健康产生重大有益影响，因为越来越多的老年人将经历这个早期且可能具有可塑性的阶段。
