Dekker Joost, van Dijk Gabriella M, Veenhof Cindy
Department of Rehabilitation Medicine, EMGO Institute, VU University Medical Centre, Amsterdam, The Netherlands.
Curr Opin Rheumatol. 2009 Sep;21(5):520-4. doi: 10.1097/BOR.0b013e32832e6eaa.
To summarize recent studies on risk factors for functional decline (i.e. worsening of pain and activity limitations) in osteoarthritis of the hip or knee; after a long period of neglect, information on risk factors for functional decline has markedly improved in recent years.
Studies show slow worsening of pain and activity limitations over time. There is a considerable between-individual variation in the course of pain and activity limitations; identification of risk factors for functional decline is therefore highly relevant. Risk factors for functional decline include characteristic physical impairments in osteoarthritis (pain, stiffness, reduced muscle strength, laxity of the knee joint, proprioceptive inaccuracy, poor standing balance and impaired range of joint motion), cognitive and visual impairments, comorbidity and overweight, psychological and social factors (anxiety, depression, fatigue, poor self-efficacy and social support), health behaviors and sociodemographic factors.
The information on risk factors can be used pragmatically to construct prediction rules on functional decline in osteoarthritis patients. Both clinicians and patients value the ability to prognosticate future pain and activity limitations. Furthermore, the information on risk factors can be used to construct causative models to explain pain and activity limitations: examples include 'instability of joints' and 'avoidance of activity' as causal mechanism of pain and activity limitations. Improved understanding of pain and activity limitations is the basis for improved treatment and rehabilitation of osteoarthritis patients.
总结近期关于髋或膝骨关节炎功能衰退（即疼痛加剧和活动受限）危险因素的研究；在长期被忽视之后，近年来有关功能衰退危险因素的信息有了显著改善。
研究表明，随着时间推移，疼痛和活动受限会缓慢加重。在疼痛和活动受限的病程中，个体之间存在相当大的差异；因此，识别功能衰退的危险因素具有高度相关性。功能衰退的危险因素包括骨关节炎的典型身体损伤（疼痛、僵硬、肌肉力量减弱、膝关节松弛、本体感觉不准确、站立平衡差和关节活动范围受损）、认知和视觉障碍、合并症和超重、心理和社会因素（焦虑、抑郁、疲劳、自我效能感差和社会支持不足）、健康行为和社会人口统计学因素。
关于危险因素的信息可实际用于构建骨关节炎患者功能衰退的预测规则。临床医生和患者都重视预测未来疼痛和活动受限的能力。此外，关于危险因素的信息可用于构建因果模型来解释疼痛和活动受限：例如，“关节不稳定”和“活动回避”作为疼痛和活动受限的因果机制。对疼痛和活动受限的更好理解是改善骨关节炎患者治疗和康复的基础。
