Stubbs Brendon, Eggermont Laura, Patchay Sandhi, Schofield Pat
School of Health and Social Care, University of Greenwich, London, UK.
Department of Clinical Neuropsychology, VU University Amsterdam, Amsterdam, the Netherlands.
Geriatr Gerontol Int. 2015 Jul;15(7):881-8. doi: 10.1111/ggi.12357. Epub 2014 Aug 28.
Chronic musculoskeletal pain (CMP) and falls are common among community-dwelling older adults. The study aims were: (i) to investigate the relationship between CMP and any falls (≥1), single falls and recurrent falls (≥2) in community-dwelling older adults; and (ii) to determine the discriminative validity of the Brief Pain Inventory (BPI) to differentiate between non-fallers and (a) any and (b) recurrent fallers.
A cross-sectional study involving 295 community-dwelling participants (mean age 77.5 ± 8.1 years, 66.4% female) was carried out. CMP was assessed and classified as none (comparison group), single and multisite (≥2). The BPI severity and interference subscales were used, and falls were recorded over 12 months. Data were analyzed with logistic regression and receiver operating characteristic curves (ROC).
Over half of the participants (154/295, 52.2%) had CMP (41.6% single and 58.4% multisite pain). Participants with CMP were at increased risk of recurrent falls (OR 2.25, 95% CI 1.03-4.88), and this risk was highest in those with multisite CMP (OR 3.43, CI 1.34-8.65). The BPI severity subscale showed good discriminative ability to differentiate between recurrent and non-fallers with an area under the curve (AUC) of 0.731 (95% CI 0.635-0.826); a mean score of 5.1 had a sensitivity of 93.3% and specificity of 56.7%. The AUC for the BPI interference subscale was 0.724 (95% CI 0.630-0.818), and a cut-off score of 4.6 had a sensitivity of 84.4% and specificity of 57.8%
Older adults with multisite CMP are at greatest risk of recurrent falls. In clinical settings, the BPI could prove useful to discriminate between recurrent and non-fallers.
慢性肌肉骨骼疼痛（CMP）和跌倒在社区居住的老年人中很常见。本研究的目的是：（i）调查社区居住老年人中CMP与任何跌倒（≥1次）、单次跌倒和反复跌倒（≥2次）之间的关系；（ii）确定简短疼痛量表（BPI）区分未跌倒者与（a）任何跌倒者和（b）反复跌倒者的判别效度。
进行了一项横断面研究，涉及295名社区居住参与者（平均年龄77.5±8.1岁，66.4%为女性）。对CMP进行评估并分类为无（对照组）、单次和多部位（≥2个部位）。使用BPI严重程度和干扰子量表，并记录12个月内的跌倒情况。采用逻辑回归和受试者工作特征曲线（ROC）分析数据。
超过一半的参与者（154/295，52.2%）患有CMP（41.6%为单次疼痛，58.4%为多部位疼痛）。患有CMP的参与者反复跌倒的风险增加（比值比2.25，95%置信区间1.03 - 4.88），且这种风险在多部位CMP患者中最高（比值比3.43，置信区间1.34 - 8.65）。BPI严重程度子量表在区分反复跌倒者和未跌倒者方面显示出良好的判别能力，曲线下面积（AUC）为0.731（95%置信区间0.635 - 0.826）；平均得分5.1时，敏感性为93.3%，特异性为56.7%。BPI干扰子量表的AUC为0.724（95%置信区间0.630 - 0.818），临界值为4.6时，敏感性为84.4%，特异性为57.8%。
多部位CMP的老年人反复跌倒的风险最大。在临床环境中，BPI可能有助于区分反复跌倒者和未跌倒者。
