Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA; Department of Allied Health Sciences, Division of Physical Therapy, School of Medicine and the Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Thurston Arthritis Research Center, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Departments of Medicine and Social Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Public Health. 2017 Jan;142:15-21. doi: 10.1016/j.puhe.2016.08.016. Epub 2016 Nov 15.
Our study had two main objectives: 1) to determine whether perceived neighbourhood physical features are associated with physical activity levels in adults with arthritis; and 2) to determine whether the conclusions are more precise when item response theory (IRT) scores are used instead of average scores for the perceived neighbourhood physical features scales.
Information on health outcomes, neighbourhood characteristics, and physical activity levels were collected using a telephone survey of 937 participants with self-reported arthritis. Neighbourhood walkability and aesthetic features and physical activity levels were measured by self-report. Adjusted proportional odds models were constructed separately for each neighbourhood physical features scale.
We found that among adults with arthritis, poorer perceived neighbourhood physical features (both walkability and aesthetics) are associated with decreased physical activity level compared to better perceived neighbourhood features. This association was only observed in our adjusted models when IRT scoring was employed with the neighbourhood physical feature scales (walkability scale: odds ratio [OR] 1.20, 95% confidence interval [CI] 1.02, 1.41; aesthetics scale: OR 1.32, 95% CI 1.09, 1.62), not when average scoring was used (walkability scale: OR 1.14, 95% CI 1.00, 1.30; aesthetics scale: OR 1.16, 95% CI 1.00, 1.36).
In adults with arthritis, those reporting poorer walking and aesthetics features were found to have decreased physical activity levels compared to those reporting better features when IRT scores were used, but not when using average scores. This study may inform public health physical environmental interventions implemented to increase physical activity, especially since arthritis prevalence is expected to be close to 20% of the population in 2020. Based on NIH initiatives, future health research will utilize IRT scores. The differences found in this study may be a precursor for research on how past and future treatment effects may vary between these two types of measurement scores.
本研究有两个主要目的：1）确定感知邻里物理特征是否与关节炎成人的身体活动水平相关；2）确定使用项目反应理论（IRT）评分而不是感知邻里物理特征量表的平均评分时，结论是否更精确。
通过对 937 名自我报告关节炎的参与者进行电话调查，收集健康结果、邻里特征和身体活动水平信息。通过自我报告测量邻里可步行性和美观特征以及身体活动水平。分别为每个邻里物理特征量表构建调整后的比例优势模型。
我们发现，在关节炎成人中，与感知到的更好的邻里特征相比，较差的感知邻里物理特征（步行能力和美观）与较低的身体活动水平相关。只有当使用 IRT 评分时，才能在调整后的模型中观察到这种关联，而不是在使用平均评分时（步行能力量表：优势比 [OR] 1.20，95%置信区间 [CI] 1.02，1.41；美观量表：OR 1.32，95% CI 1.09，1.62）（步行能力量表：OR 1.14，95% CI 1.00，1.30；美观量表：OR 1.16，95% CI 1.00，1.36）。
在关节炎成人中，与报告更好特征的人相比，报告较差步行和美观特征的人身体活动水平较低，而使用 IRT 评分时则不是这样，但使用平均评分时则不是这样。本研究可能为旨在增加身体活动的公共卫生物理环境干预措施提供信息，尤其是因为预计到 2020 年，关节炎的患病率将接近人口的 20%。基于 NIH 的倡议，未来的健康研究将使用 IRT 评分。本研究中发现的差异可能是研究过去和未来的治疗效果如何在这两种测量评分之间变化的前兆。
