Vaughan Molly W, Felson David T, LaValley Michael P, Orsmond Gael I, Niu Jingbo, Lewis Cora E, Segal Neil A, Nevitt Michael C, Keysor Julie J
Boston University, Boston, Massachusetts.
Baylor College of Medicine, Houston, Texas.
Arthritis Care Res (Hoboken). 2017 Jul;69(7):952-958. doi: 10.1002/acr.23085. Epub 2017 Jun 2.
Older adults with knee osteoarthritis (OA) who live in environments with mobility barriers may be at greater risk of developing participation restrictions, defined as difficulties in engagement in life situations. We investigated the risk of participation restriction over 5 years due to self-reported environmental features among older adults with knee OA.
Participants from the Multicenter Osteoarthritis (MOST) Study self-reported participation at baseline, 30 months, and 60 months using the instrumental role subscale of the Late Life Disability Index (LLDI). Data on self-reported environmental features were from the Home and Community Environment questionnaire administered in the MOST Knee Pain and Disability study, an ancillary study of MOST. The relative risks (RRs) of developing participation restriction at 60 months, indicated by an LLDI score <67.6 out of a possible 100, due to reported high community mobility barriers and high transportation facilitators, were calculated using robust Poisson regression, adjusting for covariates.
Sixty-nine of the 322 participants (27%) developed participation restriction by 60 months. Participants reporting high community mobility barriers at baseline had 1.8 times the risk (95% confidence interval [95% CI] 1.2-2.7) of participation restriction at 60 months, after adjusting for covariates. Self-report of high transportation facilitators at baseline resulted in a reduced but statistically nonsignificant risk of participation restriction at 60 months (RR 0.7, 95% CI 0.4-1.1).
Higher perceived environmental barriers impact the risk of long-term participation restriction among older adults with or at risk of knee OA. Approaches aimed at reducing the development of participation restrictions in this population should consider decreasing environmental barriers.
生活在存在行动障碍环境中的老年膝骨关节炎（OA）患者，可能面临更大的参与限制风险，参与限制定义为在生活情境中参与活动存在困难。我们调查了老年膝OA患者因自我报告的环境特征而在5年内出现参与限制的风险。
多中心骨关节炎（MOST）研究的参与者在基线、30个月和60个月时使用晚年残疾指数（LLDI）的工具性角色子量表自我报告参与情况。自我报告的环境特征数据来自MOST膝关节疼痛与残疾研究（MOST的一项辅助研究）中所使用的家庭与社区环境问卷。使用稳健泊松回归计算因报告的高社区行动障碍和高交通便利因素导致60个月时出现参与限制（LLDI得分低于可能的100分中的67.6分）的相对风险（RR），并对协变量进行调整。
322名参与者中有69名（27%）在60个月时出现参与限制。在调整协变量后，基线时报告高社区行动障碍的参与者在60个月时出现参与限制的风险是其他人的1.8倍（95%置信区间[95%CI]为1.2 - 2.7）。基线时自我报告高交通便利因素导致60个月时参与限制风险降低，但在统计学上无显著意义（RR 0.7，95%CI 0.4 - 1.1）。
较高的感知环境障碍会影响老年膝OA患者或有患膝OA风险的人群长期出现参与限制的风险。旨在减少该人群参与限制发生的方法应考虑减少环境障碍。
