Department of Epidemiology and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Vic, 3004, Australia.
Department of Physiotherapy, Monash University, 47-49 Moorooduc Highway, Frankston, Vic, 3199, Australia.
BMC Musculoskelet Disord. 2020 Feb 29;21(1):138. doi: 10.1186/s12891-020-3160-5.
BACKGROUND: Falls are a major cause of injury and death among older people. Evidence suggests that people with osteoarthritis (OA) are at a higher risk of falls and fall-related injuries including fractures. While studies demonstrate a link between OA and falls, little is known about the pathways that link falls with demographic factors, OA impairments, activity limitations and participation restrictions. The aim of this study was to identify risk factors for falls and fractures among people with OA or at high risk of developing OA using the International Classification of Functioning, Disability and Health (ICF) framework. METHODS: A longitudinal analysis of data from the Osteoarthritis Initiative (OAI) dataset was undertaken. Participants were considered to have OA if they reported they had been diagnosed with knee or hip OA by a medical practitioner. Outcomes were self-reported falls and fractures. Potential predictors were classified using the ICF framework. Poisson regression models were used to determine the risk factors for falls and fractures. RESULTS: Of the 4796 participants, 2270 (47%) were diagnosed with knee and/or hip OA. A higher proportion of participants with OA reported having had falls (72% vs 63%; p < 0.0001) and fractures (17% vs 14%; p = 0.012) than those without OA. Personal factors were found to be stronger predictors of falls and fractures compared to OA impairments, activity limitations and participation restrictions in this sample of participants. After adjusting for potential covariates, self-reported history of falls was a significant predictor of both increased falls (incidence rate ratio [IRR] 1.50; 95% confidence interval [CI] 1.40, 4.60) and fracture risk (IRR 1.38; 95% CI 1.13, 1.69). CONCLUSIONS: By applying the ICF framework, we have shown that personal factors were more likely to predict falls and fractures rather than OA impairments, environmental factors, activity limitations and participation restrictions in people with OA or at high risk of developing OA. This highlights the importance of questioning patients about their previous falls and past medical history, and using this information to focus our assessment and clinical decision-making processes.
背景：跌倒 是老年人受伤和死亡的主要原因。有证据表明，骨关节炎（OA）患者跌倒和与跌倒相关的伤害（包括骨折）的风险更高。虽然研究表明 OA 与跌倒之间存在关联，但对于将跌倒与人口统计学因素、OA 损伤、活动受限和参与受限联系起来的途径知之甚少。本研究旨在使用国际功能、残疾和健康分类（ICF）框架确定 OA 或有发展 OA 高风险人群的跌倒和骨折的危险因素。
方法：对 Osteoarthritis Initiative（OAI）数据集的数据进行纵向分析。如果参与者报告他们曾被医生诊断为膝或髋部 OA，则认为他们患有 OA。结果是自我报告的跌倒和骨折。使用 ICF 框架对潜在预测因素进行分类。使用泊松回归模型确定跌倒和骨折的危险因素。
结果：在 4796 名参与者中，2270 名（47%）被诊断为膝和/或髋部 OA。患有 OA 的参与者报告跌倒（72% 对 63%；p<0.0001）和骨折（17% 对 14%；p=0.012）的比例高于未患 OA 的参与者。在本研究样本中，与 OA 损伤、活动受限和参与受限相比，个人因素被发现是跌倒和骨折的更强预测因素。在调整潜在协变量后，自我报告的跌倒史是增加跌倒的显著预测因素（发病率比 [IRR] 1.50；95%置信区间 [CI] 1.40，4.60）和骨折风险（IRR 1.38；95% CI 1.13，1.69）。
结论：通过应用 ICF 框架，我们表明，在 OA 或有发展 OA 高风险的人群中，个人因素比 OA 损伤、环境因素、活动受限和参与受限更有可能预测跌倒和骨折。这强调了询问患者有关他们以前跌倒和既往病史的重要性，并利用这些信息来集中我们的评估和临床决策过程。
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