膝关节疼痛与老年人跌倒风险之间的关系通过降低力量、平衡能力差和对跌倒的担忧来介导。
Reduced strength, poor balance and concern about falls mediate the relationship between knee pain and fall risk in older people.
机构信息
Neuroscience Research Australia, University of New South Wales, Barker Street, Randwick, Sydney, New South Wales, 2031, Australia.
School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia.
出版信息
BMC Geriatr. 2020 Mar 6;20(1):94. doi: 10.1186/s12877-020-1487-2.
BACKGROUND
Pain is an independent risk factor for falling. One in two older community-dwelling people with musculoskeletal pain fall each year. This study examined physical, psychological and medical factors as potential mediators to explain the relationship between knee pain and falls.
METHODS
Three hundred and thirty-three community-dwelling people aged 70+ years (52% women) participated in this cohort study with a 1-year follow-up for falls. Participants completed questionnaires (medical history, general health and concern about falls) and underwent physical performance tests. Participants were classified into 'pain' and 'no pain' groups based on self-reported knee pain. Poisson Regression models were computed to determine the Relative Risk (RR) of having multiple falls and potential mediators for increased fall risk.
RESULTS
One hundred and eighteen (36%) participants were categorised as having knee pain. This group took more medications and had more medical conditions (P < 0.01) compared to the no pain group. The pain group had poorer balance, physical function and strength and reported increased concern about falls. Sixty one participants (20%) reported ≥2 falls, with the pain group twice as likely to experience multiple falls over the 12 month follow up (RR = 2.0, 95% confidence interval (CI) = 1.27-3.13). Concern about falls, knee extension torque and postural sway with eyes closed were identified as significant and independent mediators of fall risk, and when combined explained 23% of the relationship between knee pain and falls.
CONCLUSION
This study has identified several medical, medication, psychological, sensorimotor, balance and mobility factors to be associated with knee pain, and found the presence of knee pain doubles the risk of multiple falls in older community living people. Alleviating knee pain, as well as addressing associated risk factors may assist in preventing falls in older people with knee pain.
背景
疼痛是跌倒的独立危险因素。每年有二分之一的患有肌肉骨骼疼痛的社区老年人跌倒。本研究探讨了身体、心理和医疗因素作为潜在的中介因素，以解释膝关节疼痛与跌倒之间的关系。
方法
333 名 70 岁以上（52%为女性）的社区居住者参加了这项队列研究，随访 1 年以观察跌倒情况。参与者完成了问卷（病史、一般健康状况和对跌倒的担忧）并接受了身体机能测试。根据自我报告的膝关节疼痛，参与者被分为“疼痛”和“无疼痛”组。使用泊松回归模型来确定多次跌倒的相对风险（RR）和潜在的增加跌倒风险的中介因素。
结果
118 名（36%）参与者被归类为膝关节疼痛。与无疼痛组相比，该组服用的药物更多，患有更多的疾病（P<0.01）。疼痛组平衡、身体功能和力量更差，并且报告对跌倒的担忧增加。61 名参与者（20%）报告≥2 次跌倒，疼痛组在 12 个月的随访中更有可能经历多次跌倒（RR=2.0，95%置信区间（CI）=1.27-3.13）。对跌倒的担忧、膝关节伸展扭矩和闭眼时的姿势摆动被确定为跌倒风险的显著和独立的中介因素，当它们结合起来时，解释了膝关节疼痛与跌倒之间 23%的关系。
结论
本研究确定了一些与膝关节疼痛相关的医疗、药物、心理、感觉运动、平衡和移动因素，并发现膝关节疼痛的存在使老年人多次跌倒的风险增加一倍。减轻膝关节疼痛以及解决相关的危险因素可能有助于预防膝关节疼痛的老年人跌倒。
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