Krembil Research Institute, University Health Network, Arthritis Community Research and Evaluation Unit and University of Toronto, Toronto, Ontario, Canada.
Krembil Research Institute, University Health Network, Toronto, Ontario, Canada.
Arthritis Care Res (Hoboken). 2021 Nov;73(11):1638-1647. doi: 10.1002/acr.24366. Epub 2021 Oct 4.
The focus on disability in osteoarthritis (OA) has largely been on the ability to perform specific activities, which neglects the greater implications for social participation. We investigated the association between OA and social participation, considering activity limitations and instrumental supports as intervening variables in the association.
Data were from 21,214 respondents, ages 45-85 years, from cycle 1 of the Canadian Longitudinal Study on Aging. The questionnaire elicited information regarding self-reported doctor-diagnosed OA, difficulty with 14 activities, perceived availability and receipt of instrumental supports, and 17 social participation activities. Structural equation modeling was used. The primary outcome was social participation, and the primary predictor was OA. The intervening variables included activity limitations, received instrumental supports, and perceived instrumental supports. Latent variables were developed for intervening and social participation variables. The covariates included age, sex, body mass index, income, education, smoking, and comorbidity count.
The mean age of the respondents was 63 years, 51% were female, and 26.5% reported having OA. Two distinct social participation indicators were identified, including social participation-diversity and social participation-intensity. When intervening variables were not considered, minimal/no association was found between OA and social participation. When intervening variables were considered, unique pathways linking OA and social participation were found. The overall negative association between activity limitations and social participation was partially direct and partially buffered by both receipt of and perceived availability of instrumental supports. In the absence of activity limitations, OA was associated with greater social participation.
Enhanced social participation in people with OA who do not have activity limitations may reflect proactive steps taken by those with mild OA to maintain activity and social engagement. For those with activity limitations, findings highlight the need for interventions to mitigate limitations and draw particular attention to the importance of both provision and awareness of available instrumental supports in maintaining social participation.
骨关节炎（OA）对残疾的关注主要集中在执行特定活动的能力上，而忽略了对社会参与的更大影响。我们研究了 OA 与社会参与之间的关系，考虑到活动受限和工具性支持作为该关联的中间变量。
数据来自加拿大老龄化纵向研究第 1 周期的 21214 名 45-85 岁的受访者。问卷询问了自我报告的医生诊断的 OA、14 项活动困难、感知到的工具性支持的可用性和接受情况以及 17 项社会参与活动的信息。使用结构方程模型。主要结果是社会参与，主要预测因子是 OA。中间变量包括活动受限、获得的工具性支持和感知到的工具性支持。为中间变量和社会参与变量开发了潜在变量。协变量包括年龄、性别、体重指数、收入、教育、吸烟和合并症计数。
受访者的平均年龄为 63 岁，51%为女性，26.5%报告患有 OA。确定了两个不同的社会参与指标，包括社会参与多样性和社会参与强度。当不考虑中间变量时，OA 与社会参与之间几乎没有关联。当考虑中间变量时，发现 OA 与社会参与之间存在独特的关联途径。活动受限与社会参与之间的总体负相关部分是直接的，部分是由工具性支持的获得和感知可用性缓冲的。在没有活动受限的情况下，OA 与更大的社会参与相关。
在没有活动受限的 OA 患者中增强社会参与能力可能反映了轻度 OA 患者为保持活动和社会参与而采取的积极主动措施。对于有活动受限的患者，研究结果强调了需要采取干预措施来减轻限制，并特别关注提供和意识到可用工具性支持在维持社会参与方面的重要性。
