Mat Sumaiyah, Kamaruzzaman Shahrul Bahyah, Chin Ai-Vyrn, Tan Maw Pin
Ageing and Age-Associated Disorders Research Group, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
Geriatric Division, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
Front Public Health. 2020 Oct 14;8:571196. doi: 10.3389/fpubh.2020.571196. eCollection 2020.
To determine the temporal relationship between the presence of knee pain and knee pain severity identified at baseline with fall risk, fear of falling and changes in instrumental activity of daily living at 12-months follow-up. This was a prospective study from the Malaysian Elders Longitudinal Research (MELoR) study involving community dwelling older persons aged 55 years and older. The presence of one fall in the preceding 12 months, knee pain, and functional capacity were determined at baseline (2013-2015) and follow-up (2015-2016). Function was determined as loss of at least one of seven instrumental activities of daily living (IADL). Physical performance was evaluated at baseline using the timed-up-and-go (TUG) test. Fear of falling (FoF) was determined using the single question "Are you afraid of falling?" Data were available for 605 participants, mean () age = 69.10 (7.24) years. Knee pain was present in 30.2% at baseline. Neither the presence of knee pain nor knee pain severity at baseline were associated with falls at 1-year follow-up. Knee pain was significantly associated with FoF at follow-up [aRR (95%CI) = 1.76 (1.02-3.04)] but not changes in IADL. Among individuals with no falls at baseline, the presence of knee pain was protective of falls at follow-up after adjustment for baseline physical performance [adjusted rate ratio, aRR (95% confidence interval, CI) = 0.35 (0.13-0.97)]. Knee pain is associated with increased FoF at 1.5 years' follow-up within a multi-ethnic population aged 55 years, residing in an urban location in a middle-income South East Asian nation. Interestingly, after differences in muscle strength was accounted for, knee pain was protective against falls at follow-up. Our findings challenge previous assumptions on joint pain and falls and highlights the importance of large prospective studies and further mechanistic research incorporating psychological factors in this area of increasing prominence.
为了确定基线时确定的膝关节疼痛及其严重程度与12个月随访时的跌倒风险、跌倒恐惧和日常生活工具性活动变化之间的时间关系。这是一项来自马来西亚老年人纵向研究（MELoR）的前瞻性研究，涉及55岁及以上的社区居住老年人。在基线（2013 - 2015年）和随访（2015 - 2016年）时确定前12个月内是否有跌倒、膝关节疼痛和功能能力。功能被定义为至少丧失七项日常生活工具性活动（IADL）中的一项。在基线时使用计时起立行走（TUG）测试评估身体表现。使用“你害怕跌倒吗？”这个单一问题来确定跌倒恐惧（FoF）。共有605名参与者的数据可用，平均（）年龄 = 69.10（7.24）岁。基线时30.2%的人存在膝关节疼痛。基线时膝关节疼痛的存在与否及其严重程度均与1年随访时的跌倒无关。膝关节疼痛在随访时与跌倒恐惧显著相关[aRR（95%CI） = 1.76（1.02 - 3.04）]，但与IADL的变化无关。在基线时无跌倒的个体中，在调整基线身体表现后，膝关节疼痛的存在对随访时的跌倒有保护作用[调整率比，aRR（95%置信区间，CI） = 0.35（0.13 - 0.97）]。在一个年龄为55岁、居住在东南亚中等收入国家城市地区的多民族人群中，膝关节疼痛与1.5年随访时跌倒恐惧的增加有关。有趣的是，在考虑肌肉力量差异后，膝关节疼痛对随访时的跌倒有保护作用。我们的研究结果挑战了先前关于关节疼痛和跌倒的假设，并强调了大型前瞻性研究以及在这个日益突出的领域纳入心理因素的进一步机制研究的重要性。
