1 年步行速度下降是否能预测膝关节骨关节炎患者当前步行速度以外的死亡率风险？

Does the 1-year Decline in Walking Speed Predict Mortality Risk Beyond Current Walking Speed in Adults With Knee Osteoarthritis?

机构信息

H. Master, PT, PhD, MPH, Department of Physical Therapy, College of Health Sciences, University of Delaware, Biomechanics and Movement Science Interdisciplinary Program, University of Delaware, and Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.

T. Neogi, MD, PhD, Department of Medicine, Section of Rheumatology, Boston University School of Medicine, Boston, Massachusetts.

出版信息

J Rheumatol. 2021 Feb;48(2):279-285. doi: 10.3899/jrheum.200259. Epub 2020 Sep 1.

DOI:10.3899/jrheum.200259

PMID:33259329

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7854382/

Abstract

OBJECTIVE

To investigate whether walking speed at 1 timepoint, decline over the past 12 months, or both predict mortality risk over 11 years in adults with, or at risk of, knee osteoarthritis (OA).

METHODS

Using the data from the Osteoarthritis Initiative, we defined slow versus adequate walking speed as walking < 1.22 versus ≥ 1.22 m/s on a 20m walk test during the 12-month follow-up visit. We defined meaningful decline (yes/no) as slowing ≥ 0.08 m/s over the past year. At the 12-month visit, we classified adequate sustainers as those with adequate walking speed and no meaningful decline, slow sustainers as slow walking speed and no meaningful decline, adequate decliners as adequate walking speed and meaningful decline, and slow decliners as slow walking speed and meaningful decline. Mortality was recorded over 11 years. To examine the association of walking speed with mortality, HR and 95% CI were calculated using Cox regression, adjusted for potential confounders.

RESULTS

Of 4229 participants in the analytic sample (58% female, age 62 ± 9 yrs, BMI 29 ± 5 kg/m), 6% (n = 270) died over 11 years. Slow sustainers and slow decliners had 2-times increased mortality risk compared to adequate sustainers (HR 1.96, 95% CI 1.44-2.66 for slow sustainers, and HR 2.08, 95% CI 1.46-2.96 for slow decliners). Adequate decliners had 0.43 times the mortality risk compared with adequate sustainers (HR 0.57, 95% CI 0.32-1.01).

CONCLUSION

In adults with, or at risk of, knee OA, walking slower than 1.22 m/s in the present increased mortality risk, regardless of decline over the previous year.

摘要

目的

探讨在有或有膝关节骨关节炎（OA）风险的成年人中，1 次时间点的步行速度、过去 12 个月的下降速度或两者均与 11 年的死亡率风险相关。

方法

利用 Osteoarthritis Initiative 的数据，我们将 20m 步行测试中 12 个月随访期间行走速度<1.22m/s 定义为慢于，将≥1.22m/s 定义为快于。我们将有意义的下降（是/否）定义为过去 1 年中速度下降≥0.08m/s。在 12 个月就诊时，我们将维持正常行走速度且无明显下降的人归类为维持正常行走速度的人，将行走速度较慢且无明显下降的人归类为缓慢行走速度的人，将行走速度维持正常但有明显下降的人归类为行走速度维持正常的人，将行走速度较慢且有明显下降的人归类为行走速度缓慢的人。11 年内记录死亡率。为了研究步行速度与死亡率之间的关系，我们使用 Cox 回归计算了 HR 和 95%CI，调整了潜在的混杂因素。

结果

在分析样本的 4229 名参与者中（58%为女性，年龄 62±9 岁，BMI 29±5kg/m2），6%（n=270）在 11 年内死亡。与维持正常行走速度的人相比，缓慢行走速度的维持者和下降者的死亡风险增加了 2 倍（缓慢行走速度的维持者的 HR 为 1.96，95%CI 为 1.44-2.66，缓慢行走速度的下降者的 HR 为 2.08，95%CI 为 1.46-2.96）。与维持正常行走速度的人相比，行走速度维持正常但有明显下降的人的死亡风险降低了 0.43 倍（HR 为 0.57，95%CI 为 0.32-1.01）。