老年人轻度创伤性脑损伤与功能结局：疼痛干扰而非认知介导创伤性损伤与功能障碍之间的关系。
Mild Traumatic Brain Injury and Functional Outcome in Older Adults: Pain Interference But Not Cognition Mediates the Relationship Between Traumatic Injury and Functional Difficulties.
作者信息
Hume Camilla H, Mitra Biswadev, Wright Bradley J, Kinsella Glynda J
机构信息
Melbourne Campus, La Trobe University, Bundoora, Australia (Ms Hume); Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Australia, and School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia, and National Trauma Research Institute, The Alfred Hospital, Melbourne, Australia (Dr Mitra); and School of Psychology and Public Health, La Trobe University, Melbourne, Australia (Ms Hume and Drs Wright and Kinsella).
出版信息
J Head Trauma Rehabil. 2023;38(4):E278-E288. doi: 10.1097/HTR.0000000000000846. Epub 2022 Dec 30.
OBJECTIVE
To examine functional status of older people 3 months after mild traumatic brain injury (mTBI) and identify whether pain interference or cognition mediates any relationship found between injury status and functional outcomes.
SETTING
Patients admitted to a Melbourne-based emergency department.
PARTICIPANTS
Older adults 65 years and older: 40 with mTBI, 66 with orthopedic injury without mTBI (TC), and 47 healthy controls (CC) without injury.
DESIGN
Observational cohort study.
MAIN MEASURES
Functional outcome was measured using the World Health Organization Disability Assessment Schedule (WHODAS 2.0) and single- and dual-task conditions of the Timed-Up-and-Go task. Pain interference and cognitive performance at 3 months post-injury were examined as mediators of the relationship between injury status (injured vs noninjured) and functional outcome.
RESULTS
Patients with mTBI and/or orthopedic injury reported greater difficulties in overall functioning, including community participation, compared with noninjured older people (CC group). Both trauma groups walked slower than the CC group on the mobility task, but all groups were similar on the dual-task condition. Pain interference mediated the relationship between injury status and overall functioning [ b = 0.284; 95% CI = 0.057, 0.536), community participation ( b = 0.259; 95% CI = 0.051, 0.485), and mobility ( b = 0.116; 95% CI = 0.019, 0.247). However, cognition did not mediate the relationship between injury status and functional outcomes.
CONCLUSIONS
Three months after mild traumatic injury (with and without mTBI), patients 65 years and older had greater functional difficulties compared with noninjured peers. Pain interference, but not cognition, partially explained the impact of traumatic injury on functional outcomes. This highlights the importance of reducing pain interference for older patients after injury (including mTBI) to support better functional recovery.
目的
研究轻度创伤性脑损伤（mTBI）3个月后老年人的功能状态，并确定疼痛干扰或认知是否介导了损伤状态与功能结局之间的任何关系。
背景
入住墨尔本一家急诊科的患者。
参与者
65岁及以上的老年人：40例患有mTBI，66例患有无mTBI的骨科损伤（TC），47例无损伤的健康对照（CC）。
设计
观察性队列研究。
主要测量指标
使用世界卫生组织残疾评估量表（WHODAS 2.0）以及计时起立行走任务的单任务和双任务条件来测量功能结局。将损伤后3个月时的疼痛干扰和认知表现作为损伤状态（受伤与未受伤）与功能结局之间关系的中介因素进行研究。
结果
与未受伤的老年人（CC组）相比，患有mTBI和/或骨科损伤的患者在包括社区参与在内的整体功能方面报告有更大困难。在移动任务中，两个创伤组的行走速度均比CC组慢，但在双任务条件下所有组相似。疼痛干扰介导了损伤状态与整体功能[b = 0.284；95%置信区间= 0.057，0.536）、社区参与（b = 0.259；95%置信区间= 0.051，0.485）以及移动性（b = 0.116；95%置信区间= 0.019，0.247）之间的关系。然而，认知并未介导损伤状态与功能结局之间的关系。
结论
在轻度创伤性损伤（有和无mTBI）3个月后，65岁及以上的患者与未受伤的同龄人相比有更大的功能困难。疼痛干扰而非认知部分解释了创伤性损伤对功能结局的影响。这凸显了减少受伤后（包括mTBI）老年患者的疼痛干扰以支持更好的功能恢复的重要性。
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