血液透析患者跌倒、跌倒恐惧与身体活动水平的关系。

Relationship Among Falls, Fear of Falling, and Physical Activity Level in Patients on Hemodialysis.

机构信息

Department of Rehabilitation, Niigata Rinko Hospital, Higashi-ku, Niigata City, Niigata, Japan.

Renal Exercise and Physical Activity Network - Virtual Laboratory, Japan.

出版信息

Phys Ther. 2024 Jul 2;104(7). doi: 10.1093/ptj/pzae064.

DOI:10.1093/ptj/pzae064

PMID:38696344

Abstract

OBJECTIVE

Patients on hemodialysis are highly susceptible to falls and fractures. Amplified apprehension regarding the fear of falling (FOF) constitutes a risk factor that restricts physical activity and escalates the probability of falls among the elderly population. This study aimed to elucidate the association between falls and FOF and physical activity in patients on hemodialysis.

METHODS

A prospective cohort study was conducted across 9 centers. FOF was assessed using the Falls Efficacy Scale-International (FES-I). Physical activity was assessed using the Japanese version of the International Physical Activity Questionnaire short form. Subsequently, falls were monitored over a duration of 1 year. Logistic regression analysis was performed to evaluate the relationship between falls and FOF and physical activity. In addition, in the receiver operating characteristic analysis, the cutoff value of FES-I that predicts falls was determined using the Youden Index. A restricted cubic spline curve was utilized to analyze the nonlinear association between falls and the FES-I.

RESULTS

A total of 253 patients on hemodialysis (70.0 [59.0-77.0] years old; 105 female [41.5%]) were included in the analysis. During the 1-year observation period, 90 (35.6%) patients experienced accidental falls. The median FES-I score was 36.0 (24.0-47.0) points, and patients with higher FES-I scores had more falls. Following adjusted logistic regression analysis, FES-I exhibited an independent association with falls (OR = 1.04; 95% CI = 1.01-1.06), but physical activity was not. The area under the receiver operating characteristic curve was 0.70 (95% CI = 0.64-0.77), and the FES-I threshold value for distinguishing fallers from non-fallers was determined as 37.5 points (sensitivity 65.6%, specificity 35.0%). A nonlinear relationship between falls and FES-I was observed.

CONCLUSION

FOF was associated with the incidence of falls in patients on hemodialysis.

IMPACT

The evaluation and implementation of interventions targeting the FOF may mitigate the risk of falls.

摘要

目的

血液透析患者极易发生跌倒和骨折。对跌倒恐惧（FOF）的过度担忧是限制老年人身体活动并增加跌倒风险的一个危险因素。本研究旨在阐明血液透析患者跌倒、FOF 与身体活动之间的关系。

方法

本研究为前瞻性队列研究，共涉及 9 家中心。使用跌倒效能量表国际版（FES-I）评估 FOF，使用日本版国际体力活动问卷短表评估身体活动。随后，对患者进行了为期 1 年的跌倒监测。采用 logistic 回归分析评估跌倒与 FOF 及身体活动之间的关系。此外，在受试者工作特征分析中，采用约登指数确定 FES-I 的截断值，以预测跌倒。采用受限立方样条曲线分析跌倒与 FES-I 之间的非线性关系。

结果

共纳入 253 名血液透析患者（70.0[59.0-77.0]岁；105 名女性[41.5%]）进行分析。在 1 年观察期间，90 名（35.6%）患者发生意外跌倒。FES-I 评分中位数为 36.0（24.0-47.0）分，评分较高的患者跌倒更多。经校正后的 logistic 回归分析显示，FES-I 与跌倒独立相关（OR=1.04；95%CI=1.01-1.06），而身体活动与跌倒无关。受试者工作特征曲线下面积为 0.70（95%CI=0.64-0.77），FES-I 区分跌倒者和非跌倒者的截断值为 37.5 分（敏感度 65.6%，特异度 35.0%）。观察到跌倒与 FES-I 之间存在非线性关系。