自我报告的身体机能表现能否有助于预测临床实践中死亡率和住院事件风险最高的个体？赫特福德郡队列研究的结果。
Could self-reported physical performance help predict individuals at the highest risk of mortality and hospital admission events in clinical practice? Findings from the Hertfordshire Cohort Study.
机构信息
MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK.
NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK.
出版信息
Prim Health Care Res Dev. 2024 May 14;25:e25. doi: 10.1017/S1463423624000173.
AIM
To consider how self-reported physical function measures relate to adverse clinical outcomes measured over 20 years of follow-up in a community-dwelling cohort (aged 59-73 at baseline) as compared with hand grip strength, a well-validated predictor of adverse events.
BACKGROUND
Recent evidence has emphasized the significant association of physical activity, physical performance, and muscle strength with hospital admissions in older people. However, physical performance tests require staff availability, training, specialized equipment, and space to perform them, often not feasible or realistic in the context of a busy clinical setting.
METHODS
In total, 2997 men and women were analyzed. Baseline predictors were measured grip strength (Jamar dynamometer) and the following self-reported measures: physical activity (Dallosso questionnaire); physical function score (SF-36 Health Survey); and walking speed. Participants were followed up from baseline (1998-2004) until December 2018 using UK Hospital Episode Statistics and mortality data, which report clinical outcomes using ICD-10 coding. Predictors in relation to the risk of mortality and hospital admission events were examined using Cox regression with and without adjustment for sociodemographic and lifestyle characteristics.
FINDINGS
The mean age at baseline was 65.7 and 66.6 years among men and women, respectively. Over follow-up, 36% of men and 26% of women died, while 93% of men and 92% of women were admitted to hospital at least once. Physical activity, grip strength, SF-36 physical function, and walking speed were all strongly associated with adverse health outcomes in both sex- and fully adjusted analyses; poorer values for each of the predictors were related to greater risk of mortality (all-cause, cardiovascular-related) and any, neurological, cardiovascular, respiratory, any fracture, and falls admissions. SF-36 physical function and grip strength were similarly associated with the adverse health outcomes considered.
目的
考虑在一项社区居住队列（基线时年龄为 59-73 岁）中，与手部握力（一种经过良好验证的不良事件预测指标）相比，自我报告的身体功能测量值与 20 年随访期间不良临床结局的关系。
背景
最近的证据强调了身体活动、身体表现和肌肉力量与老年人住院之间的显著关联。然而，身体表现测试需要员工可用性、培训、专门设备和执行测试的空间，在繁忙的临床环境中通常不可行或不现实。
方法
共分析了 2997 名男性和女性。基线预测指标包括握力（Jamar 测力计）和以下自我报告的测量指标：身体活动（Dallosso 问卷）；身体功能评分（SF-36 健康调查）；和行走速度。参与者从基线（1998-2004 年）开始随访，直至 2018 年 12 月，使用英国医院发病统计数据和死亡率数据，该数据使用 ICD-10 编码报告临床结果。使用 Cox 回归分析，分别在调整和不调整社会人口统计学和生活方式特征的情况下，检查预测指标与死亡率和住院入院事件的风险关系。
结果
男性和女性的基线平均年龄分别为 65.7 和 66.6 岁。在随访期间，36%的男性和 26%的女性死亡，而 93%的男性和 92%的女性至少住院一次。在性别和完全调整分析中，身体活动、握力、SF-36 身体功能和行走速度均与不良健康结果密切相关；每个预测指标的较差值与更高的死亡率（全因、心血管相关）和任何、神经、心血管、呼吸、任何骨折和跌倒入院风险相关。SF-36 身体功能和握力与所考虑的不良健康结果具有相似的相关性。
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