Gibbs J, Hughes S, Dunlop D, Edelman P, Singer R, Chang R
Center for Health Services and Policy Research, Northwestern University, Evanston, IL 60208.
J Am Geriatr Soc. 1993 Nov;41(11):1205-11. doi: 10.1111/j.1532-5415.1993.tb07304.x.
To test the impact of joint impairment on ambulation in the elderly, using a multivariate model.
Cross-sectional observational study (baseline data from an ongoing longitudinal study).
Five hundred thirty-two persons over age 60, including continuing care retirement community (CCRC) (n = 222), homebound (n = 63), and ambulatory (n = 247) respondents. Mean age at assessment = 76.6 (SD = 6.6).
Independent variables included sociodemographics, physician measures of lower joint impairment, an index of cormorbidities derived from physical examination or chart abstract, self-assessed arthritis pain, depression, and anxiety. The dependent variable, ambulation, was measured as walk-rate, based on the time required to walk 50 feet.
For the total sample, 61% of the subjects were impaired in more than one lower joint group, with almost 50% of the homebound impaired in more than three joint groups. Demographics (particularly age and education) explained much of the variance in walk-rate. After controlling for demographics and membership in the groups purposely sampled (CCRC, homebound, ambulatory), lower joint impairment accounted for an additional 7% of the variance in walk-rate. Total amount of variance explained by the model was 56% (Adjusted R2 = .56). A 3-point change in lower joint impairment score, equivalent to the maximum impairment score for a single joint group, is associated with a 4-second change in the mean time required to walk 50 feet. The knee and lower spine joints contributed most to the impact of the lower joint impairment measure.
Among the elderly, age and education are strong predictors of performance on a walk-rate test. Independent of demographics and non-musculoskeletal conditions, joint impairment is associated with diminished walking ability in this population.
使用多变量模型测试关节损伤对老年人行走能力的影响。
横断面观察性研究（来自一项正在进行的纵向研究的基线数据）。
532名60岁以上的人，包括持续照料退休社区（CCRC）（n = 222）、居家（n = 63）和能行走（n = 247）的受访者。评估时的平均年龄为76.6岁（标准差 = 6.6）。
自变量包括社会人口统计学特征、医生对下肢关节损伤的测量、从体格检查或病历摘要得出的共病指数、自我评估的关节炎疼痛、抑郁和焦虑。因变量行走能力以步速来衡量，基于行走50英尺所需的时间。
在总样本中，61%的受试者在不止一个下肢关节组中受损，近50%的居家者在三个以上关节组中受损。人口统计学特征（尤其是年龄和教育程度）解释了步速差异的大部分原因。在控制了人口统计学特征和有意抽样的组（CCRC、居家、能行走）的成员身份后，下肢关节损伤又解释了步速差异的7%。该模型解释的总方差量为56%（调整后R2 = 0.56）。下肢关节损伤评分的3分变化，相当于单个关节组的最大损伤评分，与行走50英尺平均所需时间的4秒变化相关。膝关节和下脊柱关节对下肢关节损伤测量的影响贡献最大。
在老年人中，年龄和教育程度是步速测试表现的有力预测因素。独立于人口统计学特征和非肌肉骨骼疾病，关节损伤与该人群行走能力下降有关。
