The pathway from musculoskeletal pain to mobility difficulty in older disabled women
The pathway from musculoskeletal pain to mobility difficulty in older disabled women
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DOI：
10.1016/j.pain.2006.08.031
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发表时间：
2007-03-01
期刊：
影响因子：
7.4
通讯作者：
Guralnik, Jack M.
中科院分区：
文献类型：
--
作者：
Leveille, Suzanne G.;Bean, Jonathan;Guralnik, Jack M.
对老年人从肌肉骨骼疼痛到行动困难的途径知之甚少。我们在妇女健康与老龄化研究（Women's Health and Aging Study，WHAS）中检查了疼痛-残疾关系的潜在生理和心理介质，该研究是一个年龄≥ 65岁的妇女队列，在基线时至少有轻度残疾。根据部位和严重程度对疼痛进行分类（广泛性疼痛;下肢疼痛;其他疼痛;仅一个部位无疼痛或轻度疼痛）。在基线时爬楼梯（n = 676）或行走（n = 510）没有很大困难的女性中，报告广泛疼痛的女性比没有或轻度疼痛的女性更有可能在3年随访期间出现很大的活动困难。在调整身体损伤和抑郁和焦虑症状后，行动困难的可能性没有变化（步行aOR = 1.85，95%CI，1.08-3.17;爬楼梯，aOR = 2.68，95%CI，1.56-4.62）。下肢疼痛与爬楼梯困难的可能性增加有关，但与行走无关。然而，在调整身体障碍和心理症状后，这种关联减弱（aOR = 1.66，95%CI，0.99-2.77）。疼痛与无法行走或爬楼梯的风险增加无关。研究结果表明，疼痛是一个独特的领域作为残疾的原因，独立于通常的途径，通过身体损伤残疾。需要开展研究，以更好地了解与疼痛有关的残疾的发展情况，从而确定预防和治疗患有持续性疼痛的老年人行动能力残疾的最佳方法。(c)2006年国际疼痛研究协会。Elsevier B. V.出版，保留所有权利。
Little is known about the pathway from musculoskeletal pain to mobility difficulty among older persons. We examined potential physical and psychological mediators of the pain-disability relationship in the Women's Health and Aging Study (WHAS), a cohort of women aged >= 65 who had at least mild disability at baseline. Pain was classified according to location and severity (widespread pain; lower extremity pain; other pain; none or mild pain in only one site). Among women without a lot of difficulty in stair climbing (n = 676) or walking (n = 510) at baseline, those who reported widespread pain were more likely than those with none or mild pain to develop a lot of difficulty with mobility during the 3 year follow-up. The likelihood for mobility difficulty was unchanged after adjusting for physical impairments and symptoms of depression and anxiety (walking aOR = 1.85, 95%CI, 1.08-3.17; stair climbing, aOR = 2.68, 95%CI, 1.56-4.62). Lower extremity pain was associated with increased likelihood for difficulty with climbing stairs but not with walking. However, this association was attenuated after adjusting for physical impairments and psychological symptoms (aOR = 1.66, 95%CI, 0.99-2.77). Pain was not associated with increased risk for becoming unable to walk or climb stairs. The findings suggest that pain is a unique domain as a cause of disablement, independent of the usual pathway to disability via physical impairments. Research is needed to better understand the development of pain-related disability in order to determine optimum approaches to prevent and treat mobility disability in older persons with persistent pain. (c) 2006 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.