Everyday Quality of Life in Blacks and Whites with Osteoarthritis

描述(申请人提供)：这项研究调查了患有膝骨性关节炎(OA)的非裔美国人(AA；黑人)和非西班牙裔白人(NHW；白人)老年人的疼痛、日常活动和情绪状态以及长期生活质量之间的关系。最近的证据表明，这种潜在的非常衰弱的疾病在AAS和NHW之间的经历和影响存在相当大的差异。不幸的是，很少有关于种族/民族(R/E)差异的深入研究，以前关于OA症状的基本经验中的种族/民族(R/E)差异的工作，以及这些症状和相关残疾的情感影响。这项研究解决了AAS和NHW的OA疼痛、功能障碍和情绪幸福感的纵向研究中的差距。从生物心理社会模型出发，我们将使用功能评估、自我报告和对活动、症状和情绪状态的实时评估来构建一个全面的观点，了解OA如何影响身体和情感功能。具体目标是(1)描述膝骨性关节炎患者疼痛、残疾和情绪健康之间的联系的种族/民族差异；(2)在(A)生物因素中确定这些差异的根源 本研究的目的是：(1)分析影响膝部症状的因素，例如病程及一般健康状况；(B)人口统计特征等社会因素；及(Ii)心理因素，包括稳定的个人特征及对膝部症状的短暂(日内)情感、认知及行为反应；(3)采用经验抽样法及活动记录法，研究疼痛、功能受限及情绪困扰之间的全球关联的种族/种族差异如何反映在骨关节炎患者的日常生活中；及(4)探讨短暂的(日间)症状、活动及情绪状态的相互作用如何影响长期的身心健康。这些目标将通过一个为期5年的多地点项目实现，该项目审查人口和健康特征、与骨性关节炎相关的疼痛和残疾、限制日常活动和情绪健康之间的横向和纵向联系。对220名患有膝骨性关节炎的50岁AA和NHW成人样本进行全面的基线评估，评估内容包括：对膝骨性关节炎疼痛的生物、心理和社会脆弱性及其影响；客观功能限制；疼痛；活动受限和情绪困扰。基线结束后，参与者将立即完成为期7天的ESM程序，包括活动水平的活动评估以及每天4次电话联系，以评估当前的症状、活动和情绪。一年后，参与者将重复所有测量，包括ESM组成部分，以捕捉总体身体和情绪健康以及日常活动和情绪模式的变化。由此产生的数据将提供前所未有的洞察力，了解区分AA和NHW的OA症状的全球因素，以及日常经验如何串联起来影响长期的身体和情感健康。 公共卫生相关性：骨关节炎(OA)是最常见的慢性疾病，也是老年人疼痛和残疾的主要原因。随着人口老龄化，骨性关节炎的患病率急剧上升；这反过来又预示着残疾比率和医疗费用的上升。骨关节炎特有的疼痛和功能限制使人们面临着更大的情感痛苦；这种痛苦反过来可能会加剧骨性关节炎的疼痛并加速功能衰退。在非裔美国人(AA)和非西班牙裔白人(NHW)的老年人中，骨性关节炎的流行病学有明显的差异，但令人惊讶的是，人们对骨质疏松症的功能和情感影响的种族/民族差异知之甚少。这项研究通过研究膝骨性关节炎如何影响老年AA和NHW的日常活动和情绪健康来填补这一空白，以及这些影响在一年内如何变化。

DESCRIPTION (provided by applicant): This research examines relationships among pain, everyday activities and mood states, and long-term quality of life among African American (AA; Black) and non-Hispanic White (NHW; White) older adults with osteoarthritis (OA) of the knee. Recent evidence suggests considerable divergence in the experience and effects of this potentially very debilitating disorder among AAs and NHWs. Unfortunately, there has been little in-depth research on racial/ethnic (R/E) differences previous work on racial/ethnic (R/E) disparities in basic experience of OA symptoms, and in the emotional impact of those symptoms and related disability. This research addresses that gap in a longitudinal study of OA pain, functional disability and emotional well-being of AAs and NHWs. Working from a biopsychosocial model, we shall use functional assessments, self-reports, and real-time assessments of activities, symptoms and mood states to construct a comprehensive view of how OA affects physical and emotional functioning. Specific aims are (1) to describe racial/ethnic differences in associations among pain, disability, and emotional well-being of persons with OA of the knee; (2) to identify origins of those differences in (a) biological factors such as disease process and general health, (b) social factors such as demographic characteristics, and (ii) psychological factors, including stable personal characteristics and transitory (within-day) affective, cognitive and behavioral responses to knee symptoms; (3) to use experience sampling methods (ESM) and actigraphy to investigate how racial/ethnic differences in global associations among pain, functional limitations and emotional distress are reflected in the daily lives of OA sufferers, and (4) to explore how the interplay of transitory (within-day) symptoms, activities and mood states influences long-term physical and emotional well-being. These aims will be achieved in a 5-year, multi- site project examining cross-sectional and longitudinal associations among demographic and health characteristics, OA-related pain and disability, restriction of everyday activities, and emotional well-being. A sample of 220 AA and 220 NHW adults aged 50+ with physician-diagnosed OA of the knee will complete a comprehensive baseline assessment tapping biological, psychological and social vulnerability to OA pain and its effects; objective functional limitations; pain; activity restriction, and emotiona distress. Immediately post- baseline, participants will complete a 7-day ESM procedure comprising actigraphic assessment of activity levels along with 4 daily telephone contacts to assess current symptoms, activities, and moods. One year later, participants will repeat all measures, including the ESM component, to capture changes in overall physical and emotional well-being as well as patterns of daily activity and moods. Resulting data will offer unprecedented insight into the global factors that differentiate AAs' and NHWs' experience of OA symptoms, and how daily experiences are concatenated to influence longer-term physical and emotional well-being. PUBLIC HEALTH RELEVANCE: Osteoarthritis (OA) is the most common chronic illness and the leading cause of pain and disability among older adults. As the population ages, prevalence of OA is rising sharply; this, in turn, portends rising rates of disability and health care costs. Osteoarthritis's characteristic pain and functional limitations place persons at increased risk of significant emotional distress; that distress may, in turn, fuel OA pain and hasten functional decline. There are clear differences in the epidemiology of OA among African American (AA) and non-Hispanic White (NHW) older adults, but surprisingly little is known about racial/ethnic disparities in the functional and emotional effects of OA. This study fills that gap by examining how OA of the knee affects everyday activities and emotional well-being of older AAs and NHWs, and how those effects change over a one-year period.