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Among patients with OA, environmental barriers were linked to participation restrictions
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Among older adults with or at risk of knee osteoarthritis, those who lived in areas with higher perceived mobility barriers had a greater long-term risk of participation restrictions, according to recent findings.
Researchers used data from the Multicenter Osteoarthritis (MOST) Study — a longitudinal, prospective study designed to determine risk factors for knee osteoarthritis (OA) — and an ancillary study to MOST, the MOST Knee Pain and Disability Study (KPAD). The MOST study recruited community-dwelling participants between the ages of 50 years and 79 years who had radiographic evidence of knee or hip OA and knee or hip pain, or those at risk of knee OA due to obesity, knee pain, or prior surgery or injury of the knee.
Of the 435 patients enrolled in the MOST-KPAD studies at baseline, 113 were removed at baseline due to participation restrictions. Of the remaining 322 patients, the mean age was 70 years and the mean baseline participation score was 80 ±11.1. The researchers collected data on participation via patient self-report at each clinic visit of MOST clinic visit (baseline, 30 months and 60 months) using the instrumental role subscale of the late life disability index (LLDI).
The home and community environment questionnaire was used to determine and evaluate self-reported home and community environmental (HACE) barriers and facilitators. This questionnaire was administered in the MOST-KPAD at baseline, and for the current study, baseline scores from two HACE subscales (the community mobility barriers and transportation facilitator subscales) were used.
Researchers calculated the relative risk (RR) of participation restriction at 60 months due to high community mobility barriers and high transportation barriers. The model was adjusted for age, sex, race, education, BMI, depressive symptoms, study location, 20-meter walk time and knee pain.
The researchers found that at baseline, most patients were white and female. Sixty-eight percent of the participants had knee OA. At baseline, the median number of community mobility barriers was one out of five and the median number of transportation facilitators was four of five.
At 60 months, the researchers found high self-reported community mobility barriers at baseline were associated with 1.8-times the risk of participation restriction after adjustment for covariates. In the final adjusted model at 60 months, knee pain was identified as significant (RR:1.1).
In a secondary analysis of 30 month-data, similar estimates of effect were seen, but findings were not statistically significant after adjusting for covariates (RR: 1.5). In the final adjusted models at 30 months, a 1-year increase in age (RR: 1.1) and higher reported knee pain (RR:1.1) were identified as significant.
At 60 months, high self-reported baseline transportation facilitators were associated with lower participation restriction, but this finding did not reach statistical significance (RR: 0.7) after adjusting for covariates. In the fully adjusted model at 60 months, knee pain was found to be significant (RR: 1.1).
In the 30-month secondary analysis, similar but attenuated associations were seen for transportation facilitators (RR: 0.9). A 1-year increase in age (RR: 1.1) and higher reported knee pain (RR: 1.1) were both associated with increased risk of participation restriction.
The researchers noted that additional longitudinal and experimental studies are needed to replicate the findings.
“This study’s finding that older adults with or at risk of knee OA are at greater risk of future risk in participation if they live in areas with greater environmental barriers and that this risk increases over time, strengthens this field of study,” the researchers wrote. “As neighborhoods strive to become more supportive for older adults, many of whom have chronic conditions such as arthritis, reducing the number of physical environmental barriers, may have positive long-term impacts on participation.” – by Jennifer Byrne
Disclosure: The researchers report no relevant disclosures.
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