Depressive Symptoms and Physical Activity Mediate the Adverse Effect of Pain on Functional Dependence in Patients With Arthritis: Evidence From the Canadian Longitudinal Study on Aging.
Miriam Goubran, Zachary M Allen, Martin Bilodeau, Matthieu P Boisgontier
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引用次数: 0
Abstract
Importance: Arthritis is a chronic condition affecting hundreds of millions of people worldwide, often leading to pain and functional limitations.
Objective: This study aimed to investigate the direct and indirect effects of pain on functional dependence in individuals with arthritis. Depressive symptoms and physical activity were examined as potential mediators of this relationship.
Design: This study was a longitudinal cohort study.
Setting: The study setting included community-dwelling adults participating in the Canadian Longitudinal Study on Aging.
Participants: This study included a total of 6972 participants with arthritis including 4930 with osteoarthritis and 694 with rheumatoid arthritis.
Exposure: The exposure was the usual presence of pain or discomfort at baseline, with depressive symptoms (CESD-10) and physical activity (PASE) tested as mediators.
Main outcome and measure: The main outcome was functional dependence in activities of daily living (ADL) and instrumental activities of daily living (IADL) at follow-up, measured with a modified version of the Older Americans' Resources and Services Multidimensional Functional Assessment Questionnaire (OARS).
Results: Baseline pain was positively associated with depressive symptoms (b = 0.356 [95% CI = 0.310 to 0.402]) and negatively associated with physical activity (b = -0.083 [95% CI = -0.125 to -0.042]). Functional dependence at follow-up was significantly predicted by baseline pain (log OR = 0.607 [95% CI = 0.261 to 0.952]), depressive symptoms (log OR = 0.358 [95% CI = 0.184 to 0.533]), and physical activity (log OR = -0.598 [95% CI = -0.818 to -0.378]). Mediation analysis showed that 23.3% of the total effect of pain on functional dependence was accounted for by the indirect effect through depressive symptoms (16.2%), physical activity (6.3%), and their serial combination (0.8%).
Conclusions: The presence of pain at baseline was associated with higher odds of functional dependence in basic and instrumental activities of daily living after a mean follow-up period of 6.3 years, with depressive symptoms and lower physical activity acting as mediators.
Relevance: The findings highlight the need for arthritis care to extend beyond pain management by incorporating strategies that address depressive symptoms and promote physical activity to preserve functional independence.
重要性：关节炎是一种影响全球数亿人的慢性疾病，通常会导致疼痛和功能限制。目的：本研究旨在探讨疼痛对关节炎患者功能依赖的直接和间接影响。抑郁症状和身体活动被认为是这种关系的潜在中介。设计：本研究为纵向队列研究。研究环境：研究环境包括参加加拿大老龄化纵向研究的社区居住成年人。参与者：这项研究共包括6972名关节炎患者，其中4930名患有骨关节炎，694名患有类风湿关节炎。暴露：暴露通常是基线时疼痛或不适的存在，抑郁症状（CESD-10）和身体活动（PASE）作为介质进行测试。主要结果和测量：主要结果是日常生活活动（ADL）和日常生活工具活动（IADL）的功能依赖，使用修改版的美国老年人资源和服务多维功能评估问卷（OARS）进行测量。结果：基线疼痛与抑郁症状呈正相关（b = 0.356 [95% CI = 0.310 ~ 0.402]），与身体活动呈负相关（b = -0.083 [95% CI = -0.125 ~ -0.042]）。基线疼痛（log OR = 0.607 [95% CI = 0.261至0.952]）、抑郁症状（log OR = 0.358 [95% CI = 0.184至0.533]）和身体活动（log OR = -0.598 [95% CI = -0.818至-0.378]）显著预测了随访时的功能依赖。中介分析显示，疼痛对功能依赖的总影响中，有23.3%是通过抑郁症状（16.2%）、体力活动（6.3%）及其系列组合（0.8%）产生的间接影响。结论：在平均6.3年的随访期后，基线时疼痛的存在与日常生活中基本和工具活动的功能依赖的较高几率相关，抑郁症状和较低的体力活动是中介。相关性：研究结果强调了关节炎护理需要扩展到疼痛管理之外，通过结合解决抑郁症状和促进身体活动以保持功能独立性的策略。
期刊介绍：
Physical Therapy (PTJ) engages and inspires an international readership on topics related to physical therapy. As the leading international journal for research in physical therapy and related fields, PTJ publishes innovative and highly relevant content for both clinicians and scientists and uses a variety of interactive approaches to communicate that content, with the expressed purpose of improving patient care. PTJ"s circulation in 2008 is more than 72,000. Its 2007 impact factor was 2.152. The mean time from submission to first decision is 58 days. Time from acceptance to publication online is less than or equal to 3 months and from acceptance to publication in print is less than or equal to 5 months.
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