关节炎可能会使跌倒相关受伤风险加倍


  【24drs.com】根据5月2日版发病率与死亡率周报(Morbidity and Mortality Weekly Report)刊载的文章指出,跌倒是外伤相关发病率和年长者的死亡首因,而关节炎显著增加了跌倒和跌倒受伤风险。
  
  慢性病预防与健康促进中心、疾病控制与预防中心(CDC)Kamil E. Barbour博士等研究者建议,采用运动或物理治疗,以改善步态、平衡和下半身的力量。
  
  Barbour博士等人使用2012年行为风险因素监控系统资料,检视各州45岁以上有关节炎和无关节炎成人的跌倒与跌倒相关受伤盛行率。2012年行为风险因素监控系统是在该年度以电话访查50州、哥伦比亚特区和美国领土、未居住于机构内的成人,且访谈了338,734人。年龄校准估计则是标准化到2000年标准人口,年龄分组为45-54岁、55-64岁、65-74岁、75-84岁、85岁以上。
  
  作者们报告指出,有关节炎患者相对于无关节炎者,根据年龄校正单次跌倒、任何跌倒、跌倒2次以上、跌倒受伤盛行率中位数分别是28%、79%、137%以及149%以上(相对差异),有关节炎者的跌倒受伤年龄校正盛行率中位数达2.5倍。
  
  表1、45岁以上成人在过去12个月的跌倒与受伤盛行率
跌倒有关节炎无关节炎
单次跌倒15.1%12.1%
跌倒2次以上21.3%9.0%
跌倒受伤16.2%6.5%

  再者,有关节炎的成人中,有46州和哥伦比亚特区的过去12个月任何跌倒之年龄校正盛行率为30%以上,有16州的年龄校正盛行率达40%以上;相对的,无关节炎者中,没有任一州和领土区域的年龄校正跌倒盛行率达30%以上。
  
  作者们指出,预防跌倒的公卫介入方式须聚焦在调控风险因素,如腿部肌肉虚弱、步态与平衡问题、视力不佳,环境风险如地面光滑、使用精神科药物。
  
  作者们写道,有效预防跌倒的介入方式可以是多方面的,但最有效的单一策略包括以运动或物理治疗改善步态、平衡以及下肢强度,可降低跌倒风险达14%–37%,有效的运动介入应聚焦在改善平衡,变得更积极挑战,也需要至少50小时的课程,例如每周2两次1小时的太极课。
  
  作者们结论指出,预期关节炎成人患者到至少2030年都还是持续增加,导致更多成人处于跌倒和跌倒受伤风险。对这个日益严重的公卫问题,应提高对关节炎和跌倒之关联的警觉,评估有实证基础之关节炎介入方式对跌倒的影响,在临床和社区都广泛采行预防跌倒的计画。
  
  资料来源:http://www.24drs.com/professional/list/content.asp?x_idno=7076&x_classno=0&x_chkdelpoint=Y
  

Arthritis May Double Risk for Fall-Related Injury

By Janis C. Kelly
Medscape Medical News

Falls are the leading cause of injury-related morbidity and death among older adults, and arthritis significantly increased both falls and fall injuries, researchers report in an article published in the May 2 issue of the Morbidity and Mortality Weekly Report.

The researchers, led by Kamil E. Barbour, PhD, from the Centers for Disease Control and Prevention (CDC) National Center for Chronic Disease Prevention and Health Promotion, Atlanta, Georgia, recommended interventions that use exercise or physical therapy to improve gait, balance, and lower-body strength.

Dr. Barbour and colleagues used data from the 2012 Behavioral Risk Factor Surveillance System to examine state-specific prevalence of falls and fall-related injury in adults aged 45 years or older with vs without physician-diagnosed arthritis. The 2012 Behavioral Risk Factor Surveillance System, an annual telephone survey of noninstitutionalized adults in 50 states, the District of Columbia, and the US territories, included interviews with 338,734 individuals. Age-adjusted estimates were standardized to 2000 standard population, using age groups 45 to 54 years, 55 to 64 years, 65 to 74 years, 75 to 84 years, and 85 years and older.

"The age-adjusted median prevalence of one fall, any fall, two or more falls, and fall injuries was 28%, 79%, 137%, and 149% higher (relative differences), respectively, among adults with arthritis compared with adults without arthritis," the authors report. Age-adjusted median prevalence of fall injuries was 2.5 times higher among adults with arthritis.

Table 1. Prevalence of Falls and Injuries During the Previous 12 Months in Adults Aged 45 Years or Older

Falls With Arthritis Without Arthritis
Single fall 15.1% 12.1%
2 or more falls 21.3% 9.0%
Fall injuries 16.2% 6.5%

Furthermore, among adults with arthritis, 46 states and the District of Columbia had an age-adjusted prevalence of any fall in the past 12 months of 30% or higher, and 16 states had an age-adjusted prevalence of 40% or higher. In contrast, no state or territory had an age-adjusted prevalence of falls of 30% or higher in adults without arthritis.

The authors note that public health approaches to fall prevention have focused on modifying risk factors such as leg muscle weakness, gait and balance problems, poor vision, environmental hazards such as slippery surfaces, and psychoactive medication use.

"Effective fall prevention interventions can be multifaceted, but the most effective single strategy involves exercise or physical therapy to improve gait, balance, and lower body strength, which have been shown to reduce fall risk by 14%–37%," the authors write. Effective exercise interventions were focused on improving balance, became progressively more challenging, and required at least 50 hours of practice, such as twice-weekly 1-hour Tai Chi classes.

"The number of adults with arthritis is expected to increase steadily through at least 2030, putting more adults at higher risk for falls and fall injuries. Efforts to address this growing public health problem require raising awareness about the link between arthritis and falls, evaluating evidence-based arthritis interventions for their effects on falls, and implementing fall prevention programs more widely through changes in clinical and community practice," the authors concluded.

The authors have disclosed no relevant financial relationships.

Morb Mortal Wkly Rep. 2014;63:379-383.

    
相关报导
对于背痛 瑜珈效果和物理治疗一样好
2016/10/19 下午 02:55:24
关节炎加重了其它慢性疾病的影响
2015/6/29 上午 09:22:26
精神科药物与骨折、跌倒有关的证据越来越多
2015/1/21 上午 10:37:38

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