Barriers to mobility within communities may lead to “participation restriction” in elderly patients with knee osteoarthritis (OA), according to a study recently published in Arthritis Care & Research.1
Participation restriction has been defined by the World Health Organization’s “International Classification of Functioning, Disability, and Health” as “problems an individual may have with involvement in life situations.”2
Approximately 37% of US adults aged 60 years and older have been diagnosed with knee OA, and the number is expected to rise as rates of obesity rise and with the aging of the population, according to data from a Centers for Disease Control and Prevention National Health and Nutrition Examination Survey.3
The researchers used data from the Multicenter Osteoarthritis study, a longitudinal study conducted to identify risk factors for knee OA, and the Knee Pain and Disability study, an ancillary study. The participants (n=322; 69.3% women; mean age, 70.3 years; 93.8% whites) were asked during each visit to self-report, using the Late Life Disability Index, which assesses “2 dimensions of participation: frequency and limitation in performing life tasks,” during a period of 5 years. In addition, environmental and mobility barriers were evaluated with the Home and Community Environment questionnaire.
The study indicates that participants who reported high transportation facilitators (eg, easily accessible public transportation, handicap parking) at baseline had a “suggestive trend” of lower participation restriction compared with those with low transportation facilitation, although this trend did not reach statistical significance (relative risk, 0.7; 95% CI, 0.4-1.1; P =.08).
This is the first study to show a relationship between the long-term risk of developing participation restrictions and perceived community mobility barriers in this population, the authors wrote.
“When we’re considering someone who is having difficulty or who has an underlying medical condition that might limit their mobility, we need to think about the accessibility of their environment and the effect that that’s going to have not only on that moment in time but over time in the progression of their condition,” Debra Saliba, MD, MPH, AGSF, director of the University of California, Los Angeles, Jewish Home Borun Center for Gerontological Research; senior natural scientist at RAND Health; and president of the American Geriatrics Society, told Clinical Pain Advisor. “We know with arthritis that keeping people mobile and keeping them moving is really important to help prevent the progression of decline. This [study] really drives home that point.”
Future studies now need to identify what types of accessibility features make the most difference to those with knee arthritis, Dr Saliba said. “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,” the researchers of the current study wrote. “More longitudinal and experimental studies are needed to replicate this study’s findings.”
Summary and Clinical Applicability
- Community barriers to mobility barriers may limit social activities and participation in the daily life of older adults with or at risk for knee OA.
- Clinicians need to consider how their patients’ environment may affect their disease or recovery.
“This study sheds light on the fact that physical environments do impact people’s participation. As clinicians, it is important to consider what type of environments our patients are going home to, and how that might impact their disease or rehabilitation trajectory,” lead study author Molly Vaughan, PhD, DPT, a research public analyst at RTI International in Waltham, Massachusetts, told Clinical Pain Advisor. “It is not enough to only consider the disease, but one also needs to look at the environment, including both social and physical factors. For city planners, this study sheds light on certain physical features that could be modified to possibly improve the lives of older adults with knee arthritis.”
Study limitations include a lack of assessment of environmental changes or whether residential relocation occurred during the study period (5 years). In addition, self-reporting was used in this study, and may represent a bias, as environmental awareness varies across individuals. Finally, the study had a small sample size with a lack of geographic and racial diversity.
- Vaughan MW, Felson DT, LaValley MP, et al. Perceived community environmental factors and risk of five-year participation restriction among older adults with or at risk of knee osteoarthritis. Arthritis Care & Research 2017;69(7):952-958. doi: 10.1002/acr.23085
- World Health Organization. International classification of functioning, disability and health (ICF). World Health Organization website. http://www.who.int/classifications/icf/en/. Updated January 27, 2017. Accessed July 12, 2017.
- Dillon CF, Rasch EK, Gu Q, Hirsch R. Prevalence of knee osteoarthritis in the United States: arthritis data from the Third National Health and Nutrition Examination Survey 1991-94. J Rheumatol 2006;33:2271-2279.