關節炎可能會使跌倒相關受傷風險加倍


  【24drs.com】根據5月2日版發病率與死亡率週報(Morbidity and Mortality Weekly Report)刊載的文章指出,跌倒是外傷相關發病率和年長者的死亡首因,而關節炎顯著增加了跌倒和跌倒受傷風險。
  
  慢性病預防與健康促進中心、疾病控制與預防中心(CDC)Kamil E. Barbour博士等研究者建議,採用運動或物理治療,以改善步態、平衡和下半身的力量。
  
  Barbour博士等人使用2012年行為風險因素監控系統資料,檢視各州45歲以上有關節炎和無關節炎成人的跌倒與跌倒相關受傷盛行率。2012年行為風險因素監控系統是在該年度以電話訪查50州、哥倫比亞特區和美國領土、未居住於機構內的成人,且訪談了338,734人。年齡校準估計則是標準化到2000年標準人口,年齡分組為45-54歲、55-64歲、65-74歲、75-84歲、85歲以上。
  
  作者們報告指出,有關節炎患者相對於無關節炎者,根據年齡校正單次跌倒、任何跌倒、跌倒2次以上、跌倒受傷盛行率中位數分別是28%、79%、137%以及149%以上(相對差異),有關節炎者的跌倒受傷年齡校正盛行率中位數達2.5倍。
  
  表1、45歲以上成人在過去12個月的跌倒與受傷盛行率
跌倒有關節炎無關節炎
單次跌倒15.1%12.1%
跌倒2次以上21.3%9.0%
跌倒受傷16.2%6.5%

  再者,有關節炎的成人中,有46州和哥倫比亞特區的過去12個月任何跌倒之年齡校正盛行率為30%以上,有16州的年齡校正盛行率達40%以上;相對的,無關節炎者中,沒有任一州和領土區域的年齡校正跌倒盛行率達30%以上。
  
  作者們指出,預防跌倒的公衛介入方式須聚焦在調控風險因素,如腿部肌肉虛弱、步態與平衡問題、視力不佳,環境風險如地面光滑、使用精神科藥物。
  
  作者們寫道,有效預防跌倒的介入方式可以是多方面的,但最有效的單一策略包括以運動或物理治療改善步態、平衡以及下肢強度,可降低跌倒風險達14%–37%,有效的運動介入應聚焦在改善平衡,變得更積極挑戰,也需要至少50小時的課程,例如每週2兩次1小時的太極課。
  
  作者們結論指出,預期關節炎成人患者到至少2030年都還是持續增加,導致更多成人處於跌倒和跌倒受傷風險。對這個日益嚴重的公衛問題,應提高對關節炎和跌倒之關聯的警覺,評估有實證基礎之關節炎介入方式對跌倒的影響,在臨床和社區都廣泛採行預防跌倒的計畫。
  
  資料來源: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.

    
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對於背痛 瑜珈效果和物理治療一樣好
2016/10/19 下午 02:55:24
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2015/6/29 上午 09:22:26
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