The impact of contextual factors on participation restriction of adults with or at risk of knee osteoarthritis
Vaughan, Mary Willcox
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BACKGROUND: Knee osteoarthritis is a chronic disease that frequently results in pain, activity limitations and difficulties performing social and community activities. Despite the growing prevalence of arthritis and associated participation restrictions, few studies have measured the long-term impact of the environment and psychological factors on participation restriction in this population. METHODS: Participants from the Multicenter Osteoarthritis Study (MOST) self-reported participation at baseline, 30, 60, and 84 months using the Instrumental Role subscale of the Late Life Disability Index. For study 1, participants’ environmental features were assessed at baseline from the Home and Community Environment questionnaire administered in the MOST-Knee Pain & Disability study, an ancillary study of MOST. The relative risk of participation restriction at 60 months due to community mobility barriers and transportation facilitators was calculated using binomial regression, adjusting for covariates. For study 2, baseline levels of positive and negative affect were assessed with the Center for Epidemiological Studies Depression Scale. The relative risk of incident participation restriction over 84 months due to 1) low positive affect (vs. high positive affect), 2) high negative affect (vs. low negative affect), and 3) combinations of low/high positive and negative affect (vs. high positive affect/low negative affect) were calculated in separate analyses using binomial regression, adjusting for covariates. RESULTS: In study 1, 69 (27%) of the 322 participants developed participation restriction by 60 months. Participants reporting high community mobility barriers at baseline had 1.8 times the risk [95% CI: 1.24, 2.73] of participation restriction at 60 months, after adjusting for covariates, whereas the risk due to high transportation facilitators was not significant. In study 2, 470 participants (26%) had incident participation restriction over 7 years. The adjusted relative risks of incident participation restriction over 7 years across the three analyses were: 1) low positive affect (vs. high positive affect): RR: 1.2 [95% CI: 1.0, 1.4], 2) high negative affect (vs. low negative affect): RR: 1.5 [95% CI: 1.3, 1.7], 3) low positive affect and high negative affect (vs. high positive and low negative affect): RR: 1.8 [95% CI: 1.4, 2.1]. CONCLUSIONS: These studies highlight that people with knee osteoarthritis who have certain contextual features, such as environmental barriers or low positive and high negative affect, are at increased risk of participation restriction over time.