Predictors of Upper-Extremity Physical Function in Older Adults

Document Type : RESEARCH PAPER

Authors

1 Orthopaedic Hand and Upper Extremity Service Massachusetts General Hospital, Boston, USA

2 Massachusetts General Hospital, Boston, USA

3 Massachusetts General Hospital, Behavioral Med Services, Boston, USA

Abstract

 
Background:
Little is known about the influence of habitual participation in physical exercise and diet on upper-extremity physical function in older adults. To assess the relationship of general physical exercise and diet to upper-extremity physical function and pain intensity in older adults.
 
Methods:
A cohort of 111 patients 50 or older completed a sociodemographic survey, the Rapid Assessment of Physical Activity (RAPA), an 11-point ordinal pain intensity scale, a Mediterranean diet questionnaire, and three Patient- Reported Outcomes Measurement Information System (PROMIS) based questionnaires: Pain Interference to measure inability to engage in activities due to pain, Upper-Extremity Physical Function, and Depression. Multivariable linear regression modeling was used to characterize the association of physical activity, diet, depression, and pain interference to pain intensity and upper-extremity function.
Results:
Higher general physical activity was associated with higher PROMIS Upper-Extremity Physical Function and lower pain intensity in bivariate analyses. Adherence to the Mediterranean diet did not correlate with PROMIS Upper-Extremity Physical Function or pain intensity in bivariate analysis. In multivariable analyses factors associated with higher PROMIS Upper-Extremity Physical Function were male sex, non-traumatic diagnosis and PROMIS Pain Interference, with the latter accounting for most of the observed variability (37%). Factors associated with greater pain intensity in multivariable analyses included fewer years of education and higher PROMIS Pain Interference.
Conclusions:
General physical activity and diet do not seem to be as strongly or directly associated with upper-extremity physical function as pain interference.

Keywords


1. Menendez ME, Bot AG, Hageman MG, Neuhaus V,
Mudgal CS, Ring D. Computerized adaptive testing
of psychological factors: relation to upper-extremity
disability. J Bone Joint Surg Am. 2013; 95(20):e149.
2. Overbeek CL, Nota SP, Jayakumar P, Hageman MG,
Ring D. The PROMIS physical function correlates
with the QuickDASH in patients with upper extremity
illness. Clin Orthop Relat Res. 2015; 473(1):311-7.
3. Ring D, Kadzielski J, Fabian L, Zurakowski D, Malhotra
LR, Jupiter JB. Self-reported upper extremity health
status correlates with depression. J Bone Joint Surg
Am. 2006; 88(9):1983-8.
4. Vranceanu AM, Jupiter JB, Mudgal CS, Ring D.
Predictors of pain intensity and disability after minor
hand surgery. J Hand Surg Am. 2010; 35(6):956-60.
5. Drewnowski A, Evans WJ. Nutrition, physical activity,
and quality of life in older adults: summary. J Gerontol
A Biol Sci Med Sci. 2001; 56 (Suppl 2):89-94.
6. American College of Sports Medicine, Chodzko-Zajko
WJ, Proctor DN, Fiatarone Singh MA, Minson CT, Nigg
CR, et al. American college of sports medicine position
stand. Exercise and physical activity for older adults.
Med Sci Sports Exerc. 2009; 41(7):1510-30.
7. DiPietro L. The epidemiology of physical activity and
physical function in older people. Med Sci Sports
Exerc. 1996; 28(5):596-600.
8. Wen CP, Wai JP, Tsai MK, Yang YC, Cheng TY, Lee MC, et
al. Minimum amount of physical activity for reduced
mortality and extended life expectancy: a prospective
cohort study. Lancet. 2011; 378(9798):1244-53.
9. Brach JS, Simonsick EM, Kritchevsky S, Yaffe K,
Newman AB; Health, Aging and Body Composition
Study Research Group. The association between
physical function and lifestyle activity and exercise
in the health, aging and body composition study. J Am
Geriatr Soc. 2004; 52(4):502-9.
10. Miszko TA, Cress ME, Slade JM, Covey CJ, Agrawal SK,
Doerr CE. Effect of strength and power training on
physical function in community-dwelling older adults.
J Gerontol A Biol Sci Med Sci. 2003; 58(2):171-5.
11. Cress ME, Buchner DM, Questad KA, Esselman PC,
deLateur BJ, Schwartz RS. Exercise: effects on physical
functional performance in independent older adults.
J Gerontol A Biol Sci Med Sci. 1999; 54(5):M242-8.
12. Chandler JM, Hadley EC. Exercise to improve
physiologic and functional performance in old age.
Clin Geriatr Med. 1996; 12(4):761-84.
13. Kachooei AR, Moradi A, Janssen SJ, Ring D. The
influence of dominant limb involvement on DASH
and QuickDASH. Hand (N Y). 2015; 10(3):512-5.
14. Shahar DR, Houston DK, Hue TF, Lee JS, Sahyoun
NR, Tylavsky FA, et al. Adherence to mediterranean
diet and decline in walking speed over 8 years in
community-dwelling older adults. J Am Geriatr Soc.
2012; 60(10):1881-8.
15. Zbeida M, Goldsmith R, Shimony T, Vardi H, Naggan
L, Shahar DR. Mediterranean diet and functional
indicators among older adults in non-Mediterranean
and Mediterranean countries. J Nutr Health Aging.
2014; 18(4):411-8.
16. Gershon RC, Rothrock N, Hanrahan R, Bass M, Cella D.
The use of PROMIS and assessment center to deliver
patient-reported outcome measures in clinical
research. J Appl Meas. 2010; 11(3):304-14.
17. Henderson C, Evans-Lacko S, Flach C, Thornicroft G.
Responses to mental health stigma questions: the
importance of social desirability and data collection
method. Can J Psychiatry. 2012; 57(3):152-60.
18. Deshields TL, Tait RC, Gfeller JD, Chibnall JT.
Relationship between social desirability and selfreport
in chronic pain patients. Clin J Pain. 1995;
11(3):189-93.
19. Vega-Lopez S, Chavez A, Farr KJ, Ainsworth BE.
Validity and reliability of two brief physical activity
questionnaires among Spanish-speaking individuals
of Mexican descent. BMC Res Notes. 2014; 7:29-36.
20. Tyser AR, Beckmann J, Franklin JD, Cheng C, Hon
SD, Wang A, et al. Evaluation of the PROMIS physical
function computer adaptive test in the upper
extremity. J Hand Surg Am. 2014; 39(10):2047-51 e4.
21. Doring AC, Nota SP, Hageman MG, Ring DC.
Measurement of upper extremity disability using
the Patient-Reported Outcomes Measurement
Information System. J Hand Surg Am. 2014;
39(6):1160-5.
22. Vilagut G, Forero CG, Adroher ND, Olariu E, Cella D,
Alonso J, et al. Testing the PROMIS® Depression
measures for monitoring depression in a clinical sample
outside the US. J Psychiatr Res. 2015; 68:140-50.
23. Amtmann D, Cook KF, Jensen MP, Chen WH, Choi
S, Revicki D, et al. Development of a PROMIS item
bank to measure pain interference. Pain. 2010;
150(1):173-82.
24. Martinez-Gonzalez MA, Garcia-Arellano A, Toledo E,
Salas-Salvado J, Buil-Cosiales P, Corella D, et al. A 14-
item Mediterranean diet assessment tool and obesity
indexes among high-risk subjects: the PREDIMED
trial. PloS one. 2012; 7(8):e43134.
25. Lavrakas PJ. Encyclopedia of survey research methods.
California: Sage Publications; 2008. P. 660-1.
26. Galesic M, Bosnjak M. Effects of questionnaire length
on participation and indicators of response quality in a
web survey. Public Opin Quarter. 2009; 73(2):349-60.
27. Reiner M, Niermann C, Jekauc D, Woll A. Long-term
health benefits of physical activity--a systematic
review of longitudinal studies. BMC public health.
2013; 13:813-21.
28. Vranceanu AM, Hageman M, Strooker J, ter Meulen
D, Vrahas M, Ring D. A preliminary RCT of a mind
body skills based intervention addressing mood and
coping strategies in patients with acute orthopaedic
trauma. Injury. 2015; 46(4):552-7.