Knee Pain and Future Self-Reliance in Older Adults: Evidence From a Community-Based 3-Year Cohort Study in Japan

Abstract

BackgroundAlthough knee pain is common in older persons and can cause ambulatory limitation, its impact on self-reliance has rarely been examined in Japan, particularly in a community setting. The aim of this 3-year cohort study was to investigate the association of knee pain with dependence in activities of daily living (ADL) and mortality in community-dwelling older Japanese adults.MethodsIn 2005, presence of knee pain was assessed by a home visit survey of 1391 older adults aged 65 years or older (participation proportion = 97.3%). A total of 1265 participants who were ADL-independent at baseline were followed for 3 years, and information on outcomes, namely death and dependence in ADL, was collected.ResultsParticipants who always had knee pain were more likely to become dependent in ADL than those who reported no knee pain (multivariate-adjusted OR, 1.98; 95% CI, 1.03–3.83); however, always having knee pain was not associated with mortality or a composite outcome of ADL dependence and death. Further analyses of each component of ADL dependence revealed that knee pain was associated with a need for assistance at home (long-term care eligibility, bathing, dressing, and transferring), but not with institutionalization.ConclusionsThe participants were highly representative of the target population and the rate of follow-up was almost perfect (99.4%). The results suggest that knee pain is associated with future dependence in ADL, particularly a need for assistance at home.

The societal burden of chronic pain in Japan: an internet survey

“…By using the WPAI-GH questionnaire, one of the few ways to understand from the patient perspective how their health is affecting their job duties, this study also provides an estimate of the economic burden of chronic pain. Compared with those without chronic pain, respondents with chronic pain were characterized by significantly greater work and activity impairment relative to those without chronic pain, which is consistent with past research in Japan that focused on work effects and impairment in activities of daily living [7][8][9]. Respondents with chronic pain reported between 73-99 % more work and activity impairment compared to those without chronic pain; this equated to approximately one-third more of work time that was missed or rendered ineffective due to health problems.…”

“…A previous study in Japan found a similar percentage of chronic pain patients had sought treatment (42 %), however this included both treatment through a medical institution and folk remedies and only in patients experiencing chronic musculoskeletal pain [7]. The current finding suggests an inadequacy with current treatment options which has been previously reported in prior studies in Europe [8,18].…”

“…The aim of the current study was to address this gap by examining the effect of chronic pain across health status, work productivity, healthcare resource use, and economic outcomes as well as determining which factors were most strongly associated with greater pain severity A large percentage of chronic pain was experienced in the back, joints, neck, and shoulders, which replicates previous prevalence studies in Japan [7,8]. Nearly 60 % of patients with chronic pain were not currently treated, highlighting the unmet needs of these patients.…”

“…Very few studies have assessed the burden of chronic pain in Japan; the ones that have done so were limited by only including a specific type of pain [7][8][9]. Comparisons between those with and without chronic pain suggested, even after adjusting for demographic and health history differences, that patients with chronic pain report worse health status.…”

“…Using a nationwide mailed survey in Japan, Nakamura et al [7] found that respondents who reported experiencing musculoskeletal pain also reported more work-related effects, more impairment in daily activities, and lower health status as assessed by the Short Form-36 (SF-36). Another study using a home visit survey of the elderly in Takasaki City, found that the presence of chronic knee pain was associated with significantly increased impairments in activities of daily living [8]. Recently, DiBonaventura et al [9] compared respondents with neuropathic pain with controls, adjusting for comorbidities and other variables using the Japan National Health and Wellness Survey, and found that chronic neuropathic pain was associated with lower health status and greater workrelated impairment and healthcare resource use.…”