Restriction in social participation and lower life satisfaction among fractured in pain

Abstract

The aim of this study was to describe social participation expressed as accomplished ordinary activities, health-related quality of life (HRQoL) and life satisfaction (LS), among elderly men and women with osteoporosis-related fractures with and without pain, compared to non-fractured controls. The study was a population-based case–control study conducted at a university hospital, including 408 subjects from the Good Ageing in Skåne investigation. Fractured men and women of age 60–93 years were divided into two groups: one with pain (FP; n = 87) and one without pain (FnP; n = 82). Fractures included vertebrae, hip, pelvis or ankle according to International Classification of Diseases version 10 (ICD-10). A third group of non-fractured subjects without pain (n = 239) was used as controls (CnP). Questionnaires were used to collect information about HRQoL, LS, social participation in ordinary activities such as social, cultural and leisure time activities, pain during past month, co-morbidity, alcohol and tobacco consumption, medication, exercise earlier in life, walking-aid, and socio-demographic variables. The results showed that FP scored significantly lower than CnP in HRQoL and LS. In general, fractured were more restricted in participation and in 12 out of 21 activities FP had a significant lower participation compared to CnP. In a regression model, participation in social and leisure activities as well as fracture predicted independently levels of HRQoL and LS.

Introduction

Osteoporosis-related fractures are often associated with pain several years after the fracture (Hall-Lord et al., 2004, Jensen and Harder, 2004), and fracture and pain in combination may cause functional impairment and thereby a limitation in physical activities (Rogmark et al., 2002).

Performing well in physical activities is a prerequisite for independence, maintaining quality of life and increased life expectancy (Nguyen et al., 1996, Cooper, 1997, Gignac et al., 2000, Wang and Badley, 2002). Limitation in activity has been shown to cause restrictions in ordinary life (Guralnik et al., 2001), with increased dependence on others and need for help with personal care and housework (Pasco et al., 2005), and in the long run a growing risk for institutionalized care (Sernbo and Johnell, 1993).

Most previous studies have been restricted to describe deterioration in activity of daily life (ADL), e.g. personal ADL like clothing or bathing after fracture (Jinbaysahi et al., 2002, Lin and Chang, 2004, Hagsten et al., 2006), and a reduction of HRQoL (Hallberg et al., 2004). However, to our knowledge less is written about whether a reduced bodily function due to fracture would affect life in general, i.e. accomplished ordinary activities like social, leisure time or cultural activities as well as LS. Thus, the objectives of this work were firstly to study associations between fracture and social participation expressed as performed ordinary activities and the associations between fracture and HRQoL and LS. Secondly, the association between social participation and HRQoL and LS was studied.