Poor physical function, pain and limited exercise: risk factors for premature mortality in the range of smoking or hypertension, identified on a simple patient self-report questionnaire for usual care

Abstract

Objective: To analyse poor physical function, pain, limited exercise and smoking, assessed in a patient-friendly self-report questionnaire format that has been completed by every patient at every visit over 20-30 years in the authors' and other usual care settings, to predict 5-year mortality in a general older population.

Methods: An extended version of a Multidimensional Health Assessment Questionnaire was mailed to 2000 subjects in Finland, identified as a randomly selected control cohort for a rheumatoid arthritis cohort. The questionnaire included queries concerning baseline physical function, pain, exercise and smoking status, identical to the clinic version, as well as age and 25 medical conditions. Five-year survival was analysed according to descriptive statistics, Kaplan-Meier curves and Cox regressions.

Results: The questionnaire was returned by 1523 subjects (76%). Five-year survival was 94% in all subjects, 98% in subjects with no disease or no acutely life-threatening disease, and 17% in subjects with an acutely life-threatening disease. Hazard ratios (HRs) for 5-year mortality were 3.5 for poor physical function, 2.2 for pain, 5.2 for limited exercise and 4.6 for smoking (p<0.01); 5-year survivals were 93%, 97%, 93% and 95%, respectively, compared with 91% for hypertension. Each of the four patient history variables predicted mortality at higher levels in subjects who reported no versus one or more acutely life-threatening conditions.

Conclusions: Poor physical function, pain, limited exercise and smoking can be assessed systematically on a simple standard Multidimensional Health Assessment Questionnaire, to identify potentially modifiable risk factors for premature mortality in the infrastructure of usual medical care and health maintenance.

Figure 1

Multidimensional Health Assessment Questionnaire. The front page (A) includes 10 activities for function, two visual analogue scales for pain and patient global estimate of status, and a report of medications currently taken. Scoring templates for these measures are available on the right-hand side of the page. An index of the three patient-reported measures, routine assessment of patient index data, can be calculated from a Multidimensional Health Assessment Questionnaire in less than 10 s. The reverse side (B) includes a review of systems, fatigue visual analogue scale, recent medical history, queries about change in global status and frequency of exercise, and demographic data (not included in scoring, but providing useful data in clinical care).

Figure 1

Multidimensional Health Assessment Questionnaire. The front page (A) includes 10 activities for function, two visual analogue scales for pain and patient global estimate of status, and a report of medications currently taken. Scoring templates for these measures are available on the right-hand side of the page. An index of the three patient-reported measures, routine assessment of patient index data, can be calculated from a Multidimensional Health Assessment Questionnaire in less than 10 s. The reverse side (B) includes a review of systems, fatigue visual analogue scale, recent medical history, queries about change in global status and frequency of exercise, and demographic data (not included in scoring, but providing useful data in clinical care).

Figure 2

Kaplan–Meier survival for mortality according to (A) functional capacity (Health Assessment Questionnaire ≥1 vs <1), (B) pain (>4.0 vs ≤4.0), (C) frequency of physical exercise and (D) smoking status, over 5 years.