{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T15:50:42Z","timestamp":1782489042480,"version":"3.54.5"},"reference-count":14,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T00:00:00Z","timestamp":1777420800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T00:00:00Z","timestamp":1777420800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Musculoskeletal Care"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Difficulty with physical functioning is relevant to disability surveillance and rehabilitation planning, but national trends and socioeconomic inequalities in higher\u2010burden PFQ\u2010defined functional limitations remain incompletely characterised.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analysed seven 2\u2010year cycles of NHANES (2005\u20132018) among adults aged \u2265\u00a020\u00a0years. The primary outcome was PFQ\u2010defined functional limitation using a prespecified operational threshold of \u2265\u00a02 difficulties across 20 physical functioning items. Survey\u2010weighted logistic regression estimated per\u20102\u2010year change (odds ratios [ORs]) overall and within the poverty\u2013income ratio (PIR) and education strata; Wald tests evaluated time\u00a0\u00d7\u00a0SES interactions. Because the outcome was common, log\u2010link models additionally estimated prevalence ratios (PRs). Supplementary analyses examined alternative thresholds, multiple imputation for missing PIR, alternative handling of response 5 (\u2018do not do this activity\u2019), categorical survey cycle with adjusted prevalence estimates, and PFQ063 as supportive descriptive evidence among participants reporting limitation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The weighted prevalence of PFQ\u2010defined functional limitation increased from 22.1% in 2005\u20132006 to 30.1% in 2017\u20132018. Each 2\u2010year cycle was associated with higher odds (OR 1.08, 95% CI 1.05\u20131.12) and higher prevalence (PR 1.05, 95% CI 1.03\u20131.08) of limitation. Socioeconomic gradients persisted throughout the study period. Evidence for differential trends was limited overall, with little heterogeneity on the OR scale, modest heterogeneity by PIR on the PR scale, and minimal heterogeneity by education. In multiple\u2010imputation analyses, results were materially similar to the complete\u2010case findings (OR per cycle 1.093 vs. 1.092; PR 1.058 vs. 1.059). Among participants reporting any limitation, musculoskeletal\u2010related causes identified by PFQ063 were associated with a higher likelihood of meeting the \u2265\u00a02\u2010difficulty threshold (OR 2.64, 95% CI 2.35\u20132.96; PR 1.19, 95% CI 1.16\u20131.21), which should be interpreted as supportive descriptive evidence rather than validation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>PFQ\u2010defined functional limitation increased modestly from 2005 to 2018 and remained socially patterned among U.S. adults. These findings suggest a rising population burden of more severe self\u2010reported functional limitations, while the consistency of supplementary analyses supports the robustness of the overall interpretation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/msc.70227","type":"journal-article","created":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T03:05:13Z","timestamp":1777518313000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Trends and Socioeconomic Inequalities in PFQ\u2010Defined Functional Limitation Among U.S. Adults: NHANES 2005\u20132018"],"prefix":"10.1002","volume":"24","author":[{"given":"Liwei","family":"Liu","sequence":"first","affiliation":[{"name":"School of Traditional Chinese Medicine Jinan University  Guangzhou Guangdong China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haisheng","family":"Jia","sequence":"additional","affiliation":[{"name":"Department of Spinal Manipulation and Orthopedic Correction Jiangmen Wuyi Hospital of Traditional Chinese Medicine Affiliated to Jinan University  Jiangmen Guangdong China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuxiang","family":"Chen","sequence":"additional","affiliation":[{"name":"Jiangmen Wuyi Hospital of Traditional Chinese Medicine Affiliated to Jinan University  Jiangmen Guangdong China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yingjie","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Spinal Manipulation and Orthopedic Correction Jiangmen Wuyi Hospital of Traditional Chinese Medicine Affiliated to Jinan University  Jiangmen Guangdong China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuting","family":"Cao","sequence":"additional","affiliation":[{"name":"Jiahe No. 1 Middle School, Physical Education Teaching and Research Office  Chenzhou Hunan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-3663-3798","authenticated-orcid":false,"given":"Guang","family":"Hong","sequence":"additional","affiliation":[{"name":"Department of Spine Surgery Zhanjiang First Hospital of Traditional Chinese Medicine  Zhanjiang Guangdong China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,4,29]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6736a2"},{"key":"e_1_2_11_3_1","volume-title":"Applied Survey Data Analysis","author":"Heeringa S. G.","year":"2017"},{"key":"e_1_2_11_4_1","volume-title":"Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research","author":"Institute of Medicine","year":"2011"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/9780470580066"},{"key":"e_1_2_11_6_1","unstructured":"National Center for Health Statistics.2023.Chronic Pain Surveillance: Data Sources (NHIS BRFSS and Related Systems).https:\/\/www.cdc.gov\/nchs\/data\/factsheets\/factsheet_pain.htm."},{"key":"e_1_2_11_7_1","unstructured":"National Center for Health Statistics.2020.NHANES 2017\u20132018: Physical Functioning Questionnaire (PFQ_J) documentation.https:\/\/wwwn.cdc.gov\/nchs\/nhanes\/2017\u20102018\/PFQ_J.htm."},{"key":"e_1_2_11_8_1","unstructured":"NCHS Research Ethics Review Board.2021.NHANES ERB Approvals and Protocols.https:\/\/www.cdc.gov\/nchs\/nhanes\/about\/erb.htm."},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.7326\/m16\u20102367"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/j.pain.0000000000000454"},{"key":"e_1_2_11_11_1","volume-title":"NHANES 2017\u2013March 2020 Procedures and Analytic Guidelines","author":"Stierman B.","year":"2021"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/0304\u20103959(92)90154\u20104"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.21037\/atm.2020.02.175"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/j.pain.0000000000002291"},{"issue":"390","key":"e_1_2_11_15_1","first-page":"1","article-title":"Chronic Pain and High\u2010Impact Chronic Pain Among U.S. Adults, 2019","author":"Zelaya C. E.","year":"2020","journal-title":"NCHS data brief"}],"container-title":["Musculoskeletal Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/msc.70227","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/msc.70227","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/msc.70227","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T15:17:30Z","timestamp":1782487050000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/msc.70227"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,29]]},"references-count":14,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,6]]}},"alternative-id":["10.1002\/msc.70227"],"URL":"https:\/\/doi.org\/10.1002\/msc.70227","archive":["Portico"],"relation":{},"ISSN":["1478-2189","1557-0681"],"issn-type":[{"value":"1478-2189","type":"print"},{"value":"1557-0681","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,29]]},"assertion":[{"value":"2026-02-08","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-04-16","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-04-29","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70227"}}