Balance and falls risk in women with lower limb osteoarthritis or rheumatoid arthritis

The test-retest reliability and concurrent validity of 360° turn test in patients with knee osteoarthritis

PURPOSE

The aim of this study is to determine whether the 360° turn test is a reliable and valid evaluator that can be used to assess dynamic balance in patients with early (radiographic grades I and II) and advanced (radiographic grades III and IV) knee osteoarthritis.

MATERIALS AND METHODS

This study is a methodological research. For the test time and step count of 360° turn test; test-retest reliability were determined by calculating the intraclass correlation coefficient and concurrent validity in patients with knee osteoarthritis was investigated by correlation with the timed up and go test time.

RESULTS

The final analysis was made on 117 participants. The intraclass correlation coefficient values for the test time and step count of 360° turn test in patients with early knee osteoarthritis are 0.931 and 0.902, respectively, while they are 0.923 and 0.943 in patients with advanced knee osteoarthritis. The Pearson correlation coefficients between the time and step count of 360° turn test and the test time of the timed up and go test in patients with early knee osteoarthritis, respectively; while they are 0.547 and 0.388, the correlation in patients with advanced knee osteoarthritis are 0.697 and 0.700, respectively (p < 0.01).

CONCLUSIONS

The 360° turn test is a evaluator that has excellent test-retest reliability and moderate to strong concurrent validity in patients with both early and advanced knee osteoarthritis and can be used in the assessment of dynamic balance in this population.

Prevalence and risk factors for falls among older Chinese adults in the community: findings from the CLHLS study

Older adults have a high prevalence of falls due to a decline in physiological functions and various chronic diseases. This study aimed to investigate the prevalence of and risk factors for falls among older individuals in the Chinese Longitudinal Healthy Longevity Survey (CLHLS). We collected information from 9737 older individuals (average age=84.26 years) from the CLHLS and used binary logistic regression analysis to explore the independent risk factors and protective factors for falls. The logistic regression analysis results are reported as adjusted odds ratios (aORs) and 95% confidence intervals (95%CIs). The prevalence of falls among older adults in China was 21.6%, with women (24.6%) having a higher prevalence than men (18.1%). Logistic regression analysis revealed that never (or rarely) eating fresh fruit, difficulty with hearing, cataracts, and arthritis were the common independent risk factors for falls in older Chinese men and women. Among men, age ≥80 years (aOR=1.86), never doing housework (aOR=1.36), and dyslipidemia (aOR=1.47) were risk factors, while eating milk products once a week was a protective factor. Alcohol consumption (aOR=1.40), physical labor (aOR=1.28), and heart disease (aOR=1.21) were risk factors for falls in women, while a daily sleep duration of 6-12 h and garlic consumption once a week were protective factors. The prevalence of falls among older adults in China is 21.6% and is greater in women than in men. These risk and protective factors can be used to formulate reasonable recommendations for living habits, diet, and chronic disease control strategies.

Prevalence and risk factors of falls in adults with rheumatoid arthritis: A systematic review and meta-analysis

BACKGROUND

Despite the fact that the estimated prevalence and risk factors of falls in adults with rheumatoid arthritis (RA) are widely reported, these results have not been synthesized. The systematic review and meta-analysis aimed to investigate the prevalence and risk factors of falls in adults with RA.

METHODS

PubMed, EMBASE, Web of Science, the Cochrane Library, Cumulative Index to Nursing & Allied Health Literature (CINAHL), Wanfang Database, China Knowledge Resource Integrated Database (CNKI), Weipu Database (VIP), and Chinese Biomedical Database (CBM) were searched for relevant studies published from the inception of the database until July 4, 2022. Stata 15.0 Software was used to perform the meta-analysis. For the prevalence of falls in adults with RA and risk factors that were investigated in at least 2 studies in a comparable way, we calculated pooled incidence and odds ratios (ORs) using random-effects models, with a test for heterogeneity. A study protocol was registered in PROSPERO (CRD42022358120).

RESULTS

A total of 6,470 articles were screened and data from 34 studies involving 24,123 subjects were used in meta-analysis. The pooled prevalence of any falls was 34% (95% confidence interval, CI: 29% to 38%, I²=97.7%, P<0.001), and 16% for recurrent falls (95% CI: 12% to 20%, I²=97.5%, P<0.001). 25 risk factors were considered, including sociodemographic, medical and psychological, medication, and physical function. The strongest associations were found for history of falls (OR=3.08, 95%CI: 2.32 to 4.08, I²=0.0%, P = 0.660), history of fracture (OR=4.03, 95%CI: 3.12 to 5.21, I²=97.3%, P<0.001), walking aid use (OR=1.60, 95%CI: 1.23 to 2.08, I²=67.7%, P = 0.026), dizziness (OR=1.95, 95%CI: 1.43 to 2.64, I²=82.9%, P = 0.003), psychotropic medication use (OR=1.79, 95%CI: 1.39 to 2.30, I²=22.0%, P = 0.254), antihypertensive medicine/diuretic (OR=1.83, 95%CI: 1.37 to 2.46, I²=51.4%, P = 0.055), taking four or more medicine(OR=1.51, 95%CI: 1.26 to 1.81, I²=26.0%, P = 0.256), and HAQ score(OR=1.54, 95%CI: 1.40 to 1.69, I²=36.9%, P = 0.135).

CONCLUSIONS

This meta-analysis provides a comprehensive evidence-based assessment of the prevalence and risk factors for falls in adults with RA, confirming their multifactorial etiology. Understanding the risk factors of falls can provide healthcare personnel with a theoretical basis for the management and prevention of RA patients.

Falls prevention and osteoarthritis: time for awareness and action

Osteoarthritis (OA) and falls both commonly affect older people. While high-level evidence exists to prevent falls in older people, falls prevention is rarely considered within contemporary OA management. OA care and falls prevention have for too long been considered as separate clinical constructs. In the context of ageing populations and growing numbers of people with OA, the time to raise awareness and enact appropriate action is now. This Perspectives on Rehabilitation article draws on the findings from a comprehensive mixed-methods falls and OA research program (which uniquely spanned population, clinician, and consumer perspectives) to better understand existing evidence-practice gaps and identify key opportunities for improvements in clinical care.IMPLICATIONS FOR REHABILITATIONWhile high-level evidence exists to prevent falls in older people, falls prevention is rarely considered within contemporary OA management and this represents a concerning knowledge-to-practice gap.Given ageing populations and growth in the number of people with OA, it is time for falls prevention to be incorporated within routine OA care for older people.To achieve this, we need to re-shape current messaging around falls prevention and develop targeted resources to optimise clinician knowledge and skills in this area.

Psychometric Properties of Brief-Balance Evaluation Systems Test Among Multiple Populations: A Systematic Review and Meta-analysis

OBJECTIVE

To synthesize evidence regarding the psychometric properties of the Brief-Balance Evaluation Systems Test (BESTest) in assessing postural controls across various populations.

DATA SOURCES

Articles were searched in 9 databases from inception to March 2020.

STUDY SELECTION

Two reviewers independently screened titles, abstracts, and full-text articles to include studies that reported at least 1 psychometric property of the Brief-BESTest. There were no language restrictions.

DATA EXTRACTION

The 2 independent reviewers extracted data (including psychometric properties of Brief-BESTest) from the included studies. The methodological quality of the included studies was appraised by the Consensus-based Standards for the Selection of Health Status Measurement Instruments checklist, and the quality of statistical outcomes was assessed by the Terwee et al method. A best-evidence synthesis for each measurement property of the Brief-BESTest in each population was conducted.

DATA SYNTHESIS

Twenty-four studies encompassing 13 populations were included. There was moderate to strong positive evidence to support the internal consistency (Cronbach α>0.82), criterion validity (ρ≥0.73, r≥0.71), and construct validity (ρ≥0.66, r≥0.50, area under curve>0.72) of the Brief-BESTest in different populations. Moderate to strong positive evidence supported the responsiveness of the Brief-BESTest in detecting changes in postural controls of patients 4 weeks after total knee arthroplasty or patients with subacute stroke after 4-week rehabilitation. However, there was strong negative evidence for the structural validity of this scale in patients with various neurologic conditions. The evidence for the reliability of individual items and measurement errors remains unknown.

CONCLUSIONS

The Brief-BESTest is a valid (criterion- and construct-related) tool to assess postural control in multiple populations. However, further studies on the reliability of individual items and minimal clinically important difference of the Brief-BESTest are warranted before recommending it as an alternative to the BESTest and Mini-BESTest in clinical research/practice.

Perceptions of falls risk and falls prevention among people with osteoarthritis

PURPOSE

To understand the perceptions of falls risk and falls prevention, and the perceived enablers and barriers to engaging in falls prevention strategies/activities among people with doctor-diagnosed hip and/or knee osteoarthritis.

METHODS

A qualitative study utilising semi-structured telephone interviews. Researchers independently analysed qualitative data using an inductive method guided by the COM-B framework. Interviews were analysed thematically using open, axial, and selective coding. Recruitment ceased at 20 interviews, once data saturation was evident.

RESULTS

Participants were 18 women and two men aged 52-84 years and half had fallen in the last 12 months. Main themes were the absence of recommendations to access activities after having a fall, inconsistencies between perceptions of the relationship between OA and falls, and individual beliefs of not being at risk of falling because of taking precautions. Knowledge about falls prevention programs was limited, the term "falls prevention" was considered stigmatising and only applicable to older frail people. Home modifications were perceived as broadcasting negativity; participants felt falls terminology should be changed from a negative to a positive focus.

CONCLUSIONS

Falls were often seen as inevitable consequence of keeping active. Re-framing the language used to discuss falls is recommended to promote uptake of falls prevention activities.Implications for rehabilitationDespite growing evidence that osteoarthritis (OA) is an independent risk factor for falls, people with OA do not perceive themselves to be at risk and falls prevention is for those who are "old and frail".Re-framing the language used to discuss falls and falls prevention to focus on positive messages may promote the uptake of falls prevention activities in this population.Improving the awareness of falls and falls risk among people with OA through effective health education is needed in order to foster the uptake of, and engagement with, falls prevention activities.

Incidence and risk factors for falls among community-dwelling elderly subjects on a 1-year follow-up: a prospective cohort study from Ernakulam, Kerala, India

OBJECTIVES

There is limited knowledge regarding epidemiology and risk of falls among the elderly living in low-income and middle-income countries. In this situation, the current study aims to report the incidence of falls and associated risk factors among free living elderly population from Kerala, India.

DESIGN

Prospective cohort study with stratified random cluster sampling.

SETTING

The study location was Ernakulam, Kerala, India, and we collected information via house visits using a questionnaire. During the research, the subjects were followed up prospectively for 1 year by phone at intervals of 3 months and missing subjects were contacted by house visits.

PARTICIPANTS

Community-dwelling elderly above 65 years of age.

RESULTS

We recruited a total of 1000 participants out of which a total of 201 (20.1%) subjects reported a fall during the follow-up. The incidence rate of falls was 31 (95% CI 27.7 to 34.6) per 100 person-years. Female sex (OR 1.48, 95% CI 1.05 to 2.10, p=0.027), movement disorders including Parkinsonism (OR 2.26, 95% CI 1.00 to 5.05, p=0.048), arthritis (OR 1.48, 95% CI 1.05 to 2.09, p=0.026), dependence in basic activities of daily living (OR, 3.49, 95% CI 2.00 to 6.09, p<0.001), not using antihypertensive medications (OR, 1.53, 95% CI 1.10 to 2.13, p=0.012), living alone during daytime (OR 3.27, 95% CI 1.59 to 6.71, p=0.001) and a history of falls in the previous year (OR, 2.25, 95% CI 1.60 to 3.15, p<0.001) predicted a fall in the following year.

CONCLUSIONS

One in five community-dwelling senior citizen fall annually and one in four who fall are prone to fall again in the following year. Interventions targeting falls among the elderly need to focus on modifiable risk factors such as living alone during daytime, movement disorders, arthritis and dependence on basic activities of daily living.

Applying the International Classification of Functioning, Disability and Health framework to determine the predictors of falls and fractures in people with osteoarthritis or at high risk of developing osteoarthritis: data from the Osteoarthritis Initiative

BACKGROUND

Falls are a major cause of injury and death among older people. Evidence suggests that people with osteoarthritis (OA) are at a higher risk of falls and fall-related injuries including fractures. While studies demonstrate a link between OA and falls, little is known about the pathways that link falls with demographic factors, OA impairments, activity limitations and participation restrictions. The aim of this study was to identify risk factors for falls and fractures among people with OA or at high risk of developing OA using the International Classification of Functioning, Disability and Health (ICF) framework.

METHODS

A longitudinal analysis of data from the Osteoarthritis Initiative (OAI) dataset was undertaken. Participants were considered to have OA if they reported they had been diagnosed with knee or hip OA by a medical practitioner. Outcomes were self-reported falls and fractures. Potential predictors were classified using the ICF framework. Poisson regression models were used to determine the risk factors for falls and fractures.

RESULTS

Of the 4796 participants, 2270 (47%) were diagnosed with knee and/or hip OA. A higher proportion of participants with OA reported having had falls (72% vs 63%; p < 0.0001) and fractures (17% vs 14%; p = 0.012) than those without OA. Personal factors were found to be stronger predictors of falls and fractures compared to OA impairments, activity limitations and participation restrictions in this sample of participants. After adjusting for potential covariates, self-reported history of falls was a significant predictor of both increased falls (incidence rate ratio [IRR] 1.50; 95% confidence interval [CI] 1.40, 4.60) and fracture risk (IRR 1.38; 95% CI 1.13, 1.69).

CONCLUSIONS

By applying the ICF framework, we have shown that personal factors were more likely to predict falls and fractures rather than OA impairments, environmental factors, activity limitations and participation restrictions in people with OA or at high risk of developing OA. This highlights the importance of questioning patients about their previous falls and past medical history, and using this information to focus our assessment and clinical decision-making processes.

Time of day effect on balance performance, functional capacities and risk of fall in women with rheumatoid arthritis

Objective: This study explored the time of day effect of balance performance, functional capacities and risk of fall in three different times in patients with rheumatoid arthritis (RA) and the association between these variations and those of RA symptoms.Methods: A "discontinual" protocol, composed of three test sessions, carried out at 6 am, 2 pm and 10 pm was set up, in order to investigate the time of day effect of balance performance, functional capacities, risk of fall, stiffness, range of motion, swollen and painful joints in women with RA.Results: Time Up and Go Test (TUGT), Functional Reach Test (FRT) and tinetti test scores were significantly higher (p < .01) at 6 am and at 10 pm compared to 2 pm. Stiffness, range of motion, swollen and painful joints values were significantly higher (p < .01) at 6 am and at 10 pm compared to 2 pm. A significant difference was observed on the stiffness, range of motion and swollen joints values between 6 am and 10 pm that were higher at 6 am (p < .05).Using Pearson's coefficient, correlations were found between RA symptom values; and TUGT, FRT and Tinetti test scores.Conclusion: Results showed a time of day effect of balance performance, functional capacities and risk of falls in women with RA. This variation indicates an alteration of performance at 6 am and 10 pm. Fluctuations of stiffness, limited range of motion, swollen and painful joints noted are concomitant to those of balance performance, functional capacities, and risk of fall.Abbreviations: RA: rheumatoid arthritis; H&O questionnaire: Horne and Ostberg questionnaire; PSQI: Pittsburgh sleep quality index; HAQ: health assessment questionnaire; SF-36: the short form-36; WOMAC: Western Ontario and McMaster Universities Osteoarthritis Index; TUGT: Time Up and Go Test; FRT: Functional Reach Test.

Comparing single and multi-joint methods to detect knee joint proprioception deficits post primary unilateral total knee arthroplasty

BACKGROUND

The use of various single-joint proprioception measurements has resulted in contradictory findings after knee arthroplasty. The use of balance as a surrogate measure to assess knee proprioception post-operation has resulted in further confusion. The aim of this study was to measure single joint knee proprioception in participants after unilateral knee arthroplasty, and compares it to multi-joint balance.

METHODS

Eleven participants at 1 year after unilateral total knee arthroplasty and twelve age-matched controls were enrolled. The threshold to detect passive motion and the sensory organization test were used to measure single joint knee proprioception and multi-joint balance respectively. Two-way ANOVA and independent t-tests were used to measure differences between and within groups. Regression analysis was used to measure the association between proprioception and balance measurements.

FINDINGS

Surgical knees demonstrated significantly more deficient proprioception compared to the non-surgical knees and both knees of the control groups during flexion (P < 0.01) and extension (P < 0.05). Non-surgical knees showed similar proprioception to both knees of the control group during flexion and extension. Within the knee arthroplasty group, only deficiencies during flexion showed significant correlation with Sensory Organization Test visual ratio. No additional differences between both groups during balance measurements, nor any correlations between local joint proprioception and balance were seen.

INTERPRETATION

These findings indicate deficient surgical knee proprioception in participants one year after unilateral total knee arthroplasty. Limited associations between measurements indicate that balance may be a poor measure of single-joint proprioception.

Relationship Between L4/5 Lumbar Multifidus Cross-Sectional Area Ratio and Fall Risk in Older Adults with Lumbar Spinal Stenosis: A Retrospective Study

Various factors, including spinal deformities and trunk muscle atrophy, greatly affect the fall risk among older adults with lumbar spinal stenosis (LSS). However, the etiology of falls in older adults with degenerative LSS and trunk muscle atrophy is poorly understood. We investigated the association between trunk muscle atrophy and falls in older LSS patients. This retrospective study included 99 hospitalized older adults with LSS. Participants completed self-reported fall score questionnaires and were divided into the fall risk (n = 30) and non-fall risk (n = 69) groups. The patients' low back pain visual analog scale score, Geriatric Depression Scale score, sagittal vertical axis, L4/5 lumbar multifidus cross-sectional area ratio (LMCSAR), and center of pressure (COP) values during quiet standing were evaluated. The fall risk group had a lower L4/5 LMCSAR (p = 0.002) and increased COP excursion (p = 0.034) than the non-fall risk group. No significant differences were observed in the other measured variables between the two groups. The L4/5 LMCSAR (p < 0.001) and COP (p = 0.024) were related to fall risk and may be useful in fall risk assessment in such populations. Strategies aimed at enhancing controlled lumbar segmental motion and improving trunk muscle stability or mass may decrease the fall risk in this cohort.

The effects of toe-out and toe-in postures on static & dynamic balance, risk of fall and TUG score in healthy adults

BACKGROUND

Toe-in and toe-out foot positions have not yet been tested for dynamic balance and risk of fall. The aim of this study was to investigate the effects of these two modifications on static and dynamic postural stability and risk of fall through instrumental (Biodex Balance System^®) and functional (timed up and go-TUG test) tools.

METHODOLOGY

Twenty healthy adults (8 males, 12 females, age: 29±4.10years, BMI: 21.56±2.36kg/m²) participated in this study. Static and dynamic (levels 8 and 2) balance with single stance and double stance and dynamic (level 8 and levels 6-2) for risk of fall with double stance were tested with the Biodex Balance System with three self-selected feet positions: straight (13.8°), toe-out (35.6°) and toe-in (-11.9°) for each test condition. Additionally, TUG test was performed with toe-out and toe-in gait.

RESULTS

The results of repeated measures ANOVA showed significant differences (p<0.05) between straight and modified toe angles in balance at dynamic level 2 with both double and single stance conditions. Significant differences (p<0.001) were also found in TUG scores for the test conditions.

CONCLUSION

Toe-in and toe-out gait modifications have significant effects on balance at higher levels of platform tilt and functional balance. Further investigations with knee osteoarthritis patients and electromyography may provide insight in balancing strategies adopted by the body in toe-out and toe-in gait.

Physical Therapists' Falls Prevention Knowledge, Beliefs, and Practices in Osteoarthritis Care: A National Cross-Sectional Study

OBJECTIVE

To investigate physical therapists' knowledge, beliefs, and current practices around falls prevention in osteoarthritis (OA) care.

METHODS

Currently registered, practicing Australian physical therapists who care for patients with hip and/or knee OA were invited to participate in this cross-sectional study. A comprehensive online survey was used to collect data that were analyzed descriptively or using chi-square tests; free-text responses were classified into key themes for analysis.

RESULTS

Complete responses were received from 370 eligible physical therapists, with broad representation across Australian states and practice settings. Participants worked in public and private hospitals, community health centers, private practices, and aged-care facilities. The sample ranged from new graduates to experienced physical therapists (47% had practiced ≥11 years). Despite the majority having specific training or access to educational resources, physical therapists reported only moderate confidence in assessing falls risk (median 7 [interquartile range (IQR) 6-8]; range 0 [not at all confident] to 10 [extremely confident]) and delivering falls prevention care (median 7 [IQR 6-8]). While most participants asked about falls history (88%), only 39% used falls-risk screening tools, and of these, relatively few used appropriate tools. Time constraints (including competing clinical priorities) were the most frequently perceived barrier to including falls prevention activities within OA care.

CONCLUSION

This national snapshot of contemporary OA practice has revealed clear opportunities for optimizing clinician confidence and skills to facilitate the uptake of best-practice falls prevention strategies. Improving practice in this area may yield substantial benefits to patients and the health system if more falls can be prevented.

Understanding the profile of Personal Alert Victoria clients who fall

Personal response systems are used to support frail, older people, and people with disabilities to live independently in their own homes. This paper describes the patterns, characteristics, and outcomes of Personal Alert Victoria (PAV) clients who experience a fall. It also examines the current falls prevention referral practices of assessors who determine whether an older person would benefit from a personal response system. Deidentified data on clients from the PAV service provider from 2012 to 2014 were linked to routine data maintained by the Department of Health and Human Services in Victoria. Falls prevention referral practices of assessors were examined using an online survey. Personal response systems were most frequently activated because of a fall in this group of older people (n = 16,822; 44%). No demographic or clinical factors differentiated PAV clients who activated the system because of a fall compared to those who did not, despite a significant increase in the rate of falls-related system activations (p = 0.001) and hospitalisation (p < 0.001) between 2012 and 2014. Assessors believed that PAV clients were at increased risk of falls and frequently recommended falls prevention interventions such as strength and balance interventions (n = 112; 93%) in order to address this risk. This study has provided an insight into the issue of falls among PAV clients, which can help guide the tailoring of falls prevention interventions that can be integrated within existing service models.

Center of Pressure Trace and Sensory Components of the Limits of Stability Test in Older Adults With Vertebral Compression Fractures

BACKGROUND AND PURPOSE

Patients with vertebral compression fracture (VCF) usually exhibit impaired postural control and consequently are at an increased risk of falling. This study aimed to assess the sensory and kinematic components of the limits of stability (LOS) test in patients with VCF.

METHODS

This study enrolled 13 adults with VCF (VCF group), 13 older adults without spinal deformity (NE group), and 13 young adults (NY group). The Biodex balance system was employed to calculate the balance score and the LOS of participants. An inertia motion system was used to record kinematic data. The center of pressure signals of postural stability and LOS were used to calculate the frequency power spectrum for interpreting the sensory component.

RESULTS

Compared with the NY group, the VCF group exhibited a longer reaction time and lower balance scores and used a higher median frequency in the medial-lateral and anterior-posterior direction of body acceleration to perform the LOS test. The required ranges of hip rotation and pelvic pitch were significantly higher in the older adult group than in the NY group. In the postural stability test, the VCF group exhibited significantly higher frequency power in the 0.01- to 0.5-Hz band (visual and vestibular) under both the eyes-closed and eyes-open conditions than the other groups. In the LOS test, the VCF group also exhibited lower sensory component activity than the other groups, particularly in vestibular function (0.1-0.5 Hz).

CONCLUSIONS

Both musculoskeletal degeneration and sensory integration impairment may contribute to poor direction control and a longer reaction time in patients with VCF.

Effects of different foot progression angles and platform settings on postural stability and fall risk in healthy and medial knee osteoarthritic adults

This study aims to investigate the effects of varying toe angles at different platform settings on Overall Stability Index of postural stability and fall risk using Biodex Balance System in healthy participants and medial knee osteoarthritis patients. Biodex Balance System was employed to measure postural stability and fall risk at different foot progression angles (ranging from -20° to 40°, with 10° increments) on 20 healthy (control group) and 20 knee osteoarthritis patients (osteoarthritis group) randomly (age: 59.50 ± 7.33 years and 61.50 ± 8.63 years; body mass: 69.95 ± 9.86 kg and 70.45 ± 8.80 kg). Platform settings used were (1) static, (2) postural stability dynamic level 8 (PS8), (3) fall risk levels 12 to 8 (FR12) and (4) fall risk levels 8 to 2 (FR8). Data from the tests were analysed using three-way mixed repeated measures analysis of variance. The participant group, platform settings and toe angles all had a significant main effect on balance ( p ≤ 0.02). Platform settings had a significant interaction effect with participant group F(3, 144) = 6.97, p < 0.01 and toe angles F(21, 798) = 2.83, p < 0.01. Non-significant interactions were found for group × toe angles, F(7, 266) = 0.89, p = 0.50, and for group × toe angles × settings, F(21, 798) = 1.07, p = 0.36. The medial knee osteoarthritis group has a poorer postural stability and increased fall risk as compared to the healthy group. Changing platform settings has a more pronounced effect on balance in knee osteoarthritis group than in healthy participants. Changing toe angles produced similar effects in both the participant groups, with decreased stability and increased fall risk at extreme toe-in and toe-out angles.

Devices and tasks involved in the objective assessment of standing dynamic balancing - A systematic literature review

BACKGROUND

Static balancing assessment is often complemented with dynamic balancing tasks. Numerous dynamic balancing assessment methods have been developed in recent decades with their corresponding balancing devices and tasks.

OBJECTIVE

The aim of this systematic literature review is to identify and categorize existing objective methods of standing dynamic balancing ability assessment with an emphasis on the balancing devices and tasks being used.

DATA SOURCES

Three major scientific literature databases (Science Direct, Web of Science, PLoS ONE) and additional sources were used.

STUDY SELECTION

Studies had to use a dynamic balancing device and a task described in detail. Evaluation had to be based on objectively measureable parameters. Functional tests without instrumentation evaluated exclusively by a clinician were excluded. A total of 63 articles were included.

DATA EXTRACTION

The data extracted during full-text assessment were: author and date; the balancing device with the balancing task and the measured parameters; the health conditions, size, age and sex of participant groups; and follow-up measurements.

DATA SYNTHESIS

A variety of dynamic balancing assessment devices were identified and categorized as 1) Solid ground, 2) Balance board, 3) Rotating platform, 4) Horizontal translational platform, 5) Treadmill, 6) Computerized Dynamic Posturography, and 7) Other devices. The group discrimination ability of the methods was explored and the conclusions of the studies were briefly summarized.

LIMITATIONS

Due to the wide scope of this search, it provides an overview of balancing devices and do not represent the state-of-the-art of any single method.

CONCLUSIONS

The identified dynamic balancing assessment methods are offered as a catalogue of candidate methods to complement static assessments used in studies involving postural control.

Impact of Sensory Impairments on Functional Disability in Adults With Arthritis

INTRODUCTION

Mobility is reduced in people with sensory impairments and those with arthritis. The combined impact of these conditions may be underappreciated. This study examines the associations between impairments in vision, hearing, and balance and functional ability in adults with versus without arthritis.

METHODS

Using National Health and Nutrition Examination Survey data from 1999-2004, arthritis status, functional ability, and sensory impairments (vision, hearing, and balance) were assessed from self-reported responses by 6,654 individuals aged ≥50 years (mean age, 63.4 years; 46.3% male). Multivariable regression analyses, conducted in 2014, assessed the associations between sensory impairment and arthritis on functional ability and mobility.

RESULTS

Among study participants, 41.8% reported having arthritis; of these, 27.1%, 44.9%, and 35.1% reported impaired vision, hearing, or balance, respectively. Having multiple sensory impairments was significantly associated with reduced functional ability in people with arthritis; individuals with three sensory impairments reported the highest levels of disability for all functional domains (compared with no impairment; lower extremity mobility, 80.2% vs 39.1%; general physical activities, 94.7% vs 75.9%; activities of daily living, 69.7% vs 27.2%; instrumental activities of daily living, 77.2% vs 37.4%; leisure and social activities, 66.3% vs 30.6%; impaired gait speed, 48.1% vs 16.3%; all p<0.001). Importantly, visual deficits, in combination with arthritis, had the greatest impact on mobility, with odds of impaired mobility at least twice as high as for individuals without arthritis.

CONCLUSIONS

Addressing sensory deficits, especially difficulties with vision, may improve functional ability, which may be particularly helpful for adults with arthritis.

Home based exercise to improve turning and mobility performance among community dwelling older adults: protocol for a randomized controlled trial

BACKGROUND

Turning is a common activity for older people, and is one of the activities commonly associated with falls during walking. Falls that occur while walking and turning have also been associated with an increased risk of hip fracture in older people. Despite the importance of stability during turning, there has been little focus on identifying this impairment in at risk older people, or in evaluating interventions aiming to improve this outcome. This study will evaluate the effectiveness of a 16 week tailored home based exercise program in older adults aged (50 years and above) who were identified as having unsteadiness during turning.

METHODS/DESIGN

A single blind randomized controlled trial will be conducted, with assessors blind to group allocation. Study participants will be aged 50 years and above, living in the community and have been identified as having impaired turning ability [outside of age and gender normal limits on the Step Quick Turn (180 degree turn) task on the Neurocom® Balance Master with long plate]. After a comprehensive baseline assessment, those classified as having balance impairment while turning will be randomized to intervention or control group. The intervention group will receive a 16 week individualized balance and strength home exercise program, based on the Otago Exercise Program with additional exercises focused on improving turning ability. Intervention group will attend four visit to the assessment centre over 16 weeks period, for provision, monitoring, modification of the exercise and encourage ongoing participation. Participants in the control group will continue with their usual activities. All participants will be re-assessed on completion of the 16 week program. Primary outcome measures will be the Step Quick Turn Test and Timed-Up and Go test. Secondary outcomes will include other clinical measures of balance, psychological aspects of falls, incidence of falls and falls risk factors.

DISCUSSION

Results of this study will provide useful information for clinicians on the types of exercises to improve turning ability in older people with increased falls risk and the effectiveness of these exercises in improving outcomes.

TRIAL REGISTRATION

ACTRN12613000855729.

Balance and risk of fall in individuals with bilateral mild and moderate knee osteoarthritis

Balance is essential for mobility and performing activities of daily living. People with knee osteoarthritis display impairment in knee joint proprioception. Thus, the aim of this study was to evaluate balance and risk of fall in individuals with bilateral mild and moderate knee osteoarthritis. Sixty subjects aged between 50 and 70 years volunteered in this study. They were categorized into three groups which were healthy (n = 20), mild (n = 20) and moderate (n = 20) bilateral knee osteoarthritis groups. Dynamic and static balance and risk of fall were assessed using Biodex Stability System. In addition, Timed Up and Go test was used as a clinical test for balance. Results of this study illustrated that there were significant differences in balance (dynamic and static) and risk of fall between three groups. In addition, the main (most significant) difference was found to be between healthy group and moderate group. Furthermore, on clinical scoring of balance, the “Timed Up and Go” test, all three groups showed significant difference. In conclusion, bilateral knee osteoarthritis impaired the balance and increased the risk of fall, particularly in people with moderate knee osteoarthritis.