Current use of analgesics and the risk of falls in people with knee osteoarthritis: A population-based cohort study using primary care and hospital records

Pain Medication Frequency and Fall Risk Among Community-Dwelling Older Adults With Arthritis

Pain medication is commonly used among older adults with arthritis, elevating the risk of falling. We examined fall risks related to the frequency of taking pain medication among community-dwelling older adults with arthritis by analyzing a nationally representative sample of community-dwelling Medicare beneficiaries aged >65 with self-reported arthritis (n = 4,225) in the 2015 National Health and Aging Trends Study. The survey-weighted logistic regression revealed that after controlling for confounding factors, recent falls were associated with taking pain medication daily compared to never (OR = 1.45, 95% CI: 1.06, 1.96). The other categories of medication frequency, compared to never, were not associated with fall risk. Findings suggest that more prudent use of pain medication should be stressed by health care providers for older adults with arthritis to help reduce the risk of falls and fall injuries. Nonpharmacological pain management is encouraged to support active living among older adults with arthritis.

"Application of five different strategies to define a cohort of patients with knee osteoarthritis in a large primary care database"

BACKGROUND

Electronic health records (EHR) are frequently used for epidemiological research including drug utilisation studies in a defined population such as the population with knee osteoarthritis (KOA). We sought to describe the process of defining a cohort of patients with KOA from a large UK primary care database and estimate the annual incidence of diagnosed KOA between 2000 and 2015.

METHOD

This was a retrospective study using data from the clinical practice research datalink (CPRD). CPRD is a large primary care longitudinal electronic medical records' database that contains anonymous records of patients from general practices across United Kingdom. Five different cohort definition strategies were applied including symptoms-based or diagnosis-based strategies or a combination of both. To validate results, the annual incidence of KOA was estimated and compared to published data.

RESULTS

The study defined 898,690 patients when symptoms-based strategy was applied, 137,541 patients when diagnosis based and 83,294 when a combination of both strategies were applied. The final cohort was defined using a diagnosis-based strategy that avoided overestimation (with symptoms-based definition) or underestimation (with a combination of symptoms and diagnosis). The incidence of KOA ranged from 1.33 per 1000 CPRD registrants in 2000, 1.76 in 2008 and 1.45 patients in 2015.

CONCLUSION

This study logically/sensibly defined a cohort of patients with diagnosed KOA through the application of several strategies. This was an essential step to avoid subsequent over or underestimation of the prevalence of drug utilisation and the associated adverse clinical outcomes within primary care patients with KAO.

Knee osteoarthritis: Current status and research progress in treatment (Review)

Knee osteoarthritis (KOA) is a common chronic articular disease worldwide. It is also the most common form of OA and is characterized by high morbidity and disability rates. With the gradual increase in life expectancy and ageing population, KOA not only affects the quality of life of patients, but also poses a burden on global public health. OA is a disease of unknown etiology and complex pathogenesis. It commonly affects joints subjected to greater loads and higher levels of activity. The knee joint, which is the most complex joint of the human body and bears the greatest load among all joints, is therefore most susceptible to development of OA. KOA lesions may involve articular cartilage, synovium, joint capsule and periarticular muscles, causing irreversible articular damage. Factors such as mechanical overload, inflammation, metabolism, hormonal changes and ageing serve key roles in the acceleration of KOA progression. The clinical diagnosis of KOA is primarily based on combined analysis of symptoms, signs, imaging and laboratory examination results. At present, there is no cure for KOA and the currently available therapies primarily focus on symptomatic treatment and delay of disease progression. Knee replacement surgery is typically performed in patients with advanced disease. The current study presents a review of epidemiological characteristics, risk factors, histopathological manifestations, pathogenesis, diagnosis, treatment modalities and progress in KOA research.

The Reliability and Validity of the Lie-to-Sit-to-Stand-to-Walk Transfer (LSSWT) Test in Knee Osteoarthritis

Background

Several neuromuscular impairments may be observed in older patients with knee osteoarthritis (OA), increasing the risk of falling, which is common during transfer activities. The Lie-to-Sit-to- Stand-to-Walk Transfer (LSSWT) test was developed to evaluate complex transfer abilities. The study aims to investigate the reliability and validity of LSSWT in patients with knee OA.

Methods

Twenty-nine patients with knee OA were included in this study. The LSSWT, Timed up and go test (TUG), and Western Ontario and McMaster Universities Arthritis Index (WOMAC) were administered to the patients. Patients rested for at least an hour between the trials to avoid fatigue.

Results

The LSSWT has excellent reliability and high validity in patients with knee OA. The relative (ICC coefficient) and absolute (SEM and SRD95) reliability values are 0.96 (95% CI: 0.91-0.98), 1.00, and 2,75, respectively. The Pearson correlation coefficient of the LSSWT with the TUG is 0.73 (p < 0.01), and the Spearmen correlation coefficient of the LSSWT with the WOMAC is 0.54 (p < 0.05).

Conclusions

The LSSWT is highly reliable and valid in knee OA and is recommended for routine dynamic balance establishment. Having a low minimal clinically important difference shows the LSSWT's sensitivity. The LSSWT can easily identify dynamic balance deficits in knee OA patients and help prevent fall incidents.