The mediating role of psychological symptoms on falls risk among older adults with osteoarthritis

Physical and psychosocial characteristics differ between individuals with knee pain and different knee osteoarthritis diagnostic criteria

PURPOSE

Knee pain and osteoarthritis (OA) are common and often lead to disability among older adults. Existing published evidence, however, utilizes differing criteria to define studies' knee OA populations. We, therefore, aimed to determine whether differences exist in the characteristics of individuals with the presence of knee pain and different diagnostic criteria for knee OA.

METHODS

The Promoting Independence in Seniors with Arthritis (PISA) study is a longitudinal observational study of individuals with and without knee pain and knee OA recruited from the orthopaedics clinic of the Universiti Malaya Medical Centre and the local hospital catchment. Patients were diagnosed with OA based on the American College of Rheumatology (ACR) criteria, the presence of knee pain, and a history of physician-diagnosed knee OA. Psychosocial parameters were measured using validated measures for social participation, independence, and ability to perform activities of daily living, and life satisfaction.

RESULTS

Of the 230 included participants, mean age was 66.9 years (standard deviation: 7.2) and 166 (72.2%) were women. Kappa agreement between ACR criteria and knee pain was 0.525 and for ACR and physician-diagnosed OA it was 0.325. Binomial logistic regression analysis showed that weight, anxiety, and handgrip strength (HGS) were predictive of ACR OA. Knee pain was only predicted by HGS but not weight and anxiety. Physician-diagnosed OA was predicted by weight and HGS but not anxiety. HGS was predictive of ACR OA, knee pain, and physician-diagnosed OA.

CONCLUSION

Our study showed that the characteristics of patients with OA are different, physically and psychosocially, depending on the criteria used. Poor agreement was observed between radiological diagnosis and the other diagnostic criteria. Our findings have important implications for the interpretation and comparison of published studies using different OA criteria.

KEY MESSAGES

Exergaming to improve balance and decrease the risk of falling in adults with knee osteoarthritis: a mixed-methods feasibility study

BACKGROUND

Exergaming (exercise and gaming) is useful in improving balance in various health conditions, yet there is limited research regarding its application in individuals with knee osteoarthritis (OA).

OBJECTIVES

The primary aim of this study was to investigate the feasibility and acceptability of exergaming using Nintendo Wii Fit™ to improve balance and reduce the risk of falls in individuals with knee OA.

METHODS

A mixed-methods explanatory sequential study design was utilized in this study. Participants with knee OA and history of falling participated in a single-group pre-post experimental study design: eight weeks of usual care followed by eight weeks of an exergaming program. This was followed by semi-structured focus groups to determine the acceptability of the study.

RESULTS

The pre-defined feasibility criteria such as recruitment, retention rate (83%), and compliance (78%) were successfully met. The participants found the frequency and duration of the assessment and intervention sessions acceptable. Participants reported enjoying the exergaming, finding it motivating and interactive despite some barriers with technology. No adverse events were reported. There were encouraging results in the clinical outcome measures such as knee muscle strength, balance, fear of falling, and performance of physical function.

CONCLUSION

The study found that it is feasible and acceptable to use Nintendo Wii Fit™ as an exergaming tool to improve balance and decrease the risk of falling in adults with knee OA. Findings from this feasibility study are encouraging and support the need to conduct a fully powered randomized controlled trial study.

Influences and consequences resulting in addictions in general and to chronic alcoholism, especially for patients with spinal cord injury

Introduction: Spinal cord injury can be a cause of severe disability, with important consequences at the individual and social levels. Causes are often produced by falls or road accidents; and addictions (particularly chronic ethylism) also increase the risk of vertebral-medullary lesions. Materials and Methods: With with the approval of the TEHBA Ethics Commission (no.17464/14.06.2019), we used specific tests (DASS-21, MOS SF-36, SMAST, AUDIT, CAGE, AIS) and we questioned a group of patients admitted to the THEBA Neuro-Muscle Recovery Clinic after being treated in the Spinal Neurosurgery Service for acute and subacute vertebral medullary trauma. Results: We evaluated the link between addictions (especially ethanol), the risk of spinal cord injury, and the underlying subacute evolution of patients with this pathology. Conclusions: Substance abuse (especially ethanol) increases the risk of spinal cord injury and is a serious public health problem. Keywords: SCI, DASS-21, MOS SF-36, AUDIT, CAGE, SMAST, Neuromuscular Recovery

Analysis of the Associations between Arthritis and Fall Histories in Korean Adults

(1) Background: the purpose of the present study was to analyze the associations between arthritis and fall histories in Korean adults. (2) Methods: data from the 2015 and 2017 Korean Community Health Survey were analyzed. In total, 322,962 participants aged ≥40 years were included. The participants were divided into two different groups. First, the participants were divided into the ‘arthritis (osteoarthritis or rheumatoid arthritis) for entire life’ and ‘nonarthritis for entire life (comparison I)’ groups. Subsequently, the participants were divided into the ‘current arthritis’ and ‘noncurrent arthritis (comparison II)’ groups. Afterwards, we analyzed the prevalence odds ratios (pORs) of the fall histories of the participants using a logistic regression analysis with the 95% confidence interval (CI). The variables of income, education level, region of residence, smoking status, alcohol consumption, obesity, subjective health status, stress level, physical activity, and sleep hours were adjusted for as covariates. (3) Results: both the arthritis for entire life and current arthritis groups had higher prevalence rates of falls than the comparison I and comparison II groups, respectively (each p < 0.001). The pORs of falling ≥1 time and ≥2 times per year in the arthritis for the entire life group were 1.42 (95% CI = 1.38–1.46) and 1.69 (95% CI = 1.62–1.76), respectively. The adjusted pORs for falling ≥1 time and ≥2 times per year in the current arthritis group were 1.35 (95% CI = 1.31–1.39) and 1.56 (95% CI = 1.50–1.63), respectively. (4) Conclusions: previous arthritis has a significant impact on the risk of falling.

Rate of torque development and the risk of falls among community dwelling older adults in Japan

BACKGROUND

Rate of torque development (RTD) is defined as the slope of the torque-time curve obtained during an isometric contraction. Several studies have shown that RTD is lower in fallers than in nonfallers. However, these studies had small sample size and was not adjusted confounding factors.

RESEARCH QUESTION

Is RTD associated with falls history in healthy community dwelling older adults.

METHODS

This was cross-sectional study. In total, 122 participants aged ≥65 (mean, 71.3 ± 4.4) years were recruited for this study. We assessed RTD, muscle strength, functional capacity, and physical activity. We assessed RTD over the first 200 ms of the maximal isometric contraction, whereby the onset of contraction was deemed as the point at which torque had risen 4 Nm above the baseline. Differences between the 3 groups (no fall group, single fall group and multiple falls group) were examined using one-way analysis of variance or Kruskal-Wallis test. A post-hoc Bonferroni or Games-Howell test was used to assess the differences between the individual groups. A multivariate multinomial logistic model was built using the factors associated with the fall category.

RESULTS

RTD was significantly different between the no fall group and multiple falls group (P = 0.047). Similarly, RTD was significantly different between the single fall group and multiple falls group (P = 0.016). RTD was associated with both the no fall group and single fall group (odds ratio = 2.05, 95% confidence interval: 1.06-3.97, odds ratio = 2.45, 95% confidence interval: 1.20-4.98, respectively) in multinomial logistic regression.

SIGNIFICANCE

This is the first study to investigate the relationship between RTD and falls history in community-dwelling older adults in multivariate analysis. RTD is more strongly associated with falls history than other performance measures in community-dwelling elderly.

Falls and Recurrent Falls among Adults in A Multi-ethnic Asian Population: The Singapore Epidemiology of Eye Diseases Study

We evaluated the rate and risk factors associated with falls and recurrent falls in a multi-ethnic Asian population. 10,009 participants aged ≥40 years (mean[SD] age = 58.9[10.4] years) underwent clinical examinations and completed interviewer-administered questionnaires. Participants who self-reported at least one fall or ≥2 falls in past 12 months were defined as fallers and recurrent fallers, respectively. Age-standardized rates for falls and recurrent falls were 13.8% (95%CI, 13.1–14.6%) and 4.6% (95%CI, 4.2–5.1%), respectively. Multivariable analyses showed older age (OR = 1.20; 95%CI, 1.11–1.30), female gender (OR = 1.79; 95%CI, 1.54–2.07), diabetes (OR = 1.22; 95%CI, 1.07–1.40), cardiovascular disease (CVD, OR = 1.37; 95%CI, 1.14–1.65), ≥3 systemic comorbidities (OR = 1.35; 95%CI, 1.09–1.67), lower European Quality of Life-5 Dimensions (EQ-5D) score (OR = 1.36; 95%CI, 1.29–1.44), alcohol consumption (OR = 1.41, 95%CI, 1.11–1.78) and presenting visual impairment (VI, OR = 1.23; 95%CI, 1.02–1.47) were associated with falls. For recurrent falls, female gender (OR = 2.27; 95%CI, 1.75–2.94), diabetes (OR = 1.28; 95%CI, 1.03–1.61), CVD (OR = 2.00; 95%CI, 1.53–2.62), ≥3 systemic comorbidities (OR = 1.69; 95%CI, 1.19–2.39), lower EQ-5D score (OR = 1.47; 95%CI, 1.35–1.59), living in 1–2 room public flat (OR = 1.57; 95%CI, 1.05–2.33), monthly income <2000 Singapore Dollar (OR = 1.62; 95%CI, 1.13–2.31), alcohol consumption (OR = 1.81, 95%CI, 1.23–2.66) and presenting VI (OR = 1.34; 95%CI, 1.01–1.79) were significant risk factors. These findings will be useful for the formulation of fall prevention programs.