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Koh V, Matchar DB, Chan A. Physical strength and mental health mediate the association between pain and falls (recurrent and/or injurious) among community-dwelling older adults in Singapore. Arch Gerontol Geriatr 2023; 112:105015. [PMID: 37060804 DOI: 10.1016/j.archger.2023.105015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 03/11/2023] [Accepted: 04/02/2023] [Indexed: 04/05/2023]
Abstract
OBJECTIVE This study aims to understand if poor physical strength and depression mediate the association between pain and recurrent and/or injurious falls in a community of older adults. METHODS Data was obtained from a nationally representative longitudinal cohort study conducted in Singapore, PHASE (Wave I and II), which collected information from community-dwelling older adults above 60 years old. A hurdle negative binomial regression and binomial logistic regression were used to assess the association between pain and recurrent falls, and pain and injurious falls respectively. A subsequent mediation analysis was conducted. RESULTS Almost half of the participants (N = 1144, 39.7%) reported having either mild, moderate, or severe pain at baseline, 166 (5.4%) participants experienced injurious falls and 144 (4.7%) participants experienced recurrent falls at Wave II. After adjusting for covariates, the presence of pain significantly influenced recurrent (OR 2.8; 95% CI: 1.8, 4.4) and injurious falls (OR: 1.8; 95% CI: 1.3, 2.5). Mediation analyses demonstrated that poor physical strength and depression had a significant mediation effect between all pain characteristics on recurrent falls. Poor physical strength partially mediates the effects of pain and injurious falls as well. However, the mediating effect of poor physical strength and depression was not observed between other pain characteristics and injurious falls. CONCLUSIONS The findings highlighted differences in the underlying mechanisms between pain characteristics affecting recurrent and injurious falls. These insights will be useful for identifying patients most at risk for recurrent or injurious falls, and for tailoring future community-based fall intervention programmes.
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Affiliation(s)
- Vanessa Koh
- Programme in Health Services and Systems Research (HSSR), Duke-NUS Medical School, Singapore 169857, Singapore; Centre for Ageing Research and Education (CARE), Duke-NUS Medical School, Singapore 169857, Singapore.
| | - David B Matchar
- Programme in Health Services and Systems Research (HSSR), Duke-NUS Medical School, Singapore 169857, Singapore; Department of Medicine (General Internal Medicine), Duke University Medical Center, 3116 N Duke St, Durham, NC 27704, USA
| | - Angelique Chan
- Programme in Health Services and Systems Research (HSSR), Duke-NUS Medical School, Singapore 169857, Singapore; Centre for Ageing Research and Education (CARE), Duke-NUS Medical School, Singapore 169857, Singapore
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Higgs JP, Diamond LE, Saxby DJ, Barrett RS, Graham DF. Individual muscle contributions to the acceleration of the centre of mass during gait in people with mild-to-moderate hip osteoarthritis. Gait Posture 2023; 104:151-158. [PMID: 37421811 DOI: 10.1016/j.gaitpost.2023.06.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 05/29/2023] [Accepted: 06/26/2023] [Indexed: 07/10/2023]
Abstract
BACKGROUND People with mild-to-moderate hip osteoarthritis (OA) exhibit hip muscle weakness, alterations in hip kinematics and kinetics and hip contact forces during gait compared to healthy controls. However, it is unclear if those with hip OA use different motor control strategies to coordinate the motion of the centre of mass (COM) during gait. Such information could provide further critical assessment of conservative management strategies implemented for people with hip OA. RESEARCH QUESTION Do muscle contributions to the acceleration of the COM during walking differ between individuals with mild-to-moderate hip OA and controls? METHODS Eleven individuals with mild-to-moderate hip OA and 10 healthy controls walked at a self-selected speed while whole-body motion and ground reaction forces were measured. Muscle forces during gait were obtained using static optimisation and an induced acceleration analysis was performed to determine individual muscle contributions to the acceleration of the COM during single-leg stance (SLS). Between-group comparisons were made using independent t-tests via Statistical Parametric Modelling. RESULTS There were no between-group differences in spatial-temporal gait parameters or three-dimensional whole-body COM acceleration. The rectus femoris, biceps femoris, iliopsoas and gastrocnemius muscles in the hip OA group contributed less to the fore-aft accelerations of the COM (p < 0.05), and more to the vertical COM acceleration with the gluteus maximus (p < 0.05), during SLS, compared to the control group. SIGNIFICANCE Subtle differences exist in the way people with mild-to-moderate hip OA use their muscles to accelerate the whole-body centre of mass during the SLS phase of walking relative to healthy controls. These findings improve understanding of the complex functional consequences of hip OA and enhance our understanding of how to monitor the effectiveness of an intervention on biomechanical changes in gait in people with hip OA.
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Affiliation(s)
- Jeremy P Higgs
- Griffith University, Griffith Centre of Biomedical and Rehabilitation Engineering, Menzies Health Institute Queensland, Gold Coast, QLD 4222, Australia; Griffith University, School of Health Sciences and Social Work, Gold Coast, QLD 4222, Australia
| | - Laura E Diamond
- Griffith University, Griffith Centre of Biomedical and Rehabilitation Engineering, Menzies Health Institute Queensland, Gold Coast, QLD 4222, Australia; Griffith University, School of Health Sciences and Social Work, Gold Coast, QLD 4222, Australia
| | - David J Saxby
- Griffith University, Griffith Centre of Biomedical and Rehabilitation Engineering, Menzies Health Institute Queensland, Gold Coast, QLD 4222, Australia; Griffith University, School of Health Sciences and Social Work, Gold Coast, QLD 4222, Australia
| | - Rod S Barrett
- Griffith University, Griffith Centre of Biomedical and Rehabilitation Engineering, Menzies Health Institute Queensland, Gold Coast, QLD 4222, Australia; Griffith University, School of Health Sciences and Social Work, Gold Coast, QLD 4222, Australia
| | - David F Graham
- Griffith University, School of Health Sciences and Social Work, Gold Coast, QLD 4222, Australia; Montana State University, College of Education. Health & Human Development, Bozeman, MT 59717-2940, USA.
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Does a relationship between type of hip fracture and osteoarthritis exist? JOURNAL OF SURGERY AND MEDICINE 2022. [DOI: 10.28982/josam.7514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background/Aim: Many factors have been associated with the etiology of falls and hip fractures in the elderly. However, only a few studies have examined the relationship between osteoarthritis and hip fractures, which are common in this age group. The aim of this study was to determine the relationship between the knee and hip osteoarthritis (OA) and the type of hip fracture.
Methods: Patients who underwent surgery in the Orthopedics and Traumatology Department between January 2017 and December 2021 were eligible to participate in this retrospective cohort study. Patients who were 60 years and older with a hip fracture and adequate medical records and radiographs of bilateral hip and knee joints met the inclusion criteria. Data concerning patient co-morbidities, type of hip fracture, whether they had OA in their hip and knee joints, and the severity of their OA were assessed. The severity of the osteoarthritis presence was categorized with using the Kellgren–Lawrence (KL) classification. To categorize the patients, three groups were identified: (1) femoral neck, (2) trochanteric, and (3) subtrochanteric fracture groups. The presence and severity status of OA in the hip and knee joints and co-morbidity data were compared between the groups.
Results: Three-hundred forty-one patients with a M/F ratio of 148/193 are included in this study. Femoral neck fractures occurred in 142 (41.6%), trochanteric fractures in 147 (43.1%), and subtrochanteric fractures in 52 (15.2%) patients. The mean age of the cohort was 76.72 (10.165); The mean age of the patients in the trochanteric group was higher than in the subtrochanteric group (P = 0.001). No effect of any existing co-morbidities on fracture type was observed. The overall prevalence of OA in the cohort that was observed in the hip joint was 34.3% with 33.7% in males and 35.3% in females. These rates were 66.6%, 53.4%, and 76.7% in the knee joint, respectively. No difference could be observed between hip OA presence and any type of hip fracture group (P = 0.833 for right hip, P = 0.865 for left hip). Similar rates of moderate and severe hip OA were found in the femoral neck and trochanteric fracture groups. However, the frequency of moderate hip OA was lower and the frequency of severe hip OA was higher in subtrochanteric fracture group compared to other groups (P = 0.164 for right hip, P = 0.241 for left hip. Knee OA was observed to be more common in the trochanteric fracture group (P = 0.003 for the right knee, P = 0.002 for left knee) and also, the rate of severe OA was higher in the trochanteric fracture group compared to other groups (P = 0.013 for right knee, P = 0.006 for the left knee).
Conclusion: In contrast to OA presence in the hip, knee OA presence and severity can be significant risk factors for occurrence of trochanteric type fractures in the elderly.
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Toda H, Maruyama T, Fujita K, Yamauchi Y, Tada M. Self-Reported Walking Difficulty Associated with Stiff-Knee Gait in Japanese Patients with Knee Osteoarthritis: A Preliminary Cross-Sectional Study. Healthcare (Basel) 2021; 9:healthcare9101308. [PMID: 34682987 PMCID: PMC8544354 DOI: 10.3390/healthcare9101308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/17/2021] [Accepted: 09/27/2021] [Indexed: 11/24/2022] Open
Abstract
Background: Individuals with knee osteoarthritis are restricted in their daily activity because of walking difficulty. The purpose of this investigation was to examine the association between self-reported walking difficulty and knee flexion excursion during gait in Japanese patients with knee osteoarthritis. Methods: Twenty-eight patients with knee osteoarthritis participated in this study. Knee flexion excursions in loading response and swing during gait were measured through an inertial measurement unit-based motion capture system. The walking difficulty was assessed by a subitem in the Japanese Knee Osteoarthritis Measure. Pain intensity was assessed by a visual analog scale. Characteristics and gait variables were compared between groups that were determined a priori using the results of the walking difficulty assessment. The relationship between knee flexion excursion during gait and walking difficulty were analyzed using logistic regression. Results: The participants with walking difficulty had significantly small knee flexion excursion in both loading response and swing with large pain. After controlling the effect of pain, only knee flexion excursion in the swing was significantly related to the walking difficulty. Conclusions: This study suggested that the knee flexion excursion in swing during gait is helpful for understanding the walking difficulty experienced in Japanese patients with knee osteoarthritis.
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Affiliation(s)
- Haruki Toda
- Digital Human Research Team, Artificial Intelligence Research Center, National Institute of Advanced Industrial Science and Technology, Tokyo 135-0064, Japan; (T.M.); (M.T.)
- Correspondence: ; Tel.: +81-3-3599-8201
| | - Tsubasa Maruyama
- Digital Human Research Team, Artificial Intelligence Research Center, National Institute of Advanced Industrial Science and Technology, Tokyo 135-0064, Japan; (T.M.); (M.T.)
| | - Koji Fujita
- Department of Functional Joint Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8519, Japan;
| | - Yuki Yamauchi
- Department of Orthopaedic Surgery, Doujin Hospital, Urasoe 901-2133, Japan;
| | - Mitsunori Tada
- Digital Human Research Team, Artificial Intelligence Research Center, National Institute of Advanced Industrial Science and Technology, Tokyo 135-0064, Japan; (T.M.); (M.T.)
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Chaudhry YP, Puvanesarajah V, Oni JK, Sterling RS, Khanuja HS. A Fall Within 3 Months Before Total Joint Arthroplasty is Associated With Adverse Outcomes in Elderly Patients. J Arthroplasty 2021; 36:1246-1250. [PMID: 33190996 DOI: 10.1016/j.arth.2020.10.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 10/05/2020] [Accepted: 10/14/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Falls are associated with morbidity and death in the elderly. The consequences of falls after total joint arthroplasty (TJA) are known, but the consequences of preoperative falls are unclear. We assessed associations between preoperative fall history and hospital readmission rates and discharge disposition after primary TJA. METHODS We queried the National Surgical Quality Improvement Program Geriatric Pilot Project for cases of primary total hip arthroplasty (THA) (n = 3671) and total knee arthroplasty (TKA) (n = 6194) performed between 2014 and 2018 for patients aged ≥65 years. Patient characteristics, comorbidities, functional status indicators, and 30-day outcomes were compared among patients with falls occurring within 3 months, from >3 to 6 months, and from >6 to 12 months before surgery, and patients with no falls in the year before surgery. The timing of falls was assessed for independent associations with hospital readmission and discharge to a skilled care facility (SCF). Alpha = 0.05. RESULTS Patients who fell within 3 months before surgery had greater odds of SCF discharge (for THA, odds ratio [OR] 2.5, 95% confidence interval [CI] 1.8-3.4; for TKA, OR 1.8, 95% CI 1.4-2.3) and hospital readmission (for THA, OR 1.8, 95% CI 1.1-3.0; for TKA, OR 2.4, 95% CI 1.6-3.5) compared with the no-fall cohort. No such associations were observed for the other two fall cohorts. CONCLUSION Falls within 3 months before primary TJA are associated with SCF discharge and readmission for patients aged ≥65 years. Fall history screening should be included in preoperative evaluation. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Yash P Chaudhry
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD
| | - Varun Puvanesarajah
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD
| | - Julius K Oni
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD
| | - Robert S Sterling
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD
| | - Harpal S Khanuja
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD
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Tsindos T, Ayton D, Soh SE, Ackerman IN. Perceptions of falls risk and falls prevention among people with osteoarthritis. Disabil Rehabil 2020; 44:1839-1846. [PMID: 32809876 DOI: 10.1080/09638288.2020.1806364] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
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.
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Affiliation(s)
- Tess Tsindos
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Darshini Ayton
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Sze-Ee Soh
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.,Department of Physiotherapy, Monash University, Melbourne, Australia
| | - Ilana N Ackerman
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
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Wadsworth D, Lark S. Effects of Whole-Body Vibration Training on the Physical Function of the Frail Elderly: An Open, Randomized Controlled Trial. Arch Phys Med Rehabil 2020; 101:1111-1119. [PMID: 32145279 DOI: 10.1016/j.apmr.2020.02.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 01/28/2020] [Accepted: 02/21/2020] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To investigate the feasibility and benefits of whole-body vibration (WBV) exercise as a safe and effective training tool for countering sarcopenia and age-related declines in mobility and function in the frail elderly. DESIGN An open, randomized controlled trial. SETTING Residential care facilities. PARTICIPANTS Male and female volunteers (N=117; 82.5±7.9y). INTERVENTIONS After prescreening for contraindications, participants were randomly allocated to a control, simulated WBV (SIM), or WBV exercise group. All participants received regular care, whereas WBV and SIM participants also underwent thrice-weekly exercise sessions for 16 weeks. Delivered by overload principle, WBV training began with 5 × 1-minute bouts at 6 Hz/2 mm (1:1 min exercise:rest), progressing to 10 × 1 minute at up to 26 Hz/4 mm, maintaining knee flexion. Training for SIM participants mimicked WBV exercise stance and duration only. MAIN OUTCOME MEASURES The timed Up and Go, Parallel Walk, and 10-m Timed Walk (10mTW) tests performance were assessed, in addition to the Barthel Index Questionnaire, at baseline, 8, and 16 weeks of exercise, and 3, 6, and 12 months postexercise. RESULTS High levels of compliance were reported in SIM (89%) and WBV training (93%), with ease of use and no adverse effects. In comparison to baseline levels, WBV training elicited clinically important treatment effects in all parameters compared to SIM and control groups. Treatment effects remained apparent up to 12 months postintervention for Parallel Walk Test and 6 months for 10mTW Test. Functional test performance declined during and postintervention in non-WBV groups. CONCLUSIONS Findings indicate that 16 weeks of low-level WBV exercise provides easily accessible, adequate stimulus for the frail elderly to attain improved levels of physical functionality.
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Affiliation(s)
- Daniel Wadsworth
- School of Sport & Exercise, Massey University, New Zealand; School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Australia.
| | - Sally Lark
- Sport and Exercise New Zealand, Christchurch, New Zealand
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Chen SK, Voaklander D, Perry D, Jones CA. Falls and fear of falling in older adults with total joint arthroplasty: a scoping review. BMC Musculoskelet Disord 2019; 20:599. [PMID: 31830974 PMCID: PMC6909481 DOI: 10.1186/s12891-019-2954-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 11/18/2019] [Indexed: 01/27/2023] Open
Abstract
Background Patients waiting or recovering from total joint arthroplasty (TJA) are at risk for falls which can lead to restriction of activity and negatively impact recovery. The objective of this scoping review is to critically appraise and synthesize the evidence in the reported number of falls, fear of falling, and risk factors associated with falls in older patients waiting for or recovering from TJA. Methods Seven electronic databases were searched with no date limits and using language restriction (English). The inclusion criteria were 1) cohorts that included older adults 60+ years of age, 2) reported prevalence of falls, fear of falling, and/or risk factors for falls in patients who were waiting or recovering from TJA and 3) cross-sectional studies, cohort studies, and case control study designs. The quality assessment of selected articles was assessed using the SIGN Guidelines Checklist. Results Of the 866 citations identified, 12 studies met the inclusion criteria and were reviewed. Prevalence of falls in pre-operative TJA patients and post-operative TJA patients ranged from 23 to 63%, and 13 to 42%, respectively. Of those five studies that examined fear of falling, pre-operative TJA patients reported greater fear of falling than post-operative patients. Modifiable risk factors for falls included fear of falling, joint range of motion, and depression. Conclusions An increased risk of falls in patients with TJA was reported both for patients waiting for and recovering from surgery. A number of modifiable risk factors were identified including fear of falling that could be targeted in fall prevention programs for TJA.
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Affiliation(s)
- Serena Kuangyi Chen
- School of Public Health, University of Alberta Edmonton, Alberta, T6G 1C9, Canada
| | - Don Voaklander
- School of Public Health, University of Alberta Edmonton, Alberta, T6G 1C9, Canada
| | - Danielle Perry
- School of Public Health, University of Alberta Edmonton, Alberta, T6G 1C9, Canada
| | - C Allyson Jones
- Department of Physical Therapy, University of Alberta Edmonton, Alberta, T6G 2G4, Canada.
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Chen H, Zheng X, Huang H, Liu C, Wan Q, Shang S. The effects of a home-based exercise intervention on elderly patients with knee osteoarthritis: a quasi-experimental study. BMC Musculoskelet Disord 2019; 20:160. [PMID: 30967131 PMCID: PMC6456993 DOI: 10.1186/s12891-019-2521-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 03/21/2019] [Indexed: 11/16/2022] Open
Abstract
Background Knee osteoarthritis (KOA) is common in elderly people, causes pain, loss of physical functioning, and disability. This was a two-arm, superiority, quasi-experimental trial. The aim of this study was to evaluate the effectiveness of a home-based exercise intervention (HBEI) to reduce KOA symptoms and improve the physical functioning of elderly patients. Methods A total of 171 elderly patients (60 years of age or older) with KOA were recruited from four community centers. Patients from two community centers were randomly assigned to the intervention group (IG) and the other two centers were randomly assigned to the control group (CG). Participants in the IG received a 12-week HBEI (including four 2-h sessions supervised by a physiotherapist and fortnightly telephone support) combined with health education, while patients in the CG only received health education. The participants and physiotherapists were aware of the group assignment and alternative treatment components, but the study’s hypotheses were not disclosed to the participants. Pain intensity, joint stiffness, lower-limb muscle strength, balance, mobility, and quality of life were measured before and after the intervention by the same blinded assessor. Results A total of 171 patients (IG: n = 84, CG: n = 87) were enrolled. Data were obtained from 141 patients with an average age of 68 (range, 60–86 years) who completed the 12-week study (IG: n = 71, CG: n = 70). No significant group differences were found in any outcome measures at baseline. At week 12, the pretest/posttest changes 3significant between-group differences in decreases in pain intensity (− 1.60 (CI, − 2.75 to − 0.58)) and stiffness (− 0.79 (CI, − 1.37 to − 0.21)), with the IG exhibiting significantly larger improvements on both measures than the CG. The IG also showed significantly greater improvements on all the secondary outcomes than the CG did. Conclusions HBEI may be effective for relieving KOA symptoms, increasing the physical functioning, and improving quality of life in community-dwelling KOA elderly patients. A large randomized controlled trial with long-term follow-up is needed to confirm these findings. Trial registration Chinese Clinical Trails Registry number ChiCTR1800017026 (retrospectively registered). Registered 9 July 2018. Electronic supplementary material The online version of this article (10.1186/s12891-019-2521-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hongbo Chen
- School of Nursing, Peking University, 38 Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Xiaoyan Zheng
- The Open University of China, 75 Fuxing Road, Haidian District, Beijing, 100039, China
| | - Hongjie Huang
- Institute of Sports Medicine, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, 100191, China
| | - Congying Liu
- School of Nursing, Peking University, 38 Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Qiaoqin Wan
- School of Nursing, Peking University, 38 Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Shaomei Shang
- School of Nursing, Peking University, 38 Xueyuan Road, Haidian District, Beijing, 100191, China.
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Miyaue N, Yamanishi Y, Tada S, Ando R, Nagai M, Nomoto M. Falling After Starting Running in a Case of Myoclonus Epilepsy Associated with Ragged-red Fibers with a 8344A>G mtDNA Mutation. Intern Med 2018; 57:3439-3443. [PMID: 29984755 PMCID: PMC6306540 DOI: 10.2169/internalmedicine.1210-18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Myoclonus epilepsy associated with ragged-red fibers (MERRF) is traditionally characterized by myoclonus, generalized epilepsy and ragged-red fibers. We herein report a 42-year-old man who complained of falling after starting running, symptoms resembling those of paroxysmal kinesigenic dyskinesia. He showed only slight muscle weakness of the right quadriceps femoris. Muscle pathology and a genetic analysis identified him as having MERRF with a 8344A>G mtDNA mutation. We diagnosed his symptoms as having been caused by slight quadriceps femoris muscle weakness and exercise intolerance. This case suggests that mitochondrial myopathy should be considered in cases with strong muscle symptoms for muscle weakness.
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Affiliation(s)
- Noriyuki Miyaue
- Department of Neurology and Clinical Pharmacology, Ehime University Graduate School of Medicine, Japan
| | - Yuki Yamanishi
- Department of Neurology and Clinical Pharmacology, Ehime University Graduate School of Medicine, Japan
| | - Satoshi Tada
- Department of Neurology and Clinical Pharmacology, Ehime University Graduate School of Medicine, Japan
| | - Rina Ando
- Department of Neurology and Clinical Pharmacology, Ehime University Graduate School of Medicine, Japan
| | - Masahiro Nagai
- Department of Neurology and Clinical Pharmacology, Ehime University Graduate School of Medicine, Japan
| | - Masahiro Nomoto
- Department of Neurology and Clinical Pharmacology, Ehime University Graduate School of Medicine, Japan
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11
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Schwarzer A, Kaisler M, Kipping K, Seybold D, Rausch V, Maier C, Vollert J. Opioid intake prior to admission is not increased in elderly patients with low-energy fractures: A case-control study in a German hospital population. Eur J Pain 2018; 22:1651-1661. [PMID: 29758586 DOI: 10.1002/ejp.1247] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Recent studies revealed an increased prescription rate of opioids for elderly patients suffering bone fractures. To gain further insight, we conducted face-to-face interviews in the present study to compare the opioid intake between patients with low-energy fractures and patients suffering from internal diseases. METHODS In this case-control study, 992 patients, aged 60 years and older, were enrolled between March 2014 and February 2015. The interview comprised a fall and medication history, comorbidities, mobility and other risk factors for fractures. Odds ratios (OR) and a multiple logistic regression model were calculated. RESULTS The number of patients with pre-admission opioid intake in the last 12 months was comparable in the fracture (n = 399, 13.3%) and the control group (n = 593, 14.7% OR: 0.89, CI: 0.62-1.29). The number of patients with current opioid intake of short duration (<3 months) was similar in both groups (14% vs. 20%; OR: 0.66, CI: 0.23-1.93). Patients with opioid intake in the fracture group reported more frequently fatigue as an adverse event of opioid medication (58% vs. 30%; OR: 3.32, CI: 1.48-7.45). Patients with opioid intake showed more severe comorbidities and significantly decreased mobility compared to those without opioids. CONCLUSION Elderly patients internalized due to low-energy fractures did not take opioids more frequently than patients with internal admission, for both short (<3 months) and longer duration intake. Patients with opioid intake were generally in poorer physical condition. The risk of fracture might increase in patients suffering from fatigue as a side effect of opioid medication. SIGNIFICANCE This study is based on face-to-face interviews with patients, including details about side effects and fracture history, providing a more pronounced picture of the relation of opioid intake and risk of fracture.
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Affiliation(s)
- A Schwarzer
- Department of Pain Medicine, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Germany
| | - M Kaisler
- Department of Pain Medicine, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Germany
| | - K Kipping
- Department of Pain Medicine, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Germany
| | - D Seybold
- Department of General and Trauma Surgery, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Germany
| | - V Rausch
- Department of General and Trauma Surgery, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Germany
| | - C Maier
- Department of Pain Medicine, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Germany
| | - J Vollert
- Department of Pain Medicine, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Germany.,Pain Research, Department of Surgery and Cancer, Imperial College London, UK.,Medical Faculty Mannheim, Center of Biomedicine and Medical Technology Mannheim CBTM, Heidelberg University, Germany
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12
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Ackerman IN, Soh SE, Barker AL. Opportunities for cross-disciplinary care partnerships in physiotherapy. J Physiother 2018; 64:69-71. [PMID: 29602749 DOI: 10.1016/j.jphys.2018.02.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Accepted: 02/08/2018] [Indexed: 10/17/2022] Open
Affiliation(s)
- Ilana N Ackerman
- Department of Epidemiology and Preventive Medicine, Monash University
| | - Sze-Ee Soh
- Department of Epidemiology and Preventive Medicine, Monash University; Department of Physiotherapy, Monash University
| | - Anna L Barker
- Department of Epidemiology and Preventive Medicine, Monash University; Medibank Private Limited, Melbourne, Australia
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13
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Paker N, Bugdayci D, Demircioglu UB, Sabirli F, Ozel S. Reliability and validity of the Turkish version of Activities-specific Balance Confidence scale in symptomatic knee osteoarthritis. J Back Musculoskelet Rehabil 2017; 30:461-466. [PMID: 27858674 DOI: 10.3233/bmr-150335] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Activities-specific Balance Confidence (ABC) scale is a well known tool to evaluate the functional balance. Balance impairment may accompany to knee osteoarthritis. OBJECTIVE The aim was to investigate the reliability and validity of the Turkish version of ABC in knee osteoarthritis. METHODS Forty-nine patients with knee osteoarthritis were included. All the participants were evaluated by ABC and Berg Balance Scale (BBS). Knee Injury and Osteoarthritis Outcome Score (KOOS) was used for the assessment of the knee related condition. RESULTS Mean age was 64.7 ± 9.2. Eighty-five percent was women. Mean ABC score was 53.5% and BBS score was 40. Interclass correlation coefficient was 0.95. There was a statistically significant positive correlation between the test-retest results (t= 1.90, p= 0.063). Correlation coefficient was high (p= 0.001, r= 0.953). Cronbach's alpha was 0.97. There was a significant positive correlation between ABC-T and BBS, the symptoms, daily living activities and quality of life subscales of KOOS (r= 0.555, p< 0.001; r= 0.424, r= 0.379, r= 0.621, p< 0.01). ABC-T correlated negatively with the radiological severity (r = -0.316, p< 0.05). CONCLUSIONS ABC-T is a reproducible test with excellent internal consistency and construct validity in knee osteoarthritis. Balance confidence was moderate and related with the symptoms, daily living activities, disease severity and quality of life.
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Affiliation(s)
- Nurdan Paker
- Istanbul Physical Medicine and Rehabilitation Training Hospital, Istanbul, Turkey
| | - Derya Bugdayci
- Istanbul Physical Medicine and Rehabilitation Training Hospital, Istanbul, Turkey
| | | | - Feride Sabirli
- Istanbul Physical Medicine and Rehabilitation Training Hospital, Istanbul, Turkey
| | - Sevda Ozel
- Public Health Department, University of Istanbul School of Medicine, Istanbul, Turkey
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14
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Wada O, Asai T, Hiyama Y, Nitta S, Mizuno K. Root mean square of lower trunk acceleration during walking in patients with unilateral total hip replacement. Gait Posture 2017; 58:19-22. [PMID: 28704684 DOI: 10.1016/j.gaitpost.2017.07.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 07/03/2017] [Accepted: 07/07/2017] [Indexed: 02/02/2023]
Abstract
Although several studies have described abnormal trunk motion before and after total hip arthroplasty (THA) surgery, few studies have examined trunk motion using accelerometry. The aim of this study was to determine whether abnormal trunk motion persisted after THA using accelerometry. A total of 24 female patients (61.0±6.9years) and 20 healthy female subjects (59.9±6.8years) participated in this study. Patients were assessed at 1 month prior to surgery and 12 months after surgery. Trunk acceleration during gait was measured using a triaxial accelerometer attached to the L3 spinous process. We calculated the root mean square (RMS) and RMS ratio (RMSR) in the vertical (VT), medio-lateral (ML), and anterior-posterior (AP) directions. Results revealed that the RMS in the VT and AP directions postoperatively was greater than that preoperatively, whereas there was no difference in the RMS in the ML direction. In addition, the preoperative RMSR in the ML direction was significantly greater compared with that of healthy individuals and the postoperative RMSR. There was no difference in the RMSR in the ML direction between healthy individuals and postoperatively. These findings suggested that the trunk motion in the frontal plane prior to surgery had improved and was comparable to that of healthy individuals following THA.
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Affiliation(s)
- Osamu Wada
- Anshin Hospital, 1-4-12, Minatojima Minamimachi, Chuo-ku, Kobe City, Hyogo, Japan.
| | - Tsuyoshi Asai
- Department of Physical Therapy, Faculty of Rehabilitation, Kobe Gakuin University, 518 Ikawadanicho, Arise, Nishi-ku, Kobe, Hyogo 651-2180, Japan
| | - Yoshinori Hiyama
- Department of Physical Therapy, School of Health Sciences, Tokyo University of Technology, 5-23-22, Nishikamata, Ota-ku, Tokyo, Japan
| | - Shingo Nitta
- Anshin Hospital, 1-4-12, Minatojima Minamimachi, Chuo-ku, Kobe City, Hyogo, Japan
| | - Kiyonori Mizuno
- Anshin Hospital, 1-4-12, Minatojima Minamimachi, Chuo-ku, Kobe City, Hyogo, Japan
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15
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Tanimoto K, Takahashi M, Tokuda K, Sawada T, Anan M, Shinkoda K. Lower limb kinematics during the swing phase in patients with knee osteoarthritis measured using an inertial sensor. Gait Posture 2017; 57:236-240. [PMID: 28668737 DOI: 10.1016/j.gaitpost.2017.06.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 06/11/2017] [Accepted: 06/20/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND During gait, the swing limb requires flexible control to adapt to ever changing environmental circumstances. However, few studies have focused on the mechanics of swing limb control in patients with knee osteoarthritis (OA). Investigating the variability of swing limb kinematics, which can be represented by variables such as the peak shank angular velocity during the swing phase obtained from an inertial sensor, provides insights into the adaptability of swing limb control. The purpose of this study was to investigate how patients with knee OA control the swing limb and whether the degree of impairment and disability due to knee OA affects swing limb control. METHODS Twelve subjects diagnosed with knee OA and 11 healthy control subjects participated in this study. Subjects walked on a treadmill for 10min. The mean, coefficient of variation, and fractal scaling exponent α of the peak shank angular velocity during the swing phase were calculated. FINDINGS There were no significant differences between the groups for any of the kinematic parameters. The Knee Injury and Osteoarthritis Outcome Score (KOOS) activities of daily living (ADL) subsection correlated with the coefficient of variation (r=-0.677, p=0.016) and the scaling exponent α (r=0.604, p=0.037) of the peak shank angular velocity. INTERPRETATION Control of the swing limb was associated with the degree of impairment and disability. Larger and more random variability of peak shank angular velocity may indicate decreased ADL ability in patients with knee OA.
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Affiliation(s)
- Kenji Tanimoto
- Graduate School of Biomedical and Health Sciences, Hiroshima University, 2-3, Kasumi 1-chome, Minami-ku, Hiroshima, 734-8553 Japan
| | - Makoto Takahashi
- Department of Biomechanics, Graduate School of Biomedical and Health Sciences, Hiroshima University, 2-3, Kasumi 1-chome, Minami-ku, Hiroshima, 734-8553 Japan; Center for Advanced Practice and Research of Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, 2-3, Kasumi 1-chome, Minami-ku, Hiroshima, 734-8553 Japan
| | - Kazuki Tokuda
- Graduate School of Biomedical and Health Sciences, Hiroshima University, 2-3, Kasumi 1-chome, Minami-ku, Hiroshima, 734-8553 Japan
| | - Tomonori Sawada
- Graduate School of Biomedical and Health Sciences, Hiroshima University, 2-3, Kasumi 1-chome, Minami-ku, Hiroshima, 734-8553 Japan
| | - Masaya Anan
- Physical Therapy Course, Faculty of Welfare and Health Science, Oita University, 700, Dannoharu, Oita, 870-1192 Japan
| | - Koichi Shinkoda
- Department of Biomechanics, Graduate School of Biomedical and Health Sciences, Hiroshima University, 2-3, Kasumi 1-chome, Minami-ku, Hiroshima, 734-8553 Japan; Center for Advanced Practice and Research of Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, 2-3, Kasumi 1-chome, Minami-ku, Hiroshima, 734-8553 Japan.
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Hill KD, Wee E, Margelis S, Menz HB, Bartlett J, Bergman NR, McMahon S, Hare DL, Levinger P. Falls in people prior to undergoing total hip or total knee replacement surgery: Frequency and associated factors. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.jcgg.2016.03.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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17
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Phelan EA, Aerts S, Dowler D, Eckstrom E, Casey CM. Adoption of Evidence-Based Fall Prevention Practices in Primary Care for Older Adults with a History of Falls. Front Public Health 2016; 4:190. [PMID: 27660753 PMCID: PMC5014854 DOI: 10.3389/fpubh.2016.00190] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 08/23/2016] [Indexed: 11/13/2022] Open
Abstract
A multifactorial approach to assess and manage modifiable risk factors is recommended for older adults with a history of falls. Limited research suggests that this approach does not routinely occur in clinical practice, but most related studies are based on provider self-report, with the last chart audit of United States practice published over a decade ago. We conducted a retrospective chart review to assess the extent to which patients aged 65+ years with a history of repeated falls or fall-related health-care use received multifactorial risk assessment and interventions. The setting was an academic primary care clinic in the Pacific Northwest. Among the 116 patients meeting our inclusion criteria, 48% had some type of documented assessment. Their mean age was 79 ± 8 years; 68% were female, and 10% were non-white. They averaged six primary care visits over a 12-month period subsequent to their index fall. Frequency of assessment of fall-risk factors varied from 24% (for home safety) to 78% (for vitamin D). An evidence-based intervention was recommended for identified risk factors 73% of the time, on average. Two risk factors were addressed infrequently: medications (21%) and home safety (24%). Use of a structured visit note template independently predicted assessment of fall-risk factors (p = 0.003). Geriatrics specialists were more likely to use a structured note template (p = 0.04) and perform more fall-risk factor assessments (4.6 vs. 3.6, p = 0.007) than general internists. These results suggest opportunities for improving multifactorial fall-risk assessment and management of older adults at high fall risk in primary care. A structured visit note template facilitates assessment. Given that high-risk medications have been found to be independent risk factors for falls, increasing attention to medications should become a key focus of both public health educational efforts and fall prevention in primary care practice.
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Affiliation(s)
- Elizabeth A Phelan
- Department of Medicine, Division of Gerontology and Geriatric Medicine, School of Medicine, University of Washington, Seattle, WA, USA; Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA
| | - Sally Aerts
- Violence and Injury Prevention Program, Utah Department of Health , Salt Lake City, UT , USA
| | - David Dowler
- Program Design and Evaluation Services, Multnomah County Health Department, Oregon Health Authority , Portland, OR , USA
| | - Elizabeth Eckstrom
- Division of General Internal Medicine and Geriatrics, School of Medicine, Oregon Health and Science University , Portland, OR , USA
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18
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Zheng X, Wan Q, Jin X, Huang H, Chen J, Li Y, Zou B, Shang S. Fall efficacy and influencing factors among Chinese community-dwelling elders with knee osteoarthritis. Int J Nurs Pract 2016; 22:275-83. [PMID: 27245265 DOI: 10.1111/ijn.12423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 12/07/2015] [Accepted: 12/18/2015] [Indexed: 11/29/2022]
Abstract
Low fall efficacy can lead to activity restriction and loss of independence, which may cause severe adverse consequences. The purpose of this study was to explore fall efficacy among elders with knee osteoarthritis and influential factors in three communities in Beijing, China. A correlational descriptive study design was used with a sample of 117 participants from July 2014 to November 2014. Results showed that participants had low fall efficacy and that fall efficacy correlated with age, gender, body mass index, marital status, education, disease duration, frequency of falls, number of co-morbidities, pain, stiffness, physical function, depression, lower-extremity muscle strength and balance (r = -0.594 to 0.234, P < 0.05 to 0.001). Multiple regression analysis revealed that 52% of variance in fall efficacy was explained by fall frequency, age, body mass index, gender, pain and balance function. Findings suggest that strategies to prevent falls, reduce body weight, improve effective pain management and enhance balance function may improve fall efficacy in this population.
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Affiliation(s)
- Xiaoyan Zheng
- School of Nursing, Peking University, Beijing, China
| | - Qiaoqin Wan
- School of Nursing, Peking University, Beijing, China
| | - Xiaoyan Jin
- School of Nursing, Peking University, Beijing, China
| | - Hongjie Huang
- Institute of Sports Medicine, Peking University Third Hospital, Beijing, China
| | - Jiewen Chen
- Ganjiakou Community Hospital, Beijing, China
| | - Yanyun Li
- Nanshao Community Hospital, Beijing, China
| | - Baohong Zou
- Zhongguancun Community Hospital, Beijing, China
| | - Shaomei Shang
- School of Nursing, Peking University, Beijing, China
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Lin X, Meijer OG, Lin J, Wu W, Lin X, Liang B, van Dieën JH, Bruijn SM. Frontal plane kinematics in walking with moderate hip osteoarthritis: Stability and fall risk. Clin Biomech (Bristol, Avon) 2015; 30:874-80. [PMID: 26052069 DOI: 10.1016/j.clinbiomech.2015.05.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Revised: 05/15/2015] [Accepted: 05/18/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Hip abductor weakness and unilateral pain in patients with moderate hip osteoarthritis may induce changes in frontal plane kinematics during walking that could affect stability and fall risk. METHODS In 12 fall-prone patients with moderate hip osteoarthritis, 12 healthy peers, and 12 young controls, we assessed the number of falls in the preceding year, hip abductor strength, fear of falling, Harris Hip Score, and pain. Subjects walked on a treadmill with increasing speeds, and kinematics were measured opto-electronically. Parameters reflecting gait stability and regressions of frontal plane center of mass movements on foot placement were calculated. We analyzed the effects of, and interactions with group, and regression of all variables on number of falls. FINDINGS Patients walked with quicker and wider steps, stood shorter on their affected leg, and had larger peak speeds of frontal plane movements of the center of mass, especially toward their unaffected side. Patients' static margins of stability were larger, but the unaffected dynamic margin of stability was similar between groups. Frontal plane position and acceleration of the center of mass predicted subsequent step width. The peak speed of frontal plane movements toward unaffected had 55% common variance with number of falls, and adding the Harris Hip Score into bivariate regression led to 83% "explained" variance. INTERPRETATION Quickening and widening steps probably increase stability. Shorter affected side stance time to avoid pain, and/or weakened affected side hip abductors, may lead to faster frontal plane trunk movements toward the unaffected side, which could contribute to fall risk.
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Affiliation(s)
- XiaoBin Lin
- First Clinical College of Fujian Medical University, Fuzhou, Fujian, PR China; Department of Orthopaedics, Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, PR China; Department of Orthopaedics, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, PR China; Orthopaedic Biomechanics Laboratory, Fujian Medical University, Quanzhou, Fujian, PR China
| | - Onno G Meijer
- Orthopaedic Biomechanics Laboratory, Fujian Medical University, Quanzhou, Fujian, PR China; MOVE Research Institute Amsterdam, Faculty of Human Movement Sciences, VU University, Amsterdam, The Netherlands.
| | - JianHua Lin
- First Clinical College of Fujian Medical University, Fuzhou, Fujian, PR China; Department of Orthopaedics, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, PR China.
| | - WenHua Wu
- Department of Orthopaedics, Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, PR China; Orthopaedic Biomechanics Laboratory, Fujian Medical University, Quanzhou, Fujian, PR China
| | - XiaoCong Lin
- Department of Orthopaedics, Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, PR China; Orthopaedic Biomechanics Laboratory, Fujian Medical University, Quanzhou, Fujian, PR China
| | - BoWei Liang
- Orthopaedic Biomechanics Laboratory, Fujian Medical University, Quanzhou, Fujian, PR China; Department of Orthopaedics, The 175th Hospital of PLA, Affiliated Dongnan Hospital of Xiamen University, Zhangzhou, Fujian, PR China
| | - Jaap H van Dieën
- MOVE Research Institute Amsterdam, Faculty of Human Movement Sciences, VU University, Amsterdam, The Netherlands
| | - Sjoerd M Bruijn
- Department of Orthopaedics, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, PR China; MOVE Research Institute Amsterdam, Faculty of Human Movement Sciences, VU University, Amsterdam, The Netherlands
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Abstract
Exercise is recommended for the management of osteoarthritis (OA) in all clinical guidelines irrespective of disease severity, pain levels, and functional status. For knee OA, evidence supports the benefits of various types of exercise for improving pain and function in the short term. However, there is much less research investigating the effects of exercise in patients with OA at other joints such as the hip and hand. It is important to note that while the magnitude of exercise benefits may be considered small to moderate, these effects are comparable to reported estimates for simple analgesics and oral nonsteroidal anti-inflammatory drugs for OA pain but exercise has much fewer side effects. Exercise prescription should be individualized based on assessment findings and be patient centered involving shared decision making between the patient and clinician. Given that patient adherence to exercise declines over time, appropriate attention should be pain as reduced adherence attenuates the benefits of exercise. Given this, barriers and facilitators to exercise should be identified and strategies to maximize long-term adherence to exercise implemented.
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Fraser LA, Adachi JD, Leslie WD, Goltzman D, Josse R, Prior J, Kaiser S, Kreiger N, Kovacs CS, Anastassiades TP, Papaioannou A. Effect of Anticholinergic Medications on Falls, Fracture Risk, and Bone Mineral Density Over a 10-Year Period. Ann Pharmacother 2014; 48:954-961. [PMID: 24816210 DOI: 10.1177/1060028014535363] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Many medications used in older adults have strong anticholinergic (ACH) properties, which may increase the risk of falls and fractures. Use of these medications was identified in a population-based Canadian cohort. OBJECTIVE To identify the fall and fracture risk associated with ACH medication use. METHODS Data collection and analysis were conducted at baseline, year 5, and year 10. Cross-sectional analyses were performed to examine associations between ACH medication use and falls. Time-dependent Cox regression was used to examine time to first nontraumatic fracture. Finally, change in bone mineral density (BMD) over 10 years was compared in ACH medication users versus nonusers. RESULTS Strongly ACH medications were used by 618 of 7753 participants (8.0%) at study baseline, 592 (9.5%) at year 5, and 334 (7.7%) at year 10. Unadjusted ACH medication use was associated with falls at baseline (odds ratio = 1.50; 95% CI = 1.14-1.98; P = 0.004), but the association was no longer significant after covariate adjustment. Similar results occurred at years 5 and 10. ACH medication use was associated with increased incident fracture risk before (hazard ratio = 1.22; CI = 1.13-1.32; P < 0.001) but not after covariate adjustment. Mean (SD) change in femoral neck BMD T-score over 10 years, in those using ACH medications at both years 0 and 5, was -0.60 (0.63) in ACH users versus -0.49 (0.45) in nonusers (P = 0.041), but this was not significant after covariate adjustment. CONCLUSIONS ACH medications were not found to be independently associated with an increased risk of falling, fractures, or BMD loss. Rather, factors associated with ACH medication use explained the apparent associations.
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Vennu V, Bindawas SM. Relationship between falls, knee osteoarthritis, and health-related quality of life: data from the Osteoarthritis Initiative study. Clin Interv Aging 2014; 9:793-800. [PMID: 24855348 PMCID: PMC4020882 DOI: 10.2147/cia.s62207] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The purpose of this study was to examine the relationship between self-reported falls, doctor-diagnosed knee osteoarthritis (OA), and health-related quality of life (HRQoL). We hypothesized that falls and knee OA would be associated with poor HRQoL on both disease-specific and generic measures. METHODS This cross-sectional study used data from the publicly available Osteoarthritis Initiative data sets. A total of 4,484 subjects aged 45-79 years at baseline were divided into three subpopulations: those who had neither a history of falling nor doctor-diagnosed knee OA; those who had either a self-reported history of falling or doctor-diagnosed knee OA; and those who had both a self-reported history of falling and doctor-diagnosed knee OA. HRQoL was assessed using both disease-specific and generic measures. Multiple regression analyses were used to examine the relationship between self-reported falls, doctor-diagnosed knee OA, and HRQoL assessed using the Knee Injury and Osteoarthritis Outcome Score-Quality of Life (KOOS-QoL) subscale and two Short Form-12 (SF-12) summary scales. The models were adjusted for participant sociodemographic, lifestyle, and clinical characteristics. RESULTS Falls and knee OA were significantly associated with lower scores on the KOOS-QoL (β= -34.4, standard error 2.27, P≤0.0001) and on the physical component scale of the SF-12 (β= -9.44, standard error 0.90, P<0.0001). No significant relationship was found with the mental component scale score when adjusted for sociodemographic, lifestyle, and clinical characteristics. CONCLUSION When compared with those having neither a self-reported history of falling nor doctor-diagnosed knee OA and those with a self-reported history of falling or doctor-diagnosed knee OA, persons with both conditions (falls and knee OA) had significantly lower KOOS-QoL and physical component scale scores after adjusting for sociodemographic, lifestyle, and clinical characteristics. Future research should assess potential mediating factors in an effort to improve HRQoL in persons with knee OA who are at high risk of falling.
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Affiliation(s)
- Vishal Vennu
- Department of Rehabilitation Science, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Saad M Bindawas
- Department of Rehabilitation Science, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
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24
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Sibley KM. Clinician's Commentary on Arnold and Gyurcsik(1.). Physiother Can 2013; 64:315-6. [PMID: 23729968 DOI: 10.3138/ptc.2011-12-cc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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