Static and Dynamic Balance Disorders in Patients With Rheumatoid Arthritis and Relationships With Lower Extremity Function and Deformities: A Prospective Controlled Study

Investigation of lower extremity performance, balance, and fatigue in individuals with systemic lupus erythematosus: A comparative study

BACKGROUND

The aim of this study was to investigate lower extremity performance, balance, fatigue and pain in individuals with Systemic Lupus Erythematosus and compare them with healthy controls.

METHODS

41 participants (Systemic Lupus Erythematosus n = 21 and mean age = 38.33 ± 13.37; healthy group n = 20 and mean age = 38.95 ± 12.62 years) were included in the study. Lower extremity performance was evaluated with timed up and go test and 30 s sit-to-stand test, static and dynamic balance with Sensamove Miniboard, fatigue levels with Visual Analog Scale and Fatigue Severity Scale and pain intensity with Visual Analog Scale.

FINDINGS

Significant differences were found in favor of the healthy group in the sit-to-stand test (p = 0.001), timed up and go test (p = 0.001), static balance-center (p = 0.020), front (p = 0.001), back (p = 0.002), left (p = 0.001), right (p = 0.001); proprioception-left (p = 0.004), reaction time-front (p = 0.002) and left (p = 0.016); travel time-front (p = 0.001), back (p = 0.001), left (p = 0.001) and right (p = 0.001), Fatigue Severity Scale (p = 0.001); Visual Analog Scale-fatigue (p = 0.001) and Visual Analog Scale-pain (p = 0.001). In Systemic Lupus Erythematosus, timed up and go test had low correlation with travel time-back (r = -0.449; p = 0.041). Visual Analog Scale-fatigue had low correlation with proprioception-left (r = 0.484; p = 0.026) and proprioception-right (r = 0.461; p = 0.035). Visual Analog Scale-pain had moderate correlation with proprioception-back (r = 0.521; p = 0.015) and low correlation with proprioception-right (r = 0.441; p = 0.045).

INTERPRETATION

Compared to healthy, individuals with Systemic Lupus Erythematosus had worse lower extremity performance, static/dynamic balance, fatigue, and pain. Dynamic balance-back was related to lower extremity performance. Fatigue was related to left-right proprioception, and pain was related to back-right proprioception.

Comparison of balance and proprioception of the shoulder joint in girls with and without upper cross syndrome

INTRODUCTION

Upper cross syndrome is one of the most common disorders of the upper part of body, often associated with abnormalities of forward head, forward shoulders, elevated and protracted of scapula, and increased thoracic kyphosis. Conducting research on upper cross syndrome, especially in girls, is of highly significant, considering this issue and lack of examination of complications and consequences of this syndrome; therefore, this study aims to compare the balance and proprioception of the shoulder joint in girls with and without upper cross syndrome.Method The statistical population included two groups of 10-12-year-old female students, i.e., healthy and those with upper cross syndrome in the city of Khalkhal in Iran in 2022-2023. A total of 60 girl children were included in this study. The subjects were screened using a checker board and after quantitative evaluations of posture, they were assigned into two groups: healthy group (No. 30) and the one suffering from upper cross syndrome (No. 30). Forward head and forward shoulder angle were assessed using photography and kinovea software, kyphosis angle using Goniometer-pro app, static and dynamic balance using BESS and Y tests, also proprioception at angles of 45- and 80-degrees external rotation of the shoulder joint through photography and kinovea software. Data were analyzed through independent t-test in SPSS software version 26 at the significance level of 0.05.Results Healthy girls were in a better position in all variables of static balance (1.14 95% CI: [0.96, 1.70], p = 0.001), dynamic balance (0.81, 95% CI: [0.73,1.24], p = 0.001), proprioception of external rotation of shoulder joint at 45- (0.78, 95% CI: [0.64, 1.14], p = 0.001) and 80-degrees (0.89, 95% CI: [0.59, 1.34], p = 0.001) angles than those with upper cross syndrome.Conclusion It can be concluded that upper cross syndrome causes a decrease in balance and proprioception of the shoulder joint in female students; therefore, along with correcting the abnormalities, special attention should be paid to strengthening and improving these components. It is recommended for rehabilitation professionals to apply exercise training programs to improve the balance and proprioception and correct of the upper cross syndrome: that the strengthening of these components prevents musculoskeletal disorders.Implications for clinical practice• It is recommended for rehabilitation professionals to apply exercise training programs to improve the balance and proprioception of individual with upper cross syndrome.• It is recommended for rehabilitation professionals to apply exercise training programs to correct of the upper cross syndrome in order to prevents musculoskeletal disorders.

Atlantoaxial Instability in the Course of Rheumatoid Arthritis in Relation to Selected Parameters of Sagittal Balance

Background: Atlantoaxial instability is the most common cervical instability in patients with rheumatoid arthritis (RA). Its course may differ in different patients and may have different degrees of severity and symptoms. Methods: There are a number of studies on systemic factors associated with the development of this instability, but there are few publications in the scientific literature on the influence of biomechanical factors on the development of cervical instability. One of the areas that allows the study of biomechanical factors influencing spine pathologies is the analysis of sagittal balance using radiological parameters. The study of radiological parameters of sagittal balance has contributed to understanding the pathology of selected spine diseases and is currently an indispensable tool in planning surgical treatment. Results: The presented study, conducted on a group of RA patients with cervical instability, was performed to look for a relationship between C1-C2 instability and sagittal balance parameters. Conclusions: Among the examined selected parameters, a statistically relationship between C1-C2 instability and the Cobb angle C1-C7 and OD-HA parameters has been found. This confirms the need for further in-depth research on this areas.

The validity and reliability of the Turkish version of the Arthritis Impact Measurement Scale 2-Short Form (AIMS2-SF) for rheumatoid arthritis

The objective of this study is to investigate the validity and reliability of the Turkish version of the Arthritis Impact Measurement Scale 2-Short Form (AIMS2-SF). Subjects fulfilling the ACR 2010 classification criteria for RA were enrolled into the study. Scale reliability was investigated using test-retest reliability (intra-class correlation coefficient-ICC) and internal consistency approaches (Cronbach's α). Spearman's rank correlation coefficients evaluated relationships between quantitative parameters and validity. Construct validity was assessed by correlating AIMS2-SF with clinical parameters and functional parameters including, Nottingham Health Profile (NHP), Health Assessment Questionnaire (HAQ), Beck Depression Inventory (BDI) and Duruöz Hand Index (DHI). One hundred and sixteen patients (105 females and 11 males) were recruited. The mean age ± standard deviation (SD) was 52.45 ± 11.48 years. Cronbach's α was 0.88 and the ICC was 0.91. There were significant correlations (rho and p values) with parameters directly related to health-related quality of life (HRQoL); NHP subscales (energy levels: 0.54, pain: 0.62, emotional reaction: 0.50, sleep 0.44, social interaction: 0.51, physical activity: 0.61; p < 0.0005), HAQ (0.60, p < 0.0005), BDI (0.63, p < 0.001) and DHI (0.63, p < 0.0005). Poor or non-significant correlations were found for parameters not directly related to QoL, such as age (0.07, p = 0.45) and disease duration (0.12, p = 0.21); however, disease activity (0.43, p < 0.0005) and NRS pain (0.46, p < 0.0005) were correlated with AIMS2-SF as moderate. The Turkish AIMS2-SF version is a reliable and valid tool that may be used to evaluate QoL for RA. The scale can be easily used in daily practice.

What Influences Proprioceptive Impairments in Patients with Rheumatic Diseases? Analysis of Different Factors

Rheumatic diseases lead to postural problems, which increase the risk of falls and lead to greater disability. The aim of the present work is to evaluate posture disorders in patients with osteoarthritis (OA) and rheumatoid arthritis (RA), as well as to evaluate the influence of other factors. A total of 71 subjects were enrolled in this study. Joint position sense (JPS) and the functional assessment of proprioception on a balance platform for both lower limbs were examined. The Average Trace Error (ATE), test time (t), and Average Platform Force Variation (AFV) were calculated. Additionally, an equilibrium test was carried out in the one-legged standing position (Single Leg Stance-SLS). The results were compared in several ways and revealed the following: (1) A JPS of 10° plantar flexion in RA obtained significantly worse results when repeating the movement than OA; the ATEs were significantly lower in RA; and RA needed more support during SLS assessment. (2) RA patients with higher DAS28 had statistically significantly higher values in JPS, with 5° plantar flexion and 10° dorsal flexion, SLS assessment, and stabilometric rates. A statistically significant correlation between DAS28 and RA was found in a JPS of 10° plantar flexion. The VAS ruler demonstrated a significant moderate correlation with t. (3) Patients who experienced at least one fall demonstrated higher JPS and t. Our study shows that proprioception is the most influenced by the nature of the disease and the level of disease activity. We can see that the stability and balance functions are also greatly influenced by the patient's falling experience and the level of pain. These findings may be useful in designing an optimal proprioception-enhancing movement training plan.

Relationship between Kinesiophobia, Foot Pain and Foot Function, and Disease Activity in Patients with Rheumatoid Arthritis: A Cross-Sectional Study

The main objective of the present study was to determine the relationship between kinesiophobia and pain (general and foot pain), foot function, and disease activity in patients with rheumatoid arthritis (RA). A total of 124 interviews were carried out with participants with RA. Participants were recruited from the Hospital Universitario Virgen de las Nieves de Granada in Spain. Interviews took place in January 2021. Participants completed the following questionnaires during an appointment with their rheumatologist: Foot Function Index (FFI), Tampa Scale for Kinesiophobia (TSK-11), and the Visual Analogue Scale Pain foot (VAS Pain). Furthermore, the Simplified Disease Activity Index (SDAI) was used to measure disease activity. Of the 124 participants, 73% were women, and their mean age was 59.44 years (SD 11.26 years). In the statistical analysis, positive linear correlations (p < 0.001) were obtained between the variables TSK-11 and VAS (related to general pain or foot pain) and FFI (in its three subscales). Additionally, a negative correlation between the TSK-11 and the educational background was shown. This study provided information about the relationship between foot function and pain with different levels of kinesiophobia in patients with RA. Additionally, the educational background of the patient was considered a predictor of whether or not a patient suffered from kinesiophobia.

Comparison of hallux valgus deformed ballerinas and sedentary individuals in terms of balance parameters

BACKGROUND

We aimed to compare static and dynamic balance parameters and health quality parameters in ballerina and non-ballerina adolescents with hallux valgus deformity.

METHODS

Forty five volunteer female adolescent ballet students between the ages of 7 and 17, with hallux valgus were recruited. Group 1 = in the control group, 31 sedentary adolescents with hallux valgus were included. Group 2 = Romberg test and Flamingo test were used for static balance. The SEBT (Star Excursion Balance Test) was used to measure dynamic balance.

RESULTS

Age, sex, and body mass index (BMI) characteristics were similar between ballerina and control groups (P < .05). The Romberg test stands upright with closed eyes, with a significant difference 47.22 in group 1 and 38.13 in group 2. In contrast there was a significant difference between the two groups in the Romberg test single limb with eyes open and closed. For open eyes single limb test mean score was 55.06 in ballerinas and 44.2 in sedentary group, similarly single limb test with closed eyes mean score was 25.68 in group 1 and 18.67 in group 2.

CONCLUSION

In conclusion, the results of this study show that ballerinas have better single-limb and closed-eye balance than sedentary individuals with HV deformities.

Balance and prospective falls in patients with rheumatoid arthritis

Background

Postural control is associated with fall risk. Patients with rheumatoid arthritis (RA) have a higher risk to fall than healthy subjects. The objective of this study was to identify associations between variables of postural control with prospective falls in patients with RA.

Methods

For the baseline, the balance performance of 289 men and women with RA, ages 24–85 years, was evaluated by SPPB, FICSIT-4 and Romberg tests. Postural sway for Romberg, semitandem, tandem and one-leg stands were measured with the Leonardo Mechanograph®. Self-reported disability was assessed using the Health Assessment Questionnaire (HAQ) and the Activity-specific Balance Confidence Scale (ABC-scale). Falls were reported in quarterly reports over a year. Univariate and multiple logistic regression analysis were used to explore any associations with falling. Receiver-operating characteristics were determined, and the area under the curve is reported.

Results

A total of 238 subjects completed the 1-year follow-up, 48 (20.2%) experienced at least one fall during the observational period. Age (OR = 1.04, CI 1.01–1.07), HAQ (OR = 1.62, 1.1–2.38), FICSIT-4 scoring 0–4 (OR = 2.38, 1.13–5.0), and one-leg standing (OR = 2.14, 1.06–4.31) showed significant associations with falls. With regard to the SPPB and ABC-scale, no statistically significant associations with falls were found. The quartiles containing the worst results of medio-lateral sway of Romberg (OR = 2.63, CI 1.03–6.69), total sway of semitandem (OR = 3.07, CI 1.10–8.57) and tandem (OR = 2.86, CI 1.06–7.69), and area of sway of semitandem (OR = 2.80, CI 1.11–7.08) stands were associated with falls.

Conclusions

The assessment of a one-leg stand seems to be a good screening tool to discriminate between high and low risk of falls in RA patients in clinical practice. A low FICSIT-4 score and several sway parameters are important predictors of falls.

Trial registration

The study has been registered at the German Clinical Trials Register and the WHO International Clinical Trials Registry Platform (ICTRP) since 16 March 2017 (DRKS00011873).

Effects of a Short-Term Slackline Training Program on Energy Expenditure and Balance in Healthy Young Adults: A Preliminary Report of a Randomized Controlled Trial

The development of technology and a fast-paced lifestyle has caused a significant decrease in physical activity, especially among young people. These worrying trends can be countered by the use of attractive forms of physical recreation, including the increasingly popular slackline. The aim of this study was to evaluate energy expenditure during slackline training and to analyze changes in dynamic and static balance parameters after supervised slackline training sessions. The study enrolled 28 healthy volunteers (14 men and 14 women aged 21−25) who were randomly divided into two groups: experimental and passive control. The energy expenditure level was the primary outcome and was assessed using the SenseWear Armband. Each participant underwent an initial and final balance assessment using two selected protocols on the Balance Master platform. The intervention lasted 5 days, with 15 min of supervised training per day. The average energy expenditure expressed in MET was 6.0 (±0.7) MET per training session. An analysis of the results regarding static and dynamic balance showed that the group participating in slackline training significantly improved stability on foam surfaces with their eyes open (p < 0.003), as well as tandem walk speeds (p < 0.05), both with small effect sizes. The results suggested that slackline training has the potential to produce significant positive effects on general health statuses following the World Health Organization’s (WHO) recommendations on physical activity. The significant improvement in task-specific balance suggests that slackline training could become an important element of the prevention and rehabilitation of many injuries.

Morpho-structural characteristics of feet in patients with rheumatoid arthritis: A cross sectional study

Objective: The aim of this study was to evaluate and classify the types and incidences of foot deformities in patients with Rheumatoid Arthritis (RA). Methods: A cross-sectional study with convenience sample was obtained of 220 patients with foot pain and RA classification criteria (approved by the American College of Rheumatology and the European League against Rheumatism in 2010). A series of outcomes were assessed to measure the morphological characteristics of the feet. The Foot Posture Index (FPI), the Manchester Scale of Hallux Valgus and the Nijmegen classification of forefoot disorders were assessed. Results: The most common foot posture according to the FPI assessment are the pronated position in the left foot (32.7% of participants) and the neutral position in the right foot (34.1% of participants). The disease progression causes more developed and serious foot deformities. 1.82% of patients present a severe level of Hallux Valgus before 10 years of disease evolution whereas 4.09% of patients present a severe level of Hallux Valgus after 10 years of disease evolution. Conclusions: The most common foot type in patients with RA is the pronated foot type with deformities in the MTP joints without Hallux Valgus. However, a percentage of patients with RA presents supinated foot type. The evolution of the disease shows some morphological changes in terms of patient's feet. The presence of more developed foot deformities is increased, such us Hallux Valgus or MTP joints deformity (Grade 3 in the Nijmegen classification scale).

The evaluation of the static and dynamic balance disorders in patients with psoriatic arthritis

To evaluate the static and dynamic balances in psoriatic arthritis (PsA) and to investigate their relationship with clinical and functional parameters. Patients diagnosed with PsA and healthy controls were recruited consecutively into the study. The demographic variables such as age, sex, body mass index of the subjects were noted. Radiographic images were examined for the detection of foot deformities. 'Foot and Ankle Outcome Score' (FAOS) was used to assess foot function. The dynamic and static balance of the patients was evaluated by 'Berg Balance Scale' (BBS) and 'Neurocom Balance Master' device. The fatigue (Multidimensional Assessment of Fatigue: MAF), depression (Beck Depression Inventory: BDI) and sleep disorders (Pittsburgh Sleep Quality Index: PSQI) of all patients were evaluated. This study included 50 PsA patients and 50 healthy controls with mean ages of 45.02 (SD 12.81) and 45.12 (SD 10.56), respectively. Demographic data of both groups were similar. Concerning the balance tests, there were significant differences (p < 0.05) between patient and control groups about the all tests of sway velocity (except on foam surface eyes closed test), end sway of tandem walk test, movement time of bilateral step up over test and lift up index of left step up over test. There was no significant correlation between static and dynamic balance parameters with MAF, BDI, PSQI, foot deformities and FAOS. The static and dynamic balance impairments are seen in PsA. As the balance parameters had no significant correlation with functional and clinical data, they are acceptable as independent parameters during the course of the disease.