Reduced strength, poor balance and concern about falls mediate the relationship between knee pain and fall risk in older people

Abstract Aims Pain is an independent risk factor for falling. One in two older community-dwelling people with musculoskeletal pain fall each year. This study examined physical, psychological and medical factors as potential mediators to explain the relationship between knee pain and falls.Methods Three hundred and thirty-three community-dwelling people aged 70+ years (52% women) participated in this cohort study with a 1-year follow-up for falls. Participants completed questionnaires (medical history, general health and concern about falls) and underwent physical performance tests. Participants were classified into ‘pain’ and ‘no pain’ groups based on self-reported knee pain. Poisson Regression models were computed to determine the Relative Risk (RR) of having multiple falls and potential mediators for increased fall risk.Results One hundred and eighteen (35.5%) participants were categorised as having knee pain. This group took more medications and had more medical conditions (P <0.01) compared to the no pain group. The pain group had poorer balance, physical function and strength and reported increased concern about falls. Sixty one participants (19.5%) reported ≥ 2 falls, with the pain group twice as likely to experience multiple falls over the 12 month follow up (RR = 2.0, 95% confidence interval (CI) = 1.27 – 3.13). Concern about falls, knee extension torque and postural sway with eyes closed were identified as significant and independent mediators of fall risk, and when combined explained 23% of the relationship between knee pain and falls.Conclusion This study has identified several medical, medication, psychological, sensorimotor, balance and mobility factors to be associated with knee pain, and found the presence of knee pain doubles the risk of multiple falls in older community living people. Alleviating knee pain, as well as addressing associated risk factors may assist in preventing falls in older people with knee pain.

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Reduced strength, poor balance and concern about falls mediate the relationship between knee pain and fall risk in older people

10.21203/rs.2.12970/v1 ◽

2019 ◽

Author(s):

Cameron J Hicks ◽

Pazit Levinger ◽

Jasmine C Menant ◽

Stephen R Lord ◽

Perminder S Sachdev ◽

...

Keyword(s):

Older People ◽

Knee Pain ◽

Fall Risk ◽

Postural Sway ◽

Knee Extension ◽

Community Dwelling ◽

Pain Group ◽

Eyes Closed ◽

The Relationship

Abstract Aims Pain is an independent risk factor for falling. One in two older community-dwelling people with musculoskeletal pain fall each year. This study examined physical, psychological and medical factors as potential mediators to explain the relationship between knee pain and falls. Methods Three hundred and thirty-three community-dwelling people aged 70+ years (52% women) participated in this cohort study with a 1-year follow-up for falls. Participants completed questionnaires (medical history, general health and concern about falls) and underwent physical performance tests. Participants were classified into ‘pain’ and ‘no pain’ groups based on self-reported knee pain. Poisson Regression models were computed to determine the Relative Risk (RR) of having multiple falls and potential mediators for increased fall risk. Results One hundred and eighteen (35.5%) participants were categorised as having knee pain. This group took more medications and had more medical conditions (P <0.01) compared to the no pain group. The pain group had poorer balance, physical function and strength and reported increased concern about falls. Sixty one participants (19.5%) reported ≥ 2 falls, with the pain group twice as likely to experience multiple falls over the 12 month follow up (RR = 2.0, 95% confidence interval (CI) = 1.27 – 3.13). Concern about falls, knee extension torque and postural sway with eyes closed were identified as significant and independent mediators of fall risk, and when combined explained 23% of the relationship between knee pain and falls. Conclusion This study has identified several medical, medication, psychological, sensorimotor, balance and mobility factors to be associated with knee pain, and found the presence of knee pain doubles the risk of multiple falls in older community living people. Alleviating knee pain, as well as addressing associated risk factors may assist in preventing falls in older people with knee pain.

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Reduced strength, poor balance and concern about falls mediate the relationship between knee pain and fall risk in older people

10.21203/rs.2.12970/v3 ◽

2020 ◽

Author(s):

Cameron J Hicks ◽

Pazit Levinger ◽

Jasmine C Menant ◽

Stephen R Lord ◽

Perminder S Sachdev ◽

...

Keyword(s):

Older People ◽

Knee Pain ◽

Fall Risk ◽

Postural Sway ◽

Knee Extension ◽

Community Dwelling ◽

Pain Group ◽

Eyes Closed ◽

The Relationship

Abstract Aims Pain is an independent risk factor for falling. One in two older community-dwelling people with musculoskeletal pain fall each year. This study examined physical, psychological and medical factors as potential mediators to explain the relationship between knee pain and falls. Methods Three hundred and thirty-three community-dwelling people aged 70+ years (52% women) participated in this cohort study with a 1-year follow-up for falls. Participants completed questionnaires (medical history, general health and concern about falls) and underwent physical performance tests. Participants were classified into ‘pain’ and ‘no pain’ groups based on self-reported knee pain. Poisson Regression models were computed to determine the Relative Risk (RR) of having multiple falls and potential mediators for increased fall risk. Results One hundred and eighteen (35.5%) participants were categorised as having knee pain. This group took more medications and had more medical conditions (P <0.01) compared to the no pain group. The pain group had poorer balance, physical function and strength and reported increased concern about falls. Sixty one participants (19.5%) reported ≥ 2 falls, with the pain group twice as likely to experience multiple falls over the 12 month follow up (RR = 2.0, 95% confidence interval (CI) = 1.27 – 3.13). Concern about falls, knee extension torque and postural sway with eyes closed were identified as significant and independent mediators of fall risk, and when combined explained 23% of the relationship between knee pain and falls. Conclusion This study has identified several medical, medication, psychological, sensorimotor, balance and mobility factors to be associated with knee pain, and found the presence of knee pain doubles the risk of multiple falls in older community living people. Alleviating knee pain, as well as addressing associated risk factors may assist in preventing falls in older people with knee pain.

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Short-term balance training and acute effects on postural sway in balance-deficient older adults: a randomized controlled trial

BMC Sports Science Medicine and Rehabilitation ◽

10.1186/s13102-021-00251-x ◽

2021 ◽

Vol 13 (1) ◽

Author(s):

Niklas Sörlén ◽

Andreas Hult ◽

Peter Nordström ◽

Anna Nordström ◽

Jonas Johansson

Keyword(s):

Older Adults ◽

Postural Sway ◽

Intervention Group ◽

Community Dwelling ◽

Control Group ◽

Positive Effects ◽

Randomized Controlled ◽

Eyes Closed ◽

Balance Exercise

Abstract Background We aimed to determine the effectiveness of 4 weeks of balance exercise compared with no intervention on objectively measured postural sway. Methods This was a single-center parallel randomized controlled, open label, trial. A six-sided dice was used for allocation at a 1:1-ratio between exercise and control. The trial was performed at a university hospital clinic in Sweden and recruited community-dwelling older adults with documented postural instability. The intervention consisted of progressively challenging balance exercise three times per week, during 4 weeks, with follow-up at week five. Main outcome measures were objective postural sway length during eyes open and eyes closed conditions. Results Sixty-five participants aged 70 years (balance exercise n = 32; no intervention n = 33) were randomized. 14 participants were excluded from analysis because of early dropout before follow-up at week five, leaving 51 (n = 22; n = 29) participants for analysis. No significant differences were detected between the groups in any of the postural sway outcomes. Within-group analyses showed significant improvements in hand grip strength for the intervention group, while Timed Up & Go improvements were comparable between groups but only statistically significant in the control group. Conclusions Performing balance exercise over a four-week intervention period did not acutely improve postural sway in balance-deficient older adults. The lower limit in duration and frequency to achieve positive effects remains unclear. Trial registration Clinical trials NCT03227666, July 24, 2017, retrospectively registered.

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Fall-related efficacy is a useful and independent index to detect fall risk in Japanese community-dwelling older people: a 1-year longitudinal study

BMC Geriatrics ◽

10.1186/s12877-019-1318-5 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 3

Author(s):

Naoto Kamide ◽

Yoshitaka Shiba ◽

Miki Sakamoto ◽

Haruhiko Sato ◽

Akie Kawamura

Keyword(s):

Risk Factors ◽

Older People ◽

Physical Performance ◽

Fall Risk ◽

Community Dwelling ◽

Confounding Factors ◽

Potential Risk Factors ◽

Community Dwelling Older People ◽

Walking Time

Abstract Background Fall-related efficacy has been found to be associated with both falls and fall risk factors such as physical performance. The aim of the present study was to clarify whether fall-related efficacy is, independent of physical performance and other potential risk factors, associated with future falls in community-dwelling older people. Methods The study participants were 237 Japanese older people aged 65 years and over who were living independently in their community. Fall-related efficacy and physical performance were assessed at baseline using the short version of the Falls Efficacy Scale-International (short FES-I) and 5-m walking time, the Timed Up and Go Test, the 5 Times Sit to Stand Test, and grip strength. Physical performance was then again assessed at 1-year follow-up. The number of falls was obtained every 6 months for 1 year after the baseline survey. Instrumental activities of daily living (IADL), depression, fall history, current medications, medical history, and pain were also investigated as potential confounding factors that have possible associations with falls. The associations between the short FES-I, physical performance, and number of falls were analyzed using Poisson regression analysis adjusted for physical performance and potential confounding factors. Results The mean age of the participants (75.9% women) was 71.1 ± 4.6 years, and 92.8% could perform IADL independently. The total numbers of falls and fallers during the 1-year follow-up period were 70 and 42, respectively. On Poisson regression analysis adjusted for walking time and potential confounding factors, independent of physical performance, the short FES-I was found to be significantly associated with number of falls (relative risk = 1.09, p < 0.05). On the other hand, physical performance was not significantly associated with the number of falls. Conclusions The findings of the present study suggest that the short FES-I, independent of physical performance and other potential risk factors, is a useful index to detect fall risk in community-dwelling older people, and that fall-related efficacy is an important factor in terms of fall prevention.

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Reduced strength, poor balance and concern about falls mediate the relationship between knee pain and fall risk in older people

BMC Geriatrics ◽

10.1186/s12877-020-1487-2 ◽

2020 ◽

Vol 20 (1) ◽

Cited By ~ 1

Author(s):

Cameron Hicks ◽

Pazit Levinger ◽

Jasmine C. Menant ◽

Stephen R. Lord ◽

Perminder S. Sachdev ◽

...

Keyword(s):

Older People ◽

Knee Pain ◽

Fall Risk ◽

The Relationship

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The relationship between physical condition and change in balance functions on exercise intervention and 12-month follow-up in Japanese community-dwelling older people

Archives of Gerontology and Geriatrics ◽

10.1016/j.archger.2007.10.004 ◽

2009 ◽

Vol 48 (1) ◽

pp. 61-66 ◽

Cited By ~ 8

Author(s):

Takeshi Arai ◽

Shuichi Obuchi ◽

Yasuko Inaba ◽

Yoshitaka Shiba ◽

Keiji Satake

Keyword(s):

Older People ◽

Physical Condition ◽

Exercise Intervention ◽

Community Dwelling ◽

Community Dwelling Older People ◽

Balance Functions ◽

The Relationship

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A Pilot Study to Detect Balance Impairment in Older Adults Using an Instrumented One-Leg Stance Test

Journal of Biomechanical Engineering ◽

10.1115/1.4046636 ◽

2020 ◽

Vol 142 (9) ◽

Author(s):

Jennifer N. C. Bassement ◽

Brajesh K. Shukla ◽

Sandeep K. Yadav ◽

Vivek Vijay ◽

Arvind Mathur ◽

...

Keyword(s):

Older People ◽

Fall Risk ◽

Postural Sway ◽

Force Plate ◽

Relevant Information ◽

Community Dwelling ◽

Timed Up And Go ◽

Additional Information ◽

Young Subjects ◽

A Prospective Study

Abstract The aim of this study was to investigate whether parameters from an instrumented one-leg stance (OLS) on a force plate could provide relevant information related to fall risk in older people. Forty-two community dwelling older people including 17 fallers and 25 nonfallers, and 25 young subjects performed a OLS while standing on a force plate, with parameters related to transferring weight onto one leg and postural sway in singe-leg stance evaluated. No differences were observed between older fallers and nonfallers and the younger participants for any of the weight transfer parameters. The younger participants were able to reduce their postural sway during the OLS test after the first 0–2 s period, unlike older participants who swayed the same amount throughout the test. The older fallers swayed significantly more than both nonfallers and younger participants throughout the 10-s of OLS evaluated. When the tests were used to classify older participants as fallers, the instrumented OLS achieved 100% accuracy, compared to 69.0% classification accuracy for the five times sit-to-stand test, 61.9% for the standard OLS, and 47.6% for the timed-up-and-go test. These findings suggest that the standard OLS test might not be suitable to detect fall risk. In contrast, an instrumented version of the OLS could provide valuable additional information that could identify older fallers. Future work will include a prospective study of the instrumented OLS in a larger population of older people.

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Cost-Effectiveness of an Exercise Programme that Provided Group or Individual Training to Reduce the Fall Risk in Healthy Community-Dwelling People Aged 65–80: A Secondary Data Analysis

Healthcare ◽

10.3390/healthcare9060714 ◽

2021 ◽

Vol 9 (6) ◽

pp. 714

Author(s):

Isaac Aranda-Reneo ◽

Laura Albornos-Muñoz ◽

Manuel Rich-Ruiz ◽

María Ángeles Cidoncha-Moreno ◽

Ángeles Pastor-López ◽

...

Keyword(s):

Economic Evaluation ◽

Cost Effectiveness ◽

Older People ◽

Incremental Cost ◽

Fall Risk ◽

Community Dwelling ◽

Effective Measure ◽

The Individual ◽

The Cost ◽

Individual Training

Research has demonstrated that some exercise programs are effective for reducing fall rates in community-dwelling older people; however, the literature is limited in providing clear recommendations of individual or group training as a result of economic evaluation. The objective of this study was to assess the cost-effectiveness of the Otago Exercise Program (OEP) for reducing the fall risk in healthy, non-institutionalized older people. An economic evaluation of a multicenter, blinded, randomized, non-inferiority clinical trial was performed on 498 patients aged over 65 in primary care. Participants were randomly allocated to the treatment or control arms, and group or individual training. The program was delivered in primary healthcare settings and comprised five initial sessions, ongoing encouragement and support to exercise at home, and a reinforcement session after six months. Our hypothesis was that the patients who received the intervention would achieve better health outcomes and therefore need lower healthcare resources during the follow-up, thus, lower healthcare costs. The primary outcome was the incremental cost-effectiveness ratio, which used the timed up and go test results as an effective measure for preventing falls. The secondary outcomes included differently validated tools that assessed the fall risk. The cost per patient was USD 51.28 lower for the group than the individual sessions in the control group, and the fall risk was 10% lower when exercises had a group delivery. The OEP program delivered in a group manner was superior to the individual method. We observed slight differences in the incremental cost estimations when using different tools to assess the risk of fall, but all of them indicated the dominance of the intervention group. The OEP group sessions were more cost-effective than the individual sessions, and the fall risk was 10% lower.

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Prospective Associations of Physical Frailty With Future Falls and Fear of Falling: A 48-Month Cohort Study

Physical Therapy ◽

10.1093/ptj/pzab059 ◽

2021 ◽

Author(s):

K Makino ◽

S Lee ◽

S Bae ◽

I Chiba ◽

K Harada ◽

...

Keyword(s):

Older Adults ◽

Cohort Study ◽

Fear Of Falling ◽

Community Dwelling ◽

Cardiovascular Health Study ◽

Physical Frailty ◽

Frailty Status ◽

Community Dwelling Older Adults ◽

The Relationship

Abstract Objective The present study aimed to examine the prospective associations of physical frailty with future falls and fear of falling (FOF) among community-dwelling older adults. Methods A prospective cohort study with a 48-month follow-up was conducted in a Japanese community. Participants were 2469 community-dwelling older adults aged 65 years or older who completed baseline and follow-up assessments at intervals of 48±2 months. Primary outcomes were recent falls (defined as at least one fall within the past year) and FOF (determined by response to “Are you afraid of falling?”) at follow-up survey. Physical frailty, operationalized by the frailty phenotype (slowness, weakness, exhaustion, weight loss, and low activity) based on the criteria of the Japanese version of the Cardiovascular Health Study (J-CHS), was also assessed as a predictor of future falls and FOF. Results Multivariate logistic regression showed that pre-frailty or frailty increase the risk of not only future falls (OR: 1.57; 95%CI = 1.20-2.05) but also FOF (OR: 1.33; 95%CI = 1.05-1.69). In addition, the relationship between baseline frailty status and future falls remained significant after adjusting for baseline FOF (OR: 1.55; 95%CI = 1.19-2.02), and the relationship between baseline frailty status and future FOF also remained significant after adjusting for baseline falls (OR: 1.32; 95%CI = 1.04-1.68). Conclusions Frailty status may predict future falls and FOF among community-dwelling older adults. Strategies to prevent frailty may be beneficial to prevent not only future falls but also future FOF in a community setting. Impact Falls and FOF have a close relationship but a different clinical meaning. Older adults with physical frailty may require monitoring as high-risk not only for falls but also for FOF.

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