Abstract
ObjectiveTo identify the clinical and biomechanical characteristics associated with falls in people with RA.MethodsA total of 436 people ≥60 years of age with RA completed a 1 year prospective survey of falls in the UK. At baseline, questionnaires recorded data including personal and medical history, pain and fatigue scores, health-related quality of life (HRQoL), physical activity and medication history. The occurrence of falls wasmonitored prospectively over 12 months by monthly self-reporting. A nested sample of 30 fallers (defined as the report of one or more falls in 12 months) and 30 non-fallers was evaluated to assess joint range of motion (ROM), muscle strength and gait parameters. Multivariate regression analyses were undertaken to determine variables associated with falling.ResultsCompared with non-fallers (n = 236), fallers (n = 200) were older (P = 0.05), less likely to be married (P = 0.03), had higher pain scores (P < 0.01), experienced more frequent dizziness (P < 0.01), were frequently taking psychotropic medications (P = 0.02) and reported lower HRQoL (P = 0.02). Among those who underwent gait laboratory assessments, compared with non-fallers, fallers showed a greater anteroposterior (AP; P = 0.03) and medial-lateral (ML) sway range (P = 0.02) and reduced isokinetic peak torque and isometric strength at 60° knee flexion (P = 0.03). Fallers also showed shorter stride length (P = 0.04), shorter double support time (P = 0.04) and reduced percentage time in swing phase (P = 0.02) and in knee range of motion through the gait cycle (P < 0.01).ConclusionPeople with RA have distinct clinical and biomechanical characteristics that place them at increased risk of falling. Assessment for these factors may be important to offer more targeted rehabilitation interventions.
Highlights
Falls are a major health and social care challenge worldwide [1]
Older people with Rheumatoid arthritis (RA) may be at particular risk of falls and fracture due to disease-related factors such as pain, joint deformity, decreased muscle strength and osteoporosis associated with long-term steroid use [8]
Our analysis has shown that people with RA who are older and unmarried, and who have higher pain scores, dizziness and who take psychotropic medications are at greater risk of falls
Summary
Falls are a major health and social care challenge worldwide [1]. The aetiology is multifactorial, with an interaction between intrinsic, behavioral and environmental factors [2]. In addition to the associated injury risk, loss of confidence and independence, falls and subsequent fractures are a significant cause of illness and death in older people [1,2,3]. Rheumatoid arthritis (RA) affects approximately 1% of the UK adult population [4]. It results in significant morbidity and increased healthcare costs [5,6]. Older people with RA may be at particular risk of falls and fracture due to disease-related factors such as pain, joint deformity, decreased muscle strength and osteoporosis associated with long-term steroid use [8]
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