Abstract
BackgroundFalls, associated injuries and fear-of-falling are common in adults with RA. Fear-of-falling can be a major consequence of, and as debilitating as falling, resulting in a cycle of activity restriction, reduced quality of life, institutionalisation and potentially increase risk of falls. The objective of this study was to examine the relationship between fear-of-falling and risk factors associated with fear-of-falling in adults with rheumatoid arthritis (RA) over a 1 year period.MethodsFive hundred fifty-nine patients with RA were recruited from four outpatient clinics in this prospective cohort study. Baseline assessments included socio-demographic, medical and lifestyle related risk factors. Fall incidence was prospectively obtained monthly using postal cards over a 1 year period. Fear-of-falling was assessed at baseline and 1 year using the Short Falls Efficacy Scale-International (Short FES-I). Logistic regression was used to determine the association between high fear-of-falling (Short FES-I > 11) at baseline (outcome) and a range of putative predictor variables including previous falls, and also baseline factors associated with a high fear-of-falling at follow-up.ResultsFive hundred thirty-five (ninety-six percent) participants (mean age 62.1 yrs.; 18–88 yrs) completed 1 year follow-up and of these, 254 (47%) completed the Short FES-I questionnaire at 1 year. In a multivariate model, a history of multiple falls (OR = 6.08) higher HAQ score (OR = 4.87) and increased time to complete the Chair Stand Test (OR = 1.11) were found to be independent predictors of high fear-of-falling and had an overall classification rate of 87.7%. There were no significant differences found in fear-of-falling at 1 year follow-up in those who reported falls during the study, participant’s baseline fear appeared to predict future fear, regardless of further falls.ConclusionsFear-of-falling is significantly associated with previous falls and predictive of future falls and fear. RA patients would benefit from fall prevention measures whether or not they have previously fallen.
Highlights
Patients with rheumatoid arthritis (RA) are at high risk of falls [1,2,3] and their associated injuries, including fractures and adverse psychological effects [1, 4, 5]
The demographic, disease characteristics and fall risk factor variables of the study population at baseline (n = 559) and those continuing to the 1 year follow up (n = 254) are shown in Table 1 and demonstrate similar characteristics
This study demonstrates that fearof-falling is an important problem for adults of all ages with RA with some 70% of the population experiencing high levels of fear-of-falling, not limited to older people
Summary
Patients with rheumatoid arthritis (RA) are at high risk of falls [1,2,3] and their associated injuries, including fractures and adverse psychological effects [1, 4, 5]. Given the adverse consequences of falls, it is not surprising that many people have a fear-of-falling Such fear-of-falling can be as debilitating as falling itself and can result in activity restriction, reduced quality of life, increased use of medication, institutionalisation and may increase the risk of injurious falls [6,7,8,9,10]. There are no prospective data concerning fear-of-falling or factors which predict fear-of-falling in adults with RA. The aim of this analysis was to determine factors linked with high fear-of-falling in men and women with RA, and factors linked with the development of fear-offalling. The objective of this study was to examine the relationship between fear-of-falling and risk factors associated with fear-of-falling in adults with rheumatoid arthritis (RA) over a 1 year period
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