Abstract
Objectives: To determine the temporal relationship between the presence of knee pain and knee pain severity identified at baseline with fall risk, fear of falling and changes in instrumental activity of daily living at 12-months follow-up.Methods: This was a prospective study from the Malaysian Elders Longitudinal Research (MELoR) study involving community dwelling older persons aged 55 years and older. The presence of one fall in the preceding 12 months, knee pain, and functional capacity were determined at baseline (2013–2015) and follow-up (2015–2016). Function was determined as loss of at least one of seven instrumental activities of daily living (IADL). Physical performance was evaluated at baseline using the timed-up-and-go (TUG) test. Fear of falling (FoF) was determined using the single question “Are you afraid of falling?”Results: Data were available for 605 participants, mean (SD) age = 69.10 (7.24) years. Knee pain was present in 30.2% at baseline. Neither the presence of knee pain nor knee pain severity at baseline were associated with falls at 1-year follow-up. Knee pain was significantly associated with FoF at follow-up [aRR (95%CI) = 1.76 (1.02–3.04)] but not changes in IADL. Among individuals with no falls at baseline, the presence of knee pain was protective of falls at follow-up after adjustment for baseline physical performance [adjusted rate ratio, aRR (95% confidence interval, CI) = 0.35 (0.13–0.97)].Conclusion: Knee pain is associated with increased FoF at 1.5 years' follow-up within a multi-ethnic population aged 55 years, residing in an urban location in a middle-income South East Asian nation. Interestingly, after differences in muscle strength was accounted for, knee pain was protective against falls at follow-up. Our findings challenge previous assumptions on joint pain and falls and highlights the importance of large prospective studies and further mechanistic research incorporating psychological factors in this area of increasing prominence.
Highlights
Knee pain due to osteoarthritis (OA) is the most common type of joint pain complaint among older persons [1]
Individuals with knee pain had higher body mass index (BMI), poorer physical performance measured by TUG and hand grip strength (HGS) and lower instrumental of activity daily living (IADL) scores
By examining the prospective relationship between the presence of knee pain and the severity of knee pain with falls at followup, FoF at follow-up and Changes in IADL (cIADL), we were able to tease out the potential influence of knee pain on physical, psychological and functional outcomes in residents aged 55 years at recruitment in an urban location in Malaysia, a multi-ethnic, upper-middle income country in South-East Asia
Summary
Knee pain due to osteoarthritis (OA) is the most common type of joint pain complaint among older persons [1]. The presence of low grade, chronic pain in the knee due to OA, may negatively influence the older persons psychological state and overall quality of life. In a recent systematic review, which included 39 studies, joint pain is associated with poorer static, dynamic, multicomponent, and reactive balance which may increase the risk of falls in older persons [9]. The presence of balance impairment or instability resulting from joint pain may lead to FoF with the presence of actual fall events [10]. The presence of knee pain may lead to impairment in activities of daily living which may in turn lead to further increased FoF and other negative psychological sequelae [9]
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