Clinical and biomechanical factors associated with falls and rheumatoid arthritis: baseline cohort with longitudinal nested case–control study. (27th April 2021)

• Record Type: Journal Article
• Authors: Smith, Toby O; Clarke, Celia; Dainty, Jack R; Watts, Laura; Yates, Max; Pomeroy, Valerie M; Stanmore, Emma; O'Neill, Terence W; Macgregor, Alexander J
• Is Part Of: Rheumatology. Volume 61:Number 2(2022)
• Page Start: 679
• Page End: 687
• Publication Date: 2021-04-27
• Subjects: RA -- falls -- gait analysis -- muscle strength -- postural control; Rheumatism -- Periodicals; Rheumatology -- Periodicals; 616.723005
• DOI: 10.1093/rheumatology/keab388
• Languages: English
• ISSNs: 1462-0324

Abstract

Abstract: Objective: To identify the clinical and biomechanical characteristics associated with falls in people with RA. Methods: A 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. Results: Compared 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). Conclusion: People 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.