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Smith, Toby O. 
ORCID: https://orcid.org/0000-0003-1673-2954, Clarke, Celia, Wells, Jacob, Dainty, Jack R. ORCID: https://orcid.org/0000-0002-0056-1233, Watts, Laura, Yates, Max ORCID: https://orcid.org/0000-0003-3977-8920, Pomeroy, Valerie M. ORCID: https://orcid.org/0000-0003-4487-823X, Stanmore, Emma, O'Neill, Terrence W. and Macgregor, Alexander J. ORCID: https://orcid.org/0000-0003-2163-2325
(2022)
Clinical and biomechanical factors associated with falls and rheumatoid arthritis: Baseline cohort with longitudinal nested case-control study.
Rheumatology, 61 (2).
679–687.
ISSN 1462-0324
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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.
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