Ellen Smulders

Does osteoporosis predispose falls? a study on obstacle avoidance and balance confidence

The aim of the study was to investigate whether obstacle avoidance ability was affected in persons with osteoporosis compared to a comparison group of a community sample of older adults.BackgroundOsteoporosis is associated with changes in balance and physical performance and has psychosocial consequences which increase the risk of falling. Most falls occur during walking; therefore an efficient obstacle avoidance performance might contribute to a reduction in fall risk. Since it was shown that persons with osteoporosis are unstable during obstacle crossing it was hypothesized that they more frequently hit obstacles, specifically under challenging conditions.MethodsObstacle avoidance performance was measured on a treadmill and compared between persons with osteoporosis (n = 85) and the comparison group (n = 99). The obstacle was released at different available response times (ART) to create different levels of difficulty by increasing time pressure. Furthermore, balance confidence, measured with the short ABC-questionnaire, was compared between the groups.ResultsNo differences were found between the groups in success rates on the obstacle avoidance task (p = 0.173). Furthermore, the persons with osteoporosis had similar levels of balance confidence as the comparison group (p = 0.091). The level of balance confidence was not associated with the performance on the obstacle avoidance task (p = 0.145).ConclusionObstacle avoidance abilities were not impaired in persons with osteoporosis and they did not experience less balance confidence than the comparison group. These findings imply that persons with osteoporosis do not have an additional risk of falling because of poorer obstacle avoidance abilities.

Fall incidence and fall risk factors in people with rheumatoid arthritis

Falls in people with rheumatoid arthritis (RA) are an underestimated problem. Almost all patients with RA develop lower extremity problems, which may increase their risk of falling because of impaired levels of physical activity, mobility and postural stability as well as diminished strength and proprioception.1 2 Only three studies have reported fall frequency in patients with RA. The annual proportion of fallers in patients with RA (mean age 59.2) ranges from 33% to 35%.1 2 3 The fall incidence rate of 0.62 falls/person-year1 is well above the fall incidence rate reported in healthy elderly people (0.45).4 5 However, all three studies used retrospective self-reports to measure fall …

Efficacy of a Short Multidisciplinary Falls Prevention Program for Elderly Persons With Osteoporosis and a Fall History: A Randomized Controlled Trial

OBJECTIVE To evaluate the efficacy of the Nijmegen Falls Prevention Program (NFPP) for persons with osteoporosis and a fall history in a randomized controlled trial. Persons with osteoporosis are at risk for fall-related fractures because of decreased bone strength. A decrease in the number of falls therefore is expected to be particularly beneficial for these persons. DESIGN Randomized controlled trial. SETTING Hospital. PARTICIPANTS Persons with osteoporosis and a fall history (N=96; mean ± SD age, 71.0±4.7y; 90 women). INTERVENTION After baseline assessment, participants were randomly assigned to the exercise (n=50; participated in the NFPP for persons with osteoporosis [5.5wk]) or control group (n=46; usual care). MAIN OUTCOME MEASURES Primary outcome measure was fall rate, measured by using monthly fall calendars for 1 year. Secondary outcomes were balance confidence (Activity-specific Balance Confidence Scale), quality of life (QOL; Quality of Life Questionnaire of the European Foundation for Osteoporosis), and activity level (LASA Physical Activity Questionnaire, pedometer), assessed posttreatment subsequent to the program and after 1 year of follow-up. RESULTS The fall rate in the exercise group was 39% lower than for the control group (.72 vs 1.18 falls/person-year; risk ratio, .61; 95% confidence interval, .40-.94). Balance confidence in the exercise group increased by 13.9% (P=.001). No group differences were observed in QOL and activity levels. CONCLUSION The NFPP for persons with osteoporosis was effective in decreasing the number of falls and improving balance confidence. Therefore, it is a valuable new tool to improve mobility and independence of persons with osteoporosis.

Could martial arts fall training be safe for persons with osteoporosis?: a feasibility study

BackgroundOsteoporosis is a well-established risk factor for fall-related hip fractures. Training fall arrest strategies, such as martial arts (MA) fall techniques, might be useful to prevent hip fractures in persons with osteoporosis, provided that the training itself is safe. This study was conducted to determine whether MA fall training would be safe for persons with osteoporosis extrapolated from the data of young adults and using stringent safety criteria.MethodsYoung adults performed sideways and forward MA falls from a kneeling position on both a judo mat and a mattress as well as from a standing position on a mattress. Hip impact forces and kinematic data were collected. For each condition, the highest hip impact force was compared with two safety criteria based on the femoral fracture load and the use of a hip protector.ResultsThe highest hip impact force during the various fall conditions ranged between 1426 N and 3132 N. Sideways falls from a kneeling and standing position met the safety criteria if performed on the mattress (max 1426 N and 2012 N, respectively) but not if the falls from a kneeling position were performed on the judo mat (max 2219 N). Forward falls only met the safety criteria if performed from a kneeling position on the mattress (max 2006 N). Hence, forward falls from kneeling position on a judo mat (max 2474 N) and forward falls from standing position on the mattress (max 3132 N) did not meet both safety criteria.ConclusionsBased on the data of young adults and safety criteria, the MA fall training was expected to be safe for persons with osteoporosis if appropriate safety measures are taken: during the training persons with osteoporosis should wear hip protectors that could attenuate the maximum hip impact force by at least 65%, perform the fall exercises on a thick mattress, and avoid forward fall exercises from a standing position. Hence, a modified MA fall training might be useful to reduce hip fracture risk in persons with osteoporosis.

Step Performance in Persons With Rheumatoid Arthritis: A Case-Control Study

OBJECTIVE To investigate factors that could lead to falls in patients with rheumatoid arthritis (RA). DESIGN Case-control study. SETTING Hospital. PARTICIPANTS Patients with RA (n=15) and age- and sex-matched controls (n=15; mean ± SD age, 60.5 ± 7.1y). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Performance of participants on a step task. Furthermore, manual performance was assessed, as well as questionnaires for balance confidence, fear of falling, and activity level. RESULTS Patients with RA showed nonsignificantly increased RTs (time to anticipatory postural adjustment and foot lift) and significantly increased movement times (MTs). Push-off force and step velocity were significantly lower in patients with RA. During a manual task, delayed RTs and MTs were seen. Moreover, lower levels of balance confidence and more fear of falling were reported in patients with RA. There were no differences in activity levels. CONCLUSIONS When performing a quick step, patients with RA show delayed MT and step velocity and decreased push off. Because quick stepping often is used to avoid falls, the increase in step execution time might have undesirable consequences. Furthermore, patients with RA have lower balance confidence and more fear of falling than healthy controls; these factors also contribute to higher fall risk.