已确诊类风湿关节炎的成年人跌倒相关的足踝特征：一项横断面研究。
Foot and ankle characteristics associated with falls in adults with established rheumatoid arthritis: a cross-sectional study.
作者信息
Brenton-Rule Angela, Dalbeth Nicola, Menz Hylton B, Bassett Sandra, Rome Keith
机构信息
AUT University, Private Bag 92006, Auckland, 1142, New Zealand.
University of Auckland, Private Bag 92-019, Auckland, New Zealand.
出版信息
BMC Musculoskelet Disord. 2016 Jan 13;17:22. doi: 10.1186/s12891-016-0888-z.
BACKGROUND
People with rheumatoid arthritis (RA) have an increased risk of falls. The foot is a common site of pathology in RA and foot problems are reported in up to 90% of patients with established disease. The aim of this study was to determine whether foot and ankle characteristics are associated with falls in people with RA.
METHODS
Adults with RA were recruited from rheumatology outpatient clinics in Auckland, New Zealand. Participants reported whether they had fallen in the preceding year, and the number of falls. Clinical characteristics, common fall risk factors, and foot and ankle variables were measured. Univariate parametric and non-parametric analysis compared fallers and non-fallers on all variables to determine significant differences. Logistic regression analysis identified variables independently associated with falls.
RESULTS
Two hundred and one participants were prospectively recruited. At least one fall in the preceding 12-months was reported by 119 (59%) participants. Univariate analysis showed that fallers had significantly longer mean disease duration, more co-morbid conditions, an increase in lower limb tender joints, higher midfoot peak plantar pressures and were more likely to have a history of vascular disease than non-fallers. Fallers also reported greater difficulty with activities of daily living, increased fear of falling and greater self-reported foot impairment. Logistic regression analysis revealed that increased midfoot peak plantar pressures (odds ratio (OR) 1.12 [for each 20 kPa increase], 95% confidence interval (CI) 1.00-1.25), self-reported foot impairment (OR 1.17 [for each three point increase], 95% CI 1.05-1.31) and history of vascular disease (OR 3.22, 95% CI 1.17-8.88) were independently associated with a fall in the preceding 12 months.
CONCLUSIONS
Elevated midfoot peak plantar pressures, self-reported foot impairment and vascular disease are associated with falls in people with RA. Assessment of foot deformity, foot function and self-reported foot impairment may be of benefit when considering falls prevention strategies in people with RA.
TRIAL REGISTRATION
Australia New Zealand Clinical Trial Registry (trial ACTRN12612000597897).
背景
类风湿关节炎（RA）患者跌倒风险增加。足部是RA常见的病变部位，在高达90%的确诊患者中报告有足部问题。本研究的目的是确定足踝特征是否与RA患者的跌倒有关。
方法
从新西兰奥克兰的风湿病门诊招募成年RA患者。参与者报告他们在前一年是否跌倒以及跌倒次数。测量临床特征、常见跌倒风险因素以及足踝变量。单变量参数和非参数分析比较了跌倒者和未跌倒者在所有变量上的差异，以确定显著差异。逻辑回归分析确定与跌倒独立相关的变量。
结果
前瞻性招募了201名参与者。119名（59%）参与者报告在过去12个月中至少跌倒过一次。单变量分析显示，与未跌倒者相比，跌倒者的平均病程明显更长，合并症更多，下肢压痛关节增多，中足峰值足底压力升高，且更有可能有血管疾病史。跌倒者还报告在日常生活活动中困难更大，对跌倒的恐惧增加，自我报告的足部功能障碍更严重。逻辑回归分析显示，中足峰值足底压力升高（比值比（OR）1.12[每增加20 kPa]，95%置信区间（CI）1.00 - 1.25）、自我报告的足部功能障碍（OR 1.17[每增加三分]，95% CI 1.05 - 1.31）和血管疾病史（OR 3.22，95% CI 1.17 - 8.88）与过去12个月内的跌倒独立相关。
结论
中足峰值足底压力升高、自我报告的足部功能障碍和血管疾病与RA患者的跌倒有关。在考虑RA患者的跌倒预防策略时，评估足部畸形、足部功能和自我报告的足部功能障碍可能有益。
试验注册
澳大利亚新西兰临床试验注册中心（试验ACTRN12612000597897）
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