Ageing and Age-Associated Disorders Research Group, University of Malaya, Wilayah Persekutuan Kuala Lumpur, Malaysia.
Ageing and Age-Associated Disorders Research Group, University of Malaya, Wilayah Persekutuan Kuala Lumpur, Malaysia; Department of Rheumatology and Immunology, Singapore General Hospital, Singapore; Duke-NUS Medical School, National University Singapore, Singapore.
PM R. 2018 Mar;10(3):254-262. doi: 10.1016/j.pmrj.2017.08.405. Epub 2017 Aug 18.
Osteoarthritis (OA) is considered an established risk factor for falls. Published studies evaluating secondary falls prevention strategies among individuals with OA are limited.
To evaluate the effect of a personalized home-based exercise program to improve postural balance, fear of falling, and falls risk in older fallers with knee OA and gait and balance problems.
Randomized controlled trial.
University of Malaya Medical Centre.
Fallers who had both radiological OA and a Timed Up and Go (TUG) score of over 13.5 seconds.
Postural sway (composite sway) was quantified with the Modified Clinical Test of Sensory Interaction on Balance (mCTSIB) under 4 different sensory conditions: eyes open on firm surface, eyes closed on firm surface, eyes open on unstable foam surface, and eyes closed on unstable foam surface. Participants were asked to stand upright and to attempt to hold their position for 10 seconds for each test condition. The average reading for all conditions were calculated.
Participants randomized to the intervention arm received a home-based modified Otago Exercise Program (OEP) as part of a multifactorial intervention, whereas control participants received general health advice and conventional treatment. This was a secondary subgroup analysis from an original randomized controlled trial, the Malaysian Falls Assessment and Intervention Trial (MyFAIT) (trial registration number: ISRCTN11674947). Posturography using a long force plate balance platform (Balancemaster, NeuroCom, USA), the Knee injury and Osteoarthritis Outcome Score (KOOS) and the short-form Falls Efficacy Scale-International (short FES-I) were assessed at baseline and 6 months.
Results of 41 fallers with radiological evidence of OA and impaired TUG (intervention, 17; control, 24) were available for the final analysis. Between-group analysis revealed significant improvements in the Modified Clinical Test of Sensory Interaction on Balance (mCTSIB), Limits of Stability (LOS), and short FES-I scores by the intervention group compared to the control group at 6 months. No significant difference in time to first fall or in fall-free survival between the intervention and control groups was found.
Home-based balance and strength exercises benefited older fallers with OA and gait and balance disorders by improving postural control, with no observable trend in reduction of fall recurrence. Our findings will now inform a future, adequately powered, randomized controlled study using fall events as definitive outcomes.
I.
骨关节炎（OA）被认为是跌倒的既定危险因素。评估 OA 患者继发性跌倒预防策略的已发表研究有限。
评估个性化家庭运动方案对改善膝骨关节炎和步态及平衡问题老年跌倒者的姿势平衡、跌倒恐惧和跌倒风险的效果。
随机对照试验。
马来亚大学医学中心。
放射学 OA 合并计时起立行走测试（TUG）评分超过 13.5 秒的跌倒者。
姿势摆动（复合摆动）采用改良临床感觉相互作用平衡测试（mCTSIB）进行量化，测试在 4 种不同感觉条件下进行：睁眼在坚固表面、闭眼在坚固表面、睁眼在不稳定泡沫表面和闭眼在不稳定泡沫表面。要求参与者在每种测试条件下直立并尝试保持 10 秒。计算所有条件的平均读数。
随机分配到干预组的参与者接受家庭改良奥塔哥运动方案（OEP）作为多因素干预的一部分，而对照组参与者接受一般健康咨询和常规治疗。这是原始随机对照试验（马来西亚跌倒评估和干预试验，MyFAIT）的二次亚组分析（试验注册号：ISRCTN11674947）。采用长力板平衡平台（NeuroCom，美国 Balancemaster）进行动态姿势描记术，在基线和 6 个月时评估膝关节损伤和骨关节炎结局评分（KOOS）和简化跌倒效能量表-国际版（short FES-I）。
41 名有放射学 OA 证据和 TUG 受损的跌倒者（干预组 17 名，对照组 24 名）的结果可用于最终分析。组间分析显示，干预组在 6 个月时在改良临床感觉相互作用平衡测试（mCTSIB）、稳定性极限（LOS）和简化跌倒效能量表-国际版（short FES-I）评分方面有显著改善，而对照组无显著改善。干预组和对照组之间首次跌倒时间或无跌倒生存时间无显著差异。
家庭平衡和力量练习使 OA 和步态及平衡障碍的老年跌倒者受益，改善姿势控制，无跌倒复发减少的明显趋势。我们的发现将为未来使用跌倒事件作为明确结局的、充分有力的、随机对照研究提供信息。
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