Akyol Yeşim, Ulus Yasemin, Tander Berna, Tomak Leman, Zahiroğlu Yeliz, Bilgici Ayhan, Kuru Ömer
Department of Physical Medicine and Rehabilitation, Medicine Faculty of Ondokuz Mayıs University, Samsun, Turkey.
Department of Biostatistics, Medicine Faculty of Ondokuz Mayıs University, Samsun, Turkey.
Turk J Phys Med Rehabil. 2018 Jul 17;64(3):213-221. doi: 10.5606/tftrd.2018.1687. eCollection 2018 Sep.
This study aims to compare fall history and fear of falling (FOF) in patients with rheumatoid arthritis (RA) and healthy controls and to evaluate associated factors for fall risk and FOF in patients with RA.
Between March 2016 and July 2016, a total of 120 patients with RA and 60 age- and sex-matched healthy volunteers were included in the study. The presence of FOF (Yes/No), fall history, and the number of falls within the past 12 month were questioned. All participants were assessed with the Falls Efficacy Scale-International (FES-I), 10 Meter Walk Test (10MWT), One-Leg Stand Test (OLST), Berg Balance Scale (BBS), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI). Pain Severity and Patient Global Assessment (PGA) by Visual Analog Scale (VAS), disability by the Health Assessment Questionnaire (HAQ), and disease activity by Disease Activity Score in 28 joints (DAS28) were evaluated in patients with RA.
There was no statistically difference between the RA patients and healthy controls in terms of presence of fall history, while the presence of FOF and FES-I scores were significantly higher in the RA patients (p<0.05). In the patient group, the FES-I score was positively correlated with pain VAS, PGA, DAS-28, HAQ, BAI, BDI, and 10MWT and negatively BBS and OLST (p<0.05). The number of falls, HAQ, BBS, and BDI scores were found to be significant independent risk factors affecting variations in the FES-I scores (p<0.001).
Fear of falling seems to be an important problem in patients with RA, and patients without fall history may also have FOF. The most important factors associated with FOF were impaired balance, increased disability and depression, and number of falls in RA patients. Strategies for preventing falls, maintaining balance, improving emotional status and against FOF are of utmost importance in patients with RA.
本研究旨在比较类风湿关节炎（RA）患者和健康对照者的跌倒史及跌倒恐惧（FOF）情况，并评估RA患者跌倒风险和FOF的相关因素。
2016年3月至2016年7月，共有120例RA患者和60例年龄及性别匹配的健康志愿者纳入本研究。询问FOF的存在情况（是/否）、跌倒史以及过去12个月内的跌倒次数。所有参与者均接受国际跌倒效能量表（FES-I）、10米步行测试（10MWT）、单腿站立测试（OLST）、伯格平衡量表（BBS）、贝克抑郁量表（BDI）和贝克焦虑量表（BAI）评估。对RA患者评估视觉模拟量表（VAS）的疼痛严重程度和患者整体评估（PGA）、健康评估问卷（HAQ）评估的残疾程度以及28个关节疾病活动评分（DAS28）评估的疾病活动度。
RA患者和健康对照者在跌倒史方面无统计学差异，而RA患者中FOF的存在情况及FES-I评分显著更高（p<0.05）。在患者组中，FES-I评分与疼痛VAS、PGA、DAS-28、HAQ、BAI、BDI及10MWT呈正相关，与BBS和OLST呈负相关（p<0.05）。跌倒次数、HAQ、BBS及BDI评分被发现是影响FES-I评分变化的重要独立危险因素（p<0.001）。
跌倒恐惧似乎是RA患者中的一个重要问题，且无跌倒史的患者也可能存在FOF。与RA患者FOF相关的最重要因素是平衡功能受损、残疾增加、抑郁以及跌倒次数。预防跌倒、维持平衡、改善情绪状态及对抗FOF的策略对RA患者至关重要。
