Centre of Health, Activity and Rehabilitation Research, Queen Margaret University, Edinburgh, United Kingdom.
Centre of Health, Activity and Rehabilitation Research, Queen Margaret University, Edinburgh, United Kingdom.
Gait Posture. 2020 Oct;82:110-117. doi: 10.1016/j.gaitpost.2020.08.128. Epub 2020 Aug 30.
Static postural balance performance is often impaired in people receiving haemodialysis (HD) for the treatment of stage-5 chronic kidney disease (CKD-5). However, the question as to whether lower postural balance is associated with adverse clinical outcomes such as falls has not been addressed yet.
We conducted a prospective cohort study to explore the association between static postural balance and falls in people receiving HD. We hypothesised that higher postural sway would be associated with increased odds of falling.
Seventy-five prevalent CKD-5 patients receiving HD (age: 61.8 ± 13.4 years) from three Renal Units were enrolled in this prospective cohort study. At baseline, postural balance was assessed with a force platform in eyes open (EO) and eyes closed (EC) conditions. Centre of pressure (CoP) measures of range, velocity and area were taken for the analysis. Falls experienced by study participants were prospectively recorded during 12 months of follow-up. Secondary outcomes included timed-up and go, five-repetition sit-to-stand test and the Tinetti falls efficacy scale (FES).
In multivariable logistic regression analysis, higher CoP range in medial-lateral direction during EC was associated with increased odds of falling (OR: 1.04, 95 %CI: 1.00-1.07, p = 0.036). In ROC curve analysis, CoP velocity in EO exhibited the greatest prognostic accuracy (AUC: 0.69, 95 %CI: 0.55-0.82), however this was not statistically different from CoP measures of area and range. None of the postural balance measures exceeded the prognostic accuracy of the FES (AUC: 0.70, 95 %CI: 0.58-0.83, p = 0.005).
This prospective cohort study showed that higher postural sway in medial-lateral direction was associated with increased odds of falling in people receiving HD. CoP measures of range, velocity and area displayed similar prognostic value in discriminating fallers from non-fallers. The overall utility of static posturography to detect future fall-risk may be limited in a clinical setting.
接受血液透析（HD）治疗终末期慢性肾脏病（CKD-5）的患者常出现静态姿势平衡能力受损。然而，目前尚不清楚较低的姿势平衡是否与跌倒等不良临床结局相关。
我们进行了一项前瞻性队列研究，旨在探讨 HD 患者的静态姿势平衡与跌倒之间的关系。我们假设，更大的姿势摆动与跌倒风险增加相关。
本前瞻性队列研究纳入了来自三个肾脏科的 75 例接受 HD 的 CKD-5 患者（年龄：61.8±13.4 岁）。基线时，使用力平台在睁眼（EO）和闭眼（EC）条件下评估姿势平衡。记录了中心压力（CoP）的范围、速度和面积等指标。在 12 个月的随访期间，前瞻性地记录了研究参与者的跌倒情况。次要结局包括计时起立行走测试、五次重复坐立站起测试和 Tinetti 跌倒效能量表（FES）。
在多变量逻辑回归分析中，EC 时 CoP 内侧-外侧范围越大，跌倒风险越高（OR：1.04，95 %CI：1.00-1.07，p=0.036）。ROC 曲线分析显示，EO 时 CoP 速度的预测准确性最大（AUC：0.69，95 %CI：0.55-0.82），但与 CoP 面积和范围的测量值无统计学差异。在预测跌倒方面，没有任何一种姿势平衡测量指标的准确性超过 FES（AUC：0.70，95 %CI：0.58-0.83，p=0.005）。
这项前瞻性队列研究表明，HD 患者的内侧-外侧方向姿势摆动越大，跌倒风险越高。CoP 范围、速度和面积的测量值在区分跌倒者和非跌倒者方面具有相似的预测价值。在临床环境中，静态姿势描记术检测未来跌倒风险的整体效用可能有限。
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