School of Health Sciences and Manchester Academic Health Science Centre (MAHSC), Jean McFarlane Building, University Place, University of Manchester, Manchester, M13 9LP, UK.
Manchester University NHS Foundation Trust, M13 9WL, Manchester, UK.
BMC Musculoskelet Disord. 2021 Mar 10;22(1):260. doi: 10.1186/s12891-021-04068-0.
Falls, associated injuries and fear-of-falling are common in adults with RA. Fear-of-falling can be a major consequence of, and as debilitating as falling, resulting in a cycle of activity restriction, reduced quality of life, institutionalisation and potentially increase risk of falls. The objective of this study was to examine the relationship between fear-of-falling and risk factors associated with fear-of-falling in adults with rheumatoid arthritis (RA) over a 1 year period.
Five hundred fifty-nine patients with RA were recruited from four outpatient clinics in this prospective cohort study. Baseline assessments included socio-demographic, medical and lifestyle related risk factors. Fall incidence was prospectively obtained monthly using postal cards over a 1 year period. Fear-of-falling was assessed at baseline and 1 year using the Short Falls Efficacy Scale-International (Short FES-I). Logistic regression was used to determine the association between high fear-of-falling (Short FES-I > 11) at baseline (outcome) and a range of putative predictor variables including previous falls, and also baseline factors associated with a high fear-of-falling at follow-up.
Five hundred thirty-five (ninety-six percent) participants (mean age 62.1 yrs.; 18-88 yrs) completed 1 year follow-up and of these, 254 (47%) completed the Short FES-I questionnaire at 1 year. In a multivariate model, a history of multiple falls (OR = 6.08) higher HAQ score (OR = 4.87) and increased time to complete the Chair Stand Test (OR = 1.11) were found to be independent predictors of high fear-of-falling and had an overall classification rate of 87.7%. There were no significant differences found in fear-of-falling at 1 year follow-up in those who reported falls during the study, participant's baseline fear appeared to predict future fear, regardless of further falls.
Fear-of-falling is significantly associated with previous falls and predictive of future falls and fear. RA patients would benefit from fall prevention measures whether or not they have previously fallen.
跌倒、相关损伤和恐跌在类风湿关节炎（RA）成人中很常见。恐跌可能是跌倒的主要后果，与跌倒一样具有致残性，导致活动受限、生活质量下降、住院治疗以及潜在跌倒风险增加的恶性循环。本研究的目的是在 1 年内观察与 RA 成人跌倒相关的恐惧因素与跌倒恐惧之间的关系。
本前瞻性队列研究从四个门诊诊所招募了 559 名 RA 患者。基线评估包括社会人口统计学、医疗和生活方式相关的危险因素。在 1 年内，通过邮寄卡片每月前瞻性地获取跌倒发生率。在基线和 1 年内使用简易跌倒效能量表-国际版（Short FES-I）评估恐跌。使用逻辑回归确定基线时（结局）高恐跌（Short FES-I＞11）与一系列潜在预测变量之间的关联，包括既往跌倒，以及与随访时高恐跌相关的基线因素。
535 名（96%）参与者（平均年龄 62.1 岁；18-88 岁）完成了 1 年的随访，其中 254 名（47%）在 1 年时完成了 Short FES-I 问卷。在多变量模型中，多次跌倒史（OR=6.08）、更高的 HAQ 评分（OR=4.87）和完成椅子站立测试的时间延长（OR=1.11）被发现是高恐跌的独立预测因素，总体分类率为 87.7%。在研究期间报告跌倒的参与者中，在 1 年随访时没有发现恐跌有显著差异，参与者的基线恐惧似乎预测了未来的恐惧，无论是否进一步跌倒。
恐跌与既往跌倒显著相关，且可预测未来的跌倒和恐惧。无论是否有过跌倒，RA 患者都将受益于防跌倒措施。
