Emma K Stanmore1,2, Jackie Oldham3, Dawn A Skelton4, Terence O'Neill5,6, Mark Pilling7, Chris Todd8. 1. School of Health Sciences and Manchester Academic Health Science Centre (MAHSC), Jean McFarlane Building, University Place, University of Manchester, Manchester, M13 9LP, UK. emma.stanmore@manchester.ac.uk. 2. Manchester University NHS Foundation Trust, M13 9WL, Manchester, UK. emma.stanmore@manchester.ac.uk. 3. School of Health Sciences, Citylabs, Nelson Street, University of Manchester, Manchester, M13 9LP, UK. 4. School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Rd, Glasgow, G4 0BA, UK. 5. Versus Arthritis Centre for Epidemiology and Centre for Musculoskeletal Research, University of Manchester, Manchester, M13 9PT, UK. 6. Department of Rheumatology, Salford Royal National Health Service Foundation Trust, Salford, M6 8HD, UK. 7. Behaviour and Health Research Unit, Forvie Site, University of Cambridge School of Clinical Medicine, Box 113 Cambridge Biomedical Campus, Cambridge, CB2 0SR, UK. 8. School of Health Sciences and Manchester Academic Health Science Centre (MAHSC), Jean McFarlane Building, University Place, University of Manchester, Manchester, M13 9LP, UK.
Abstract
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: Fear-of-falling is significantly associated with previous falls and predictive of future falls and fear. RApatients would benefit from fall prevention measures whether or not they have previously fallen.
Authors: A Trombetti; K F Reid; M Hars; F R Herrmann; E Pasha; E M Phillips; R A Fielding Journal: Osteoporos Int Date: 2015-07-21 Impact factor: 4.507
Authors: Anna E Oswald; Stephen R Pye; Terence W O'Neill; Diane Bunn; Karl Gaffney; Tarnya Marshall; Alan J Silman; Deborah P M Symmons Journal: J Rheumatol Date: 2006-02-15 Impact factor: 4.666
Authors: Emma K Stanmore; Jackie Oldham; Dawn A Skelton; Terence O'Neill; Mark Pilling; A John Campbell; Chris Todd Journal: Arthritis Care Res (Hoboken) Date: 2013-05 Impact factor: 4.794