Studies have shown that people with rheumatoid arthritis (RA) have a higher risk for falling than the general population, according to Sabine Wiegmann, PhDcandidate. The onset of RA, the severity of disease activity, medication side effects, and foot deformities can contribute to compromising postural control in a patient with RA, thereby increasing the risk for a fall.

There is a range of tools that clinicians can use to evaluate balance performance and risk for falls in patients with RA. These include the Short Physical Performance Battery (SPPB), the Frailty and Injuries: Cooperative Studies of Intervention Technique-4 (FICSIT-4), Activity-specific Balance Confidence Scale (ABC-scale), Romberg test, semi tandem balance assessment, tandem balance assessment, and one-leg stands.

Participants Asked to Keep a Fall Diary During Observation.

Wiegmann and colleagues sought to determine which screening tools are most effective in determining fall risk in patients with RA. “The aim of this study was to identify associations between variables of postural control with prospective falls in patients with RA,” Wiegmann explains.

In this prospective, observational study, the balance performance of 289 adults with RA who were aged 24-85 was evaluated at baseline. The occurrence of falls in this group was reported quarterly over the course of 1 year. Clinical characteristics including age, sex, height, weight, BMI, RA disease duration, C-reactive protein, and Disease Activity Score were collected. Participants were asked to keep a fall diary over the year they were observed. Postural sway was measured with Leonardo Mechanograph®, a modular gait analysis system used for locomotion analysis.

People Who Experienced Falls Were Older, Had More Limited Activity

Patients who experienced falls were significantly older (P=0.016) than the rest of the study group and, according to their Health Assessment Questionnaire (HAQ), had more limited activity in their daily lives (P=0.001).

Patients who reported falls had a significantly greater range in FICSIT-4 scores (interquartile range [IQR], 4.0-5.0; P=0.03), and a considerably higher percentage of fallers (29.2%) were poor performers on the FICSIT-4 dicho (ie, a dichotomous variable of FICSIT-4 that was integrated into the analysis to reflect poor balance), scoring between 0 and 4 (P=0.019).

Poor Assessment Performance Was Greater in the Fall Group

Subjects who achieved the worst results in the assessments or failed them were of greater number in the fall group than in the non-fall group. Fallers and non-fallers were significantly different regarding sway parameters assessed by the Romberg, semi tandem, and tandem tests. For the Romberg, differences were observed in path length and the velocity of center of pressure (CoP) in the medio-lateral direction (P=0.039); for semi tandem stance, differences were observed in path length and the velocity of CoP in the mediolateral direction (P=0.019 and 0.020, respectively) as well as in the area of sway (P=0.029), the path length, and speed of movement (P=0.039); for the tandem stance, differences were observed in the path length and speed of movement (both P=0.034), as well as the path length and velocity of CoP in the anteriorposterior direction (both P=0.015) (Table).

Given the study’s findings, the one-leg stand could have value as a prognostic tool despite concerns regarding the safety of its implementation as standard practice for some patients. “The one-leg stand is an appropriate screening tool for fall risk in patients with RA,” Wiegmann notes. “The fall risk is increased if a 10-second one-leg stand is failed.”

Conclusions regarding preventative interventions were also discussed based on the study’s findings. “The training of medio-lateral and anterior-posterior balance strategies should be the focus of fall prevention strategies and therapy for allers,” Wiegmann says.