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The Rheumatoid Arthritis and Falls (RAF) study: a prospective study of fall risk factors in adults with rheumatoid arthritis
Poster Abstracts
The Rheumatoid Arthritis and Falls (RAF) study: a prospective study of fall risk factors in adults with rheumatoid arthritis Emma K Stanmore, Jackie Oldham, Dawn A Skelton, Terence O’Neill, Mark Pilling, A John Campbell, Chris Todd
Abstract Background Rheumatoid arthritis is linked to an increased risk of falls resulting in osteoporotic fractures, which may involve lower limb joints, leading to impaired mobility, impaired balance, and postural instability. This study aimed to investigate the association between potential risk factors and falls in community dwelling adults with rheumatoid arthritis. Methods Adults with rheumatoid arthritis were recruited from four outpatient clinics in the northwest of England and followed for 1 year after clinical assessment, using monthly falls calendars and telephone calls. Outcome measures included fall occurrence, reason for fall, type and severity of injuries, fractures, fall location, lie-times, use of health services, and functional ability. Risk factors for falls included lower limb muscle strength, postural stability, number of swollen and tender joints, functional status, history of falling, fear of falling, pain, fatigue, and medication. Data on demographics, vision, co-morbidities, history of surgery, fractures, and joint replacements were also recorded. Findings 559 adults with rheumatoid arthritis (386 women, 173 men, aged 18–88 years) had baseline measurements taken. 535 (96%) participants completed 1-year follow-up. Univariate logistic regression showed that falls risk was independent of age and gender. Multivariate logistic regression revealed that a history of multiple falls in the previous 12 months was the most significant predictive risk factor (odds ratio 5·3 [95% CI 2·3–12·3], p=0<0·001). The most significant modifiable risk factors were swollen and tender lower limb joints (odds ratio 1·7 [95% CI 1·1–2·7], p=0·03), psychotropic medication (1·8 [1·1–3·1], p=0·03), and fatigue (1·13 [1·02–1·2], p=0·01). Interpretation Adults of all ages with rheumatoid arthritis are at high risk of falls. In clinical practice, patients with rheumatoid arthritis at high risk of falls can be identified by asking whether they have fallen in the past year. The management of swollen and tender lower limb joints, fatigue, and consideration of psychotropic medicines may be the most effective strategy to reduce falls in this group of patients. Funding Arthritis Research UK.
www.thelancet.com
Published Online February 27, 2013 Poster 97 School of Nursing, Midwifery and Social Work and Manchester Academic Health Science Centre, University of Manchester, Manchester, UK (E K Stanmore, M Pilling, C Todd); Arthritis Research UK Epidemiology Unit, University of Manchester, Manchester, UK (J Oldham, T O’Neill); School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK (D A Skelton); and Department of Medicine, Dunedin School of Medicine, Dunedin, New Zealand (A J Campbell). Correspondence to: Dr Emma K Stanmore, School of Nursing, Midwifery and Social Work and Manchester Academic Health Science Centre, Jean McFarlane Building, University Place, Oxford Road, Manchester M13 9LP, UK Emma.K.Stanmore@ manchester.ac.uk
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The Rheumatoid Arthritis and Falls (RAF) study: a prospective study of fall risk factors in adults with rheumatoid arthritis Emma K Stanmore, Jackie Oldham, Dawn A Skelton, Terence O’Neill, Mark Pilling, A John Campbell, Chris Todd
Abstract Background Rheumatoid arthritis is linked to an increased risk of falls resulting in osteoporotic fractures, which may involve lower limb joints, leading to impaired mobility, impaired balance, and postural instability. This study aimed to investigate the association between potential risk factors and falls in community dwelling adults with rheumatoid arthritis. Methods Adults with rheumatoid arthritis were recruited from four outpatient clinics in the northwest of England and followed for 1 year after clinical assessment, using monthly falls calendars and telephone calls. Outcome measures included fall occurrence, reason for fall, type and severity of injuries, fractures, fall location, lie-times, use of health services, and functional ability. Risk factors for falls included lower limb muscle strength, postural stability, number of swollen and tender joints, functional status, history of falling, fear of falling, pain, fatigue, and medication. Data on demographics, vision, co-morbidities, history of surgery, fractures, and joint replacements were also recorded. Findings 559 adults with rheumatoid arthritis (386 women, 173 men, aged 18–88 years) had baseline measurements taken. 535 (96%) participants completed 1-year follow-up. Univariate logistic regression showed that falls risk was independent of age and gender. Multivariate logistic regression revealed that a history of multiple falls in the previous 12 months was the most significant predictive risk factor (odds ratio 5·3 [95% CI 2·3–12·3], p=0<0·001). The most significant modifiable risk factors were swollen and tender lower limb joints (odds ratio 1·7 [95% CI 1·1–2·7], p=0·03), psychotropic medication (1·8 [1·1–3·1], p=0·03), and fatigue (1·13 [1·02–1·2], p=0·01). Interpretation Adults of all ages with rheumatoid arthritis are at high risk of falls. In clinical practice, patients with rheumatoid arthritis at high risk of falls can be identified by asking whether they have fallen in the past year. The management of swollen and tender lower limb joints, fatigue, and consideration of psychotropic medicines may be the most effective strategy to reduce falls in this group of patients. Funding Arthritis Research UK.
www.thelancet.com
Published Online February 27, 2013 Poster 97 School of Nursing, Midwifery and Social Work and Manchester Academic Health Science Centre, University of Manchester, Manchester, UK (E K Stanmore, M Pilling, C Todd); Arthritis Research UK Epidemiology Unit, University of Manchester, Manchester, UK (J Oldham, T O’Neill); School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK (D A Skelton); and Department of Medicine, Dunedin School of Medicine, Dunedin, New Zealand (A J Campbell). Correspondence to: Dr Emma K Stanmore, School of Nursing, Midwifery and Social Work and Manchester Academic Health Science Centre, Jean McFarlane Building, University Place, Oxford Road, Manchester M13 9LP, UK Emma.K.Stanmore@ manchester.ac.uk
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