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BMC Musculoskeletal Disorders
Published in: BMC Musculoskeletal Disorders 1/2019

Open Access 01-12-2019 | Osteoarthrosis | Research article

Falls and fear of falling in older adults with total joint arthroplasty: a scoping review

Published in: BMC Musculoskeletal Disorders | Issue 1/2019

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Abstract

Background

Patients waiting or recovering from total joint arthroplasty (TJA) are at risk for falls which can lead to restriction of activity and negatively impact recovery. The objective of this scoping review is to critically appraise and synthesize the evidence in the reported number of falls, fear of falling, and risk factors associated with falls in older patients waiting for or recovering from TJA.

Methods

Seven electronic databases were searched with no date limits and using language restriction (English). The inclusion criteria were 1) cohorts that included older adults 60+ years of age, 2) reported prevalence of falls, fear of falling, and/or risk factors for falls in patients who were waiting or recovering from TJA and 3) cross-sectional studies, cohort studies, and case control study designs. The quality assessment of selected articles was assessed using the SIGN Guidelines Checklist.

Results

Of the 866 citations identified, 12 studies met the inclusion criteria and were reviewed. Prevalence of falls in pre-operative TJA patients and post-operative TJA patients ranged from 23 to 63%, and 13 to 42%, respectively. Of those five studies that examined fear of falling, pre-operative TJA patients reported greater fear of falling than post-operative patients. Modifiable risk factors for falls included fear of falling, joint range of motion, and depression.

Conclusions

An increased risk of falls in patients with TJA was reported both for patients waiting for and recovering from surgery. A number of modifiable risk factors were identified including fear of falling that could be targeted in fall prevention programs for TJA.
Appendix
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Literature
1.
Carroll NV, Slattum PW, Cox FM. The cost of falls among the community-dwelling elderly. J Manag Care Pharm. 2005;11(4):307–16.PubMed
2.
Muir SW, Berg K, Chesworth B, Klar N, Speechley M. Quantifying the magnitude of risk for balance impairment on falls in community-dwelling older adults: a systematic review and meta-analysis. J Clin Epidemiol. 2010;63(4):389–406.PubMedCrossRef
3.
Jones CA, Pohar S. Health-related quality of life after total joint arthroplasty: a scoping review. Clin Geriatr Med. 2012;28(3):395–429.PubMedCrossRef
4.
Moutzouri M, Gleeson N, Billis E, Tsepis E, Panoutsopoulou I, Gliatis J. The effect of total knee arthroplasty on patients' balance and incidence of falls: a systematic review. Knee Surg Sports Traumatol Arthrosc. 2017;25(11):3439–51.PubMedCrossRef
5.
di Laura FG, Filardo G, Giunchi D, Fusco A, Zaffagnini S, Candrian C. Risk of falls in patients with knee osteoarthritis undergoing total knee arthroplasty: a systematic review and best evidence synthesis. J Orthop. 2018;15(3):903–8.CrossRef
6.
Guideline for the prevention of falls in older persons. American Geriatrics Society, British Geriatrics Society, and American Academy of Orthopaedic Surgeons Panel on Falls Prevention. J Am Geriatr Soc. 2001;49(5):664–72.
7.
Deandrea S, Lucenteforte E, Bravi F, Foschi R, La Vecchia C, Negri E. Risk factors for falls in community-dwelling older people: a systematic review and meta-analysis. Epidemiology. 2010:658–68.PubMedCrossRef
8.
de Zwart AH, van der Esch M, Pijnappels MA, Hoozemans MJ, van der Leeden M, Roorda LD, Dekker J, Lems WF, van Dieen JH. Falls associated with muscle strength in patients with knee osteoarthritis and self-reported knee instability. J Rheumatol. 2015;42(7):1218–23.PubMedCrossRef
9.
Leveille SG, Jones RN, Kiely DK, Hausdorff JM, Shmerling RH, Guralnik JM, Kiel DP, Lipsitz LA, Bean JF. Chronic musculoskeletal pain and the occurrence of falls in an older population. JAMA. 2009;302(20):2214–21.PubMedPubMedCentralCrossRef
10.
Picorelli AMA, Hatton AL, Gane EM, Smith MD. Balance performance in older adults with hip osteoarthritis: a systematic review. Gait Posture. 2018;65:89–99.PubMedCrossRef
11.
Manlapaz DG, Sole G, Jayakaran P, Chapple CM. Risk factors for falls in adults with knee osteoarthritis: a systematic review. PM R. 2019;11(7):745–57.PubMedCrossRef
12.
Arnold CM, Gyurcsik NC. Risk factors for falls in older adults with lower extremity arthritis: a conceptual framework of current knowledge and future directions. Physiother Can. 2012;64(3):302–14.PubMedPubMedCentralCrossRef
13.
Leveille SG, Bean J, Bandeen-Roche K, Jones R, Hochberg M, Guralnik JM. Musculoskeletal pain and risk for falls in older disabled women living in the community. J Am Geriatr Soc. 2002;50(4):671–8.PubMedCrossRef
14.
Chu L-W, Chi I, Chiu AY. Incidence and predictors of falls in the Chinese elderly. Ann Acad Med Singap. 2005;34(1):60–72.PubMed
15.
Tinetti ME, Richman D, Powell L: Falls efficacy as a measure of fear of falling. J Gerontol 1990, 45(6):P23-P243.PubMedCrossRef
16.
Scheffer AC, Schuurmans MJ, van Dijk N, van der Hooft T, de Rooij SE. Fear of falling: measurement strategy, prevalence, risk factors and consequences among older persons. Age Ageing. 2008;37(1):19–24.PubMedCrossRef
17.
18.
Levinger P, Menz HB, Wee E, Feller JA, Bartlett JR, Bergman NR. Physiological risk factors for falls in people with knee osteoarthritis before and early after knee replacement surgery. Knee Surg Sports Traumatol Arthrosc. 2011;19(7):1082–9.PubMedCrossRef
19.
Lo CWT, Tsang WWN, Yan CH, Lord SR, Hill KD, Wong AYL. Risk factors for falls in patients with total hip arthroplasty and total knee arthroplasty: a systematic review and meta-analysis. Osteoarthr Cartil. 2019;27(7):979–93.CrossRef
20.
Arksey H, O'Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 2005;8(1):19–32.CrossRef
21.
Morrison A, Polisena J, Husereau D, Moulton K, Clark M, Fiander M, Mierzwinski-Urban M, Clifford T, Hutton B, Rabb D. The effect of English-language restriction on systematic review-based meta-analyses: a systematic review of empirical studies. Int J Technol Assess Health Care. 2012;28(2):138–44.PubMedCrossRef
22.
23.
24.
25.
Ikutomo H, Nagai K, Nakagawa N, Masuhara K. Falls in patients after total hip arthroplasty in Japan. J Orthop Sci. 2015;20(4):663–8.PubMedCrossRef
26.
Soison A, Riratanapong S, Chouwajaroen N, Chantowart C, Buranapiyawong L, Kaewkot S, Kosuwon W. Prevalence of fall in patients with total knee arthroplasty living in the community. J Med Assoc Thail. 2014;97(12):1338–43.
27.
Pozzi F, Abujaber S, Fenstermacher S, Zeni J. Relationship between functional performance and falls in female patients with end stage hip osteoarthritis. Osteoarthr Cartil. 2015;23:A349.CrossRef
28.
Mitchell S, McCaskie A, Francis R, Peaston R, Birrell F, Lingard E. The need for a falls prevention programme for patients undergoing hip and knee replacement surgery. J Orthop Nurs. 2007;11(2):98–103.CrossRef
29.
Hill KD, Wee E, Margelis S, Menz HB, Bartlett J, Bergman NR, McMahon S, Hare DL, Levinger P. Falls in people prior to undergoing total hip or total knee replacement surgery: frequency and associated factors. Journal of Clinical Gerontology and Geriatrics. 2016;7(4):146–52.CrossRef
30.
Tsonga T, Michalopoulou M, Malliou P, Godolias G, Kapetanakis S, Gkasdaris G, Soucacos P. Analyzing the history of falls in patients with severe knee osteoarthritis. Clinics in Orthopedic Surgery. 2015;7(4):449–56.PubMedPubMedCentralCrossRef
31.
Matsumoto H, Okuno M, Nakamura T, Yamamoto K, Hagino H. Fall incidence and risk factors in patients after total knee arthroplasty. Arch Orthop Trauma Surg. 2012;132(4):555–63.PubMedCrossRef
32.
Tsonga T, Michalopoulou M, Kapetanakis S, Giovannopoulou E, Malliou P, Godolias G, Soucacos P. Reduction of falls and factors affecting falls a year after total knee arthroplasty in elderly patients with severe knee osteoarthritis. Open Orthop J. 2016;10:522–31.PubMedPubMedCentralCrossRef
33.
Swinkels A, Newman JH, Allain TJ. A prospective observational study of falling before and after knee replacement surgery. Age Ageing. 2008;38(2):175–81.PubMedCrossRef
34.
Smith TO, Pearson M, Latham SK. Are people following hip and knee arthroplasty at greater risk of experiencing a fall and fracture? Data from the osteoarthritis initiative. Arch Orthop Trauma Surg. 2016;136(6):865–72.PubMedCrossRef
35.
Riddle D, Golladay G. A longitudinal comparative study of falls in persons with knee arthroplasty and persons with or at high risk for knee osteoarthritis. Age Ageing. 2016;45(6):794–800.PubMedPubMedCentralCrossRef
36.
Powell LE, Myers AM. The Activities-specific Balance Confidence (ABC) Scale. The J Gerontol Ser A, Biol Sci Med Sci. 1995;50A(1):28.CrossRef
37.
Yardley L, Beyer N, Hauer K, Kempen G, Piot-Ziegler C, Todd C. Development and initial validation of the falls efficacy scale-international (FES-I). Age Ageing. 2005;34(6):614–9.CrossRefPubMed
38.
Hill KD, Schwarz JA, Kalogeropoulos AJ, Gibson SJ. Fear of falling revisited. Arch Phys Med Rehabil. 1996;77(10):1025–9.PubMedCrossRef
39.
Tinetti ME, Speechley M, Ginter SF. Risk factors for falls among elderly persons living in the community. N Engl J Med. 1988;319(26):1701–7.PubMedCrossRef
40.
Delbaere K, Close JCT, Heim J, Sachdev PS, Brodaty H, Slavin MJ, Kochan NA, Lord SR. A multifactorial approach to understanding fall risk in older people. J Am Geriatr Soc. 2010;58(9):1679–85.PubMedCrossRef
41.
Memtsoudis SG, Dy CJ, Ma Y, Chiu Y-L, Della Valle AG, Mazumdar M. In-hospital patient falls after total joint arthroplasty: incidence, demographics, and risk factors in the United States. The J Arthroplasty. 2012;27(6):82–828. e821.CrossRef
42.
Mandl LA, Lyman S, Quinlan P, Bailey T, Katz J, Magid SK. Falls among patients who had elective orthopaedic surgery: a decade of experience from a musculoskeletal specialty hospital. J Orthop Sports Phys Ther. 2013;43(2):91–6.PubMedCrossRef
43.
Muraki S, Akune T, Oka H, En-yo Y, Yoshida M, Nakamura K, Kawaguchi H, Yoshimura N. Prevalence of falls and the association with knee osteoarthritis and lumbar spondylosis as well as knee and lower back pain in Japanese men and women. Arthritis Care & Research. 2011;63(10):1425–31.CrossRef
44.
Patel KV, Phelan EA, Leveille SG, Lamb SE, Missikpode C, Wallace RB, Guralnik JM, Turk DC. High prevalence of falls, fear of falling, and impaired balance in older adults with pain in the United States: findings from the 2011 National Health and aging trends study. J Am Geriatr Soc. 2014;62(10):1844–52.PubMedPubMedCentralCrossRef
45.
Chiacchiero M, Dresely B, Silva U, DeLosReyes R, Vorik B. The relationship between range of movement, flexibility, and balance in the elderly. Topics Geriatr Rehabil. 2010;26(2):148–55.CrossRef
46.
Zijlstra GR, van Haastregt JCM, van Eijk JTM, van Rossum E, Stalenhoef PA, GIJM K. Prevalence and correlates of fear of falling, and associated avoidance of activity in the general population of community-living older people. Age Ageing. 2007;36(3):304–9.PubMedCrossRef
47.
Brouwer BJ, Walker C, Rydahl SJ, Culham EG. Reducing fear of falling in seniors through education and activity programs: a randomized trial. J Am Geriatr Soc. 2003;51(6):829–34.PubMedCrossRef
48.
Kumar A, Delbaere K, Zijlstra GA, Carpenter H, Iliffe S, Masud T, Skelton D, Morris R, Kendrick D. Exercise for reducing fear of falling in older people living in the community: Cochrane systematic review and meta-analysis. Age Ageing. 2016;45(3):345–52.PubMedCrossRef
49.
Hale WA, Delaney MJ, Cable T. Accuracy of patient recall and chart documentation of falls. The Journal of the American Board of Family Practice. 1993;6(3):239–42.PubMed
50.
Ganz DA, Higashi T, Rubenstein LZ. Monitoring falls in cohort studies of community-dwelling older people: effect of the recall interval. J Am Geriatr Soc. 2005;53(12):2190–4.PubMedCrossRef
51.
Westby MD, Marshall DA, Jones CA. Development of quality indicators for hip and knee arthroplasty rehabilitation. Osteoarthr Cartil. 2018;26(3):370–82.CrossRef
52.
Johnson RL, Duncan CM, Ahn KS, Schroeder DR, Horlocker TT, Kopp SL. Fall-prevention strategies and patient characteristics that impact fall rates after total knee arthroplasty. Anesth Analg. 2014;119(5):1113–8.PubMedCrossRef
53.
Clarke HD, Timm VL, Goldberg BR, Hattrup SJ. Preoperative patient education reduces in-hospital falls after total knee arthroplasty. Clin Orthop Relat Res. 2012;470(1):244–9.PubMedCrossRef
54.
Kim TE, Mariano ER. Developing a multidisciplinary fall reduction program for lower-extremity joint arthroplasty patients. Anesthesiol Clin. 2014;32(4):853–64.PubMedCrossRef
55.
Campbell AJ, Robertson MC. Rethinking individual and community fall prevention strategies: a meta-regression comparing single and multifactorial interventions. Age Ageing. 2007;36(6):656–62.PubMedCrossRef
56.
Bula CJ, Monod S, Hoskovec C, Rochat S. Interventions aiming at balance confidence improvement in older adults: an updated review. Gerontology. 2011;57(3):276–86.PubMedCrossRef
Metadata
Title
Falls and fear of falling in older adults with total joint arthroplasty: a scoping review
Publication date
01-12-2019
Published in
BMC Musculoskeletal Disorders / Issue 1/2019
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-019-2954-9

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