Hip osteoarthritis signs and symptoms are associated with increased fall risk among community-dwelling older adults with chronic low back pain: a prospective study

Abstract

Background Older adults with concurrent low back and hip pain are predisposed to reductions in physical performance and health-related quality of life. Yet no study to date has assessed whether or not coexisting hip impairments increase fall risk in older adults with chronic low back pain (CLBP). The objective of this study was to determine if hip osteoarthritis (OA) signs and symptoms per American College of Rheumatology (ACR) criteria are associated with fall risk over a 1-year span. Methods Falls were prospectively monitored for 1 year via fall calendars. Age, sex, body mass index (BMI), anxiolytic use, balance confidence, LBP-related disability, and prior fall history were identified as covariates. Hip pain, pain with hip internal rotation (IR), hip IR range of motion (ROM) ≥ 15°, and morning stiffness lasting ≤ 60 min were evaluated at baseline and summed to represent hip OA impairment burden. A generalized linear model with a Poisson distribution and log link function assessed the association between ACR criteria and fall risk beyond established covariates. As a secondary analysis, binary logistic regression assessed ACR criteria and the odds of falling two or more times within a year. Results Data from two-hundred and ten participants were analyzed. Hip OA signs and symptoms were present in 97.1% of the participants, and hip OA impairment burden was significantly greater (p < 0.050) in participants who fell ≥ 2 times compared to single and non-fallers. Higher hip OA impairment burden was associated with significantly increased fall risk (p = 0.001, risk ratio = 1.23, 95% CI 1.09–1.38) and odds of falling multiple times (p < 0.05, odds ratio = 1.41, 95% CI 1.01–1.95) after adjustment for covariates. Conclusions Older adults with CLBP and concomitant hip impairments are an at-risk group for falling. Healthcare professionals should employ falls screening and preventive measures to avoid negative sequelae in this vulnerable population.

Multi-Dimensional Impact of Chronic Low Back Pain among Underserved African American and Latino Older Adults

“…Previous studies show that older adults with a higher number of chronic diseases were more likely to have fallen in the past year compared to those with fewer chronic diseases [ 80 ]. In addition, multiple studies have documented that older adults with chronic low back pain are at risk for falling [ 81 , 82 , 83 , 84 ].…”

Relationship between the Risk of Falling and Physical Function in Elderly Individuals with Lower Extremity Arthritis

“…Future research should focus on longitudinal designs to explore the causal pathways linking arthritis to fall risk and incorporate objective measures of physical function. It is also imperative to develop and evaluate comprehensive management strategies that address both the physical and psychological aspects of fall risk in this population, including strength training, balance exercises, and cognitive-behavioral interventions to reduce fear of falling (13,19).…”

“…The diagnosis and ongoing assessment of knee osteoarthritis hinge clinical symptoms and specific radiographic findings, underscoring the condition's complex nature and its impact on physical functionality (10,11). The economic and functional burdens of falls on older individuals are notable, with those experiencing multiple falls within a year facing heightened risks of mobility and daily activity impairments (12,13). Comparative analyses reveal that individuals without osteoarthritis score higher on self-reported functional assessments than those with advanced knee osteoarthritis, who show diminished functionality in certain areas (14,15).…”

A Clinical Measure of Trunk Neuromuscular Function Predicts Falling in Older Adults With Chronic Low Back Pain

“…Bivariate correlation matrices and variance inflation factors were utilized to assess for multicollinearity among regression model variables. The relationship between the number of falls and aberrant movements was analyzed with Generalized Linear Models adjusting for 8 covariates: age, sex, BMI, composite LBP intensity, number of prior falls, anxiolytic use, number of American College of Rheumatology criteria for hip OA signs and symptoms, and dynamic balance performance (FSST) 9,11,12,33,37,39,44,45. Both negative binomial and Poisson distributions with log link functions were tested; findings were consistent between models, and the Poisson model was chosen to maintain consistency with a prior publication on this cohort 37.…”