Impact of Knee Pain on Fear of Falling, Changes in Instrumental Activities of Daily Living, and Falls Among Malaysians Age 55 Years and Above

Abstract

Objectives: To determine the temporal relationship between the presence of knee pain and knee pain severity identified at baseline with fall risk, fear of falling and changes in instrumental activity of daily living at 12-months follow-up. Methods: This was a prospective study from the Malaysian Elders Longitudinal Research (MELoR) study involving community dwelling older persons aged 55 years and older. The presence of one fall in the preceding 12 months, knee pain, and functional capacity were determined at baseline (2013–2015) and follow-up (2015–2016). Function was determined as loss of at least one of seven instrumental activities of daily living (IADL). Physical performance was evaluated at baseline using the timed-up-and-go (TUG) test. Fear of falling (FoF) was determined using the single question “Are you afraid of falling?” Results: Data were available for 605 participants, mean ( SD ) age = 69.10 (7.24) years. Knee pain was present in 30.2% at baseline. Neither the presence of knee pain nor knee pain severity at baseline were associated with falls at 1-year follow-up. Knee pain was significantly associated with FoF at follow-up [aRR (95%CI) = 1.76 (1.02–3.04)] but not changes in IADL. Among individuals with no falls at baseline, the presence of knee pain was protective of falls at follow-up after adjustment for baseline physical performance [adjusted rate ratio, aRR (95% confidence interval, CI) = 0.35 (0.13–0.97)]. Conclusion: Knee pain is associated with increased FoF at 1.5 years' follow-up within a multi-ethnic population aged 55 years, residing in an urban location in a middle-income South East Asian nation. Interestingly, after differences in muscle strength was accounted for, knee pain was protective against falls at follow-up. Our findings challenge previous assumptions on joint pain and falls and highlights the importance of large prospective studies and further mechanistic research incorporating psychological factors in this area of increasing prominence.

Are multimorbidity patterns associated with fear of falling in community-dwelling older adults?

“…This is due to the fact that this pattern is strongly related to rheumatic and joint diseases, which may increase the risk of older adults developing fear of falling [29,35]. In addition, other studies show that musculoskeletal conditions such as pain and osteoporosis increase the chances of older adults presenting fear of falling by 1.76 (95%CI 1.02; 3.04) [51] and 2.04 (95%CI 1.60; 2.60) [52], respectively. According to the literature, disorders such as pain or chronic conditions would exacerbate the disabling effect of fear of falling, as well as reduce healthy behaviors and patient compliance to treatment [53].…”

Factors associated with falls in patients with knee osteoarthritis: A cross-sectional study

“…This condition limits activities and can cause significant muscle atrophy, loss of balance, gait disorder, functional activity limitations, and changes in physical condition, all of which may lead to an increased risk of falls. [3,10] Our findings showed that patients with knee OA and a history of falls had higher KOOS symptom scores than those without previous falls. These results are consistent with those reported by a previous study [33] in which authors observed a higher KOOS symptom score in patients with knee OA, which indicates loss of functional capacity, which leads to reduced lower extremity muscle strength and a high risk of falls.…”

“…This condition limits activities and can cause significant muscle atrophy, loss of balance, gait disorder, functional activity limitations, and changes in physical condition, all of which may lead to an increased risk of falls. [3,10]…”

“…Among these individuals, up to 42.8% were reported to have a severe incidence. [3] Previous research [4,5] has shown a 2-fold increase in fall prevalence among the community-dwelling Indonesian elderly population (aged ≥ 50 years) over the last 2 years owing to lack of awareness regarding falls and fall risk. Therefore, identification of factors associated with fall risk is necessary to minimize fall incidence in this population.…”

Knee osteoarthritis patients assessed during walking for ankle inversion movement discrimination sensitivity

“…In general, male adults have been considered to be stronger in the lower limbs than their female counterparts ( Ditroilo et al, 2010 ), and in the KOA cohort, female patients have been reported to have more severe impairments in lower extremity neuromuscular control than male patients. However, a recent large-sample, prospective investigation based in an Asian community suggested that muscle strength was not associated with fear of falling ( Mat et al, 2020 ), signifying the need of further investigations regarding the characteristics of neuromuscular control during walking, as this remains the most common functional activity where fall accidents occur ( Promsri et al, 2023 ). To date, a gender difference on lower limb proprioception has been investigated in healthy cohorts, and some clinical populations ( Karkousha, 2016 ; Lu et al, 2022 ; Shi et al, 2023a ), yet not in KOA ( Salamanna et al, 2023 ).…”