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Clinician Article

Physical therapies for improving balance and reducing falls risk in osteoarthritis of the knee: a systematic review.



  • Mat S
  • Tan MP
  • Kamaruzzaman SB
  • Ng CT
Age Ageing. 2015 Jan;44(1):16-24. doi: 10.1093/ageing/afu112. Epub 2014 Aug 22. (Review)
PMID: 25149678
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Disciplines
  • Family Medicine (FM)/General Practice (GP)
    Relevance - 6/7
    Newsworthiness - 6/7
  • General Internal Medicine-Primary Care(US)
    Relevance - 6/7
    Newsworthiness - 6/7
  • Rheumatology
    Relevance - 6/7
    Newsworthiness - 5/7
  • Physical Medicine and Rehabilitation
    Relevance - 6/7
    Newsworthiness - 4/7
  • Geriatrics
    Relevance - 5/7
    Newsworthiness - 4/7
  • Surgery - Orthopaedics
    Relevance - 5/7
    Newsworthiness - 4/7

Abstract

INTRODUCTION: osteoarthritis (OA) of knee has been reported as a risk factor for falls and reduced balance in the elderly. This systematic review evaluated the effectiveness of physical therapies in improving balance and reducing falls risk among patients with knee OA.

METHODS: a computerised search was performed to identify relevant studies up to November 2013. Two investigators identified eligible studies and extracted data independently. The quality of the included studies was assessed by the PeDro score.

RESULTS: a total of 15 randomised controlled trials involving 1482 patients were identified. The mean PeDro score was 7. The pooled standardised mean difference in balance outcome for strength training = 0.3346 (95% CI: 0.3207-0.60, P = 0.01 < 0.00001, P for heterogeneity = 0.85, I(2) = 0%). Tai Chi = 0.7597 (95% CI: 0.5130-1.2043, P<=0.0014, P for heterogeneity = 0.26, I(2) = 0%) and aerobic exercises = 0.6880 (95% CI: 0.5704-1.302, P < 0.00001, P for heterogeneity = 0.71, I(2) = 0%). While pooled results for falls risk outcomes in, strength training, Tai chi and aerobics also showed a significant reduction in reduced risk of falls significantly with pooled result 0.55 (95% CI: 0.41-0.68, P < 0.00001, P for heterogeneity = 0.39, I(2) = 6%).

CONCLUSION: strength training, Tai Chi and aerobics exercises improved balance and falls risk in older individuals with knee OA, while water-based exercises and light treatment did not significantly improve balance outcomes. Strength training, Tai Chi and aerobics exercises can therefore be recommended as falls prevention strategies for individuals with OA. However, a large randomised controlled study using actual falls outcomes is recommended to determine the appropriate dosage and to measure the potential benefits in falls reduction.


Clinical Comments

Family Medicine (FM)/General Practice (GP)

Thinking in terms of cost effective delivery of preventive care, Tai Chi is probably the winner. One teacher (who doesn't need postgraduate level training with the pay bracket to match) could provide this on a group basis across older people's neighbours and residential care facilities. Who is going to initiate the large hard endpoint RCT suggested? It might just be people from the Trust I work for!

Geriatrics

This systematic review and meta-analysis looked at various non-pharmacological interventions to reduce falls in patients with osteoarthritis. The findings were generally in keeping with what we already know from larger reviews looking at unselected patients with falls. The authors recommend certain interventions based on "significant" pooled differences. Other interventions may be equally beneficial but there are insufficient published data to show this effect.

Geriatrics

This is a systematic review with few studies of small sample sizes, and heterogeneity of the interventions, samples (some studies only involved women) and in the assessment tools.

Geriatrics

Systematic review that finds strength training, Tai Chi and aerobics exercises improve balance and fall risk in older adults with knee OA. This was predictable given the results from multiple overlapping reviews of treatments for falls prevention in the elderly.

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