Derivation of a clinical prediction rule to determine fall risk in community-dwelling individuals with knee osteoarthritis: a cross-sectional study

Abstract

Summary

We derived a clinical prediction rule (CPR) to determine fall risk. The probability of falls increased, with positive likelihood ratio being 17.8 and post-test probability (positive predictive value) being 88.2%, in cases where the CPR score was 2 points. Our CPR could be a useful screening test to detect fall risk probability.

Purpose

We aimed to examine the risk factors for falls in individuals with knee osteoarthritis (OA) and derive a clinical prediction rule (CPR) to determine fall risk.

Methods

Eighty-one individuals with medial compartment knee OA were included. The outcome was whether the participants had a self-reported fall within the past 1 year of this study being conducted. The collected data included sex, age, body mass index, Kellgren-Lawrence grade, lesion type (bilateral or unilateral knee OA), pain (rated using the visual analog scale), muscle strength test of the quadriceps femoris, one-leg standing test (OLST), five times sit-to-stand test (FTSST), and 5-m walk test, which were used in binomial logistic regression analysis. The outcome measure of the analysis was whether the study participants belonged to a fall or non-fall group. Receiver operating characteristic (ROC) analysis was performed for the outcome measurements, and the factors were selected by binomial logistic regression analysis. Then, a CPR to determine fall risk was extracted, and its diagnostic characteristics were calculated.

Results

Binomial logistic regression analysis showed that the OLST and FTSST were significant. ROC analysis showed that the cut-off values of the OLST and FTSST were 5.3 s and 7.9 s, respectively. The post-test probability (positive predictive value) increased to 88.2% (positive likelihood ratio = 17.8) when the OLST and FTSST were both positive (the CPR score was 2 points).

Conclusion

The CPR obtained from this study would be useful as a screening test to detect the fall risk probability in individuals with knee OA.

This is a preview of subscription content, log in to check access.

References

  1. 1.

    Hartholt KA, van Beeck EF, Polinder S, van der Velde N, van Lieshout EMM, Panneman MJM, van der Cammen TJM, Patka P (2011) Societal consequences of falls in the older population: injuries, healthcare costs, and long-term reduced quality of life. J Trauma 71:748–753

    Article  Google Scholar 

  2. 2.

    Rubenstein LZ (2006) Falls in older people: epidemiology, risk factors and strategies for prevention. Age Ageing 35:ii37–ii41

    Article  Google Scholar 

  3. 3.

    Tinetti ME, Speechley M, Ginter SF (1988) Risk factors for falls among elderly persons living in the community. N Engl J Med 319:1701–1707

    CAS  Article  Google Scholar 

  4. 4.

    Stalenhoef PA, Diederiks JP, Knottnerus JA, Kester AD, Crebolder HF (2002) A risk model for the prediction of recurrent falls in community-dwelling elderly: a prospective cohort study. J Clin Epidemiol 55:1088–1094

    CAS  Article  Google Scholar 

  5. 5.

    Hopewell S, Adedire O, Copsey BJ et al (2018) Multifactorial and multiple component interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev 7:CD012221

    PubMed  Google Scholar 

  6. 6.

    Tinetti ME, Kumar C (2010) The patient who falls: “It’s always a trade-off”. JAMA 303:258–266

    CAS  Article  Google Scholar 

  7. 7.

    Manlapaz DG, Sole G, Jayakaran P, Chapple CM (2019) Risk factors for falls in adults with knee osteoarthritis: a systematic review. PM&R 11:745–757. https://doi.org/10.1002/pmrj.12066

    Article  Google Scholar 

  8. 8.

    Tanaka T, Matsumoto H, Son BK, Imaeda S, Uchiyama E, Taniguchi S, Nishino A, Miura T, Tanaka T, Otsuki T, Nishide K, Iijima K, Okata J (2018) Environmental and physical factors predisposing middle-aged and older Japanese adults to falls and fall-related fractures in the home. Geriatr Gerontol Int 18:1372–1377

    Article  Google Scholar 

  9. 9.

    Gale CR, Cooper C, Aihie Sayer A (2016) Prevalence and risk factors for falls in older men and women: the English Longitudinal Study of Ageing. Age Ageing 45:789–794

    Article  Google Scholar 

  10. 10.

    Aibar-Almazán A, Martínez-Amat A, Cruz-Díaz D, Jiménez-García JD, Achalandabaso A, Sánchez-Montesinos I, de la Torre-Cruz M, Hita-Contreras F (2018) Sarcopenia and sarcopenic obesity in Spanish community-dwelling middle-aged and older women: association with balance confidence, fear of falling and fall risk. Maturitas 107:26–32

    Article  Google Scholar 

  11. 11.

    Himes CL, Reynolds SL (2012) Effect of obesity on falls, injury, and disability. J Am Geriatr Soc 60:124–129

    Article  Google Scholar 

  12. 12.

    Ikezoe T, Asakawa Y, Tsutoa A (2003) The relationship between quadriceps strength and balance to fall of elderly admitted to a nursing home. J Phys Ther Sci 15:75–79

    Article  Google Scholar 

  13. 13.

    Vellas BJ, Wayne SJ, Romero L, Baumgartner RN, Rubenstein LZ, Garry PJ (1997) One-leg balance is an important predictor of injurious falls in older persons. J Am Geriatr Soc 45:735–738

    CAS  Article  Google Scholar 

  14. 14.

    Ikezoe T, Asakawa Y, Shima H, Ichihashi N (2009) Physical function screening of institutionalized elderly women to predict their risk of falling. JPN J Phys Fit Sport 58:489–498 (in Japanese)

    Google Scholar 

  15. 15.

    Anderson ML, Allen KD, Golightly YM, Arbeeva LS, Goode A, Huffman KM, Schwartz TA, Hill CH (2019) Fall risk and utilization of balance training for adults with symptomatic knee osteoarthritis: secondary analysis from a randomized clinical trial. J Geriatr Phys Ther 42:E39–E44

    Article  Google Scholar 

  16. 16.

    Mat S, Ng CT, Tan PJ, Ramli N, Fadzli F, Rozalli FI, Mazlan M, Hill KD, Tan MP (2018) Effect of modified Otago exercises on postural balance, fear of falling, and fall risk in older fallers with knee osteoarthritis and impaired gait and balance: a secondary analysis. PM R 10:254–262

    Article  Google Scholar 

  17. 17.

    McGinn TG, Guyatt GH, Wyer PC, Naylor CD, Stiell IG, Richardson WS (2000) Users’ guides to the medical literature: XXII: how to use articles about clinical decision rules. Evidence-Based Medicine Working Group. JAMA 284:79–84

    CAS  Article  Google Scholar 

  18. 18.

    Katoh M, Yamasaki H (2009) Comparison of reliability of isometric leg muscle strength measurements made using a hand-held dynamometer with and without a restraining belt. J Phys Ther Sci 21:37–42

    Article  Google Scholar 

  19. 19.

    Michikawa T, Nishiwaki Y, Takebayashi T, Toyama Y (2009) One-leg standing test for elderly populations. J Orthop Sci 14:675–685

    Article  Google Scholar 

  20. 20.

    Whitney SL, Wrisley DM, Marchetti GF, Gee MA, Redfern MS, Furman JM (2005) Clinical measurement of sit-to-stand performance in people with balance disorders: validity of data for the five-times-sit-to-stand test. Phys Ther 85:1034–1045

    Article  Google Scholar 

  21. 21.

    Wilson CM, Kostsuca SR, Boura JA (2013) Utilization of a 5-meter walk test in evaluating self-selected gait speed during preoperative screening of patients scheduled for cardiac surgery. Cardiopulm Phys Ther J 24:36–43

    Article  Google Scholar 

  22. 22.

    Shimada H, Makizako H, Doi T, Tsutsumimoto K, Nakakubo S (2016) Prevalence of accidental falls in the older adults with mild cognitive impairment. Japanese Journal of Physical Therapy Fundamentals 19:48–54 (in Japanese)

    Google Scholar 

  23. 23.

    Tiedemann A, Shimada H, Sherrington C, Murray S, Lord S (2008) The comparative ability of eight functional mobility tests for predicting falls in community-dwelling older people. Age Ageing 37:430–435

    Article  Google Scholar 

  24. 24.

    Gillespie LD, Robertson MC, Gillespie WJ et al (2012) Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev 9:CD007146

    Google Scholar 

  25. 25.

    Deyle GD, Gill NW, Allison SC, Hando BR, Rochino DA (2012) Knee OA: which patients are unlikely to benefit from manual PT and exercise? J Fam Pract 61:1–8

    Google Scholar 

  26. 26.

    Currier LL, Froehlich PJ, Carow SD, McAndrew RK, Cliborne AV, Boyles RE, Mansfield LT, Wainner RS (2007) Development of a clinical prediction rule to identify patients with knee pain and clinical evidence of knee osteoarthritis who demonstrate a favorable short-term response to hip mobilization. Phys Ther 87:1106–1119

    Article  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Tetsuya Amano.

Ethics declarations

All study participants were informed of this study and provided written informed consent. This study was approved by the Research Ethics Committee of Tokoha University (approval no. R-2018-505H).

Conflicts of interest

None.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Amano, T., Suzuki, N. Derivation of a clinical prediction rule to determine fall risk in community-dwelling individuals with knee osteoarthritis: a cross-sectional study. Arch Osteoporos 14, 90 (2019). https://doi.org/10.1007/s11657-019-0641-y

Download citation

Keywords

  • Prognosis prediction
  • Clinical prediction rule
  • Osteoarthritis
  • Knee
  • Falls