Background/Purpose

People with rheumatoid arthritis (RA) have an increased risk of falls. The consequences of falls can be devastating including loss of confidence and independence, injury and death. The foot is a common site of pathology in RA and foot problems are reported in up to 90% of patients with established disease. Previous studies in non-RA populations have identified that foot and ankle problems are associated with falls and falls risk in older adults. The aim of this study was to determine whether foot and ankle characteristics are associated with falls in people with RA. 

Methods

Adults with RA according to the 2010 ACR/EULAR classification criteria were recruited from rheumatology outpatient clinics in Auckland, New Zealand. All participants reported whether they had fallen in the preceding year, and the number of falls. The Prevention of Falls Network Europe (ProFanE) definition of, “an event that results in a person coming to rest unintentionally on the ground or other lower level”, was used to identify falls. RA characteristics, common fall risk factors, and foot and ankle variables were measured. Foot and ankle testing included foot deformity, plantar sensation, muscle strength, ankle range of motion, gait speed, peak plantar pressures, postural stability, foot pain and self-reported foot impairment. Univariate parametric and non-parametric analysis compared fallers and non-fallers on all variables to determine significant differences. Logistic regression analysis identified variables independently associated with falls.

Results

Two hundred and one participants were prospectively recruited. At least one fall in the preceding 12 months was reported by 119 (59%) participants. Significant factors associated with falls in the univariate analysis are presented in Table 1. Fallers had significantly longer mean disease duration, more co-morbid conditions, slower gait speed, higher mid-foot peak plantar pressures and were more likely to have a history of stroke than non-fallers. Fallers also reported greater difficulty with the activities of daily living, increased fear of falling and greater self-reported foot impairment. In logistic regression analysis, including age, sex and all variables at a level of p<0.15 in the univariate analysis, increased mid-foot peak plantar pressures (odds ratio 1.12 [for each 20kPa increase], p=0.037) and self-reported foot impairment (odds ratio 1.16 [for each 3 point increase], p=0.007) were independently associated with a fall in the preceding 12 months.

Conclusion

Elevated mid-foot peak plantar pressures and self-reported foot impairment are associated with falls in people with RA. Assessment of foot deformity, foot function and self-reported foot impairment may be of benefit when considering falls prevention in people with RA.

Table 1: Significant factors associated with falls in univariate analysis. Data are presented as mean (SD) unless specified.

	Non-fallers n=82	Fallers n=119	P value
Clinical features
Disease duration	13.6 (12.8)	17.4 (13.9)	0.03
HAQII	0.76 (0.60)	0.98 (0.62)	0.01
Number of co-morbid conditions	1.0 (0.9)	1.3 (1.1)	0.02
History CVA/TIA, no. (%)	0 (0)	9 (7.6)	0.03
Fear of falling (short FES-I)	11 (5)	13 (5)	0.002
Foot and ankle features
6 metre walk time (s)	5.8 (2.1)	6.5 (2.9)	0.04
Peak Plantar Pressure mid-foot (Kpa)	100 (44)	122 (71)	0.048
Foot impairment (LFISAP)	12 (9)	16 (8)	0.002
HAQ, Health Assessment Questionnaire; FES-I, Falls Efficacy Scale-International; LFISAP, Leeds Foot Impact Scale Activities/Impairment subscale

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/foot-and-ankle-characteristics-associated-with-falls-in-adults-with-rheumatoid-arthritis/