Fear of Falling Linked to Previous Falls in Rheumatoid Arthritis

Among patients with rheumatoid arthritis (RA), the fear of falling is significantly associated with previous falls and markers of poor function, and is predictive of future falls and fear, thereby affecting activity levels and social engagement, according to study results published in BMC Musculoskeletal Disorders.

Patients with RA who have previously fallen may often experience a fear of falling that can lead to a reduction in activity, quality of life, institutionalization, and may also increase the risk for future falls.

A team of researchers conducted a UK-based, 1-year prospective study to determine the relationship between the fear of falling and associated risk factors in adults with RA.

Data were collected between August 2008 and September 2013 from patients with RA enrolled in the prospective cohort study from 4 outpatient clinics. Rheumatoid arthritis status was measured using the Disease Activity Score, and self-reported functional status was measured using the Health Assessment Questionnaire (HAQ). Fear of falling was analyzed at baseline and at 1 year using the Short Falls Efficacy Scale-International (Short FES-I) questionnaire. Logistic regression analysis was used to evaluate the association between fear of falling and predictor variables, including previous falls.

Of the 559 eligible participants, 535 (96%) patients with RA completed the follow-up of falls at 1 year. A total of 254 participants (47%) completed the follow-up questionnaire after 1 year and 281 participants did not respond (53%).

The majority of participants were women (n=386 at baseline; n=174 at 1 year); the mean age of participants was 62.1 years; and more than half of the baseline participants were retired (n=327, 58.5%); 82 participants were unable to work due to their disabilities (14.7%).

At baseline and the 1-year follow-up, high fear-of-falling ranges were scored by 69.9% and 71.7% of participants, respectively. At baseline, patients who reported a fall had a significantly higher mean baseline Short FES-I score compared with those who did not report a fall (16.8 vs 14.4, respectively; P <.001). However, a history of falls was not significantly associated with a change in the fear of falling after a year of follow-up. In addition, fear of falling was not significantly associated with age (P =.8) and did not significantly vary between men and women (P =.41).

The most significant predictors of future fears of falling were a history of multiple falls (odds ratio [OR], 6.08; 95% CI, 1.19-30.99; P =.03), higher HAQ scores (OR, 4.87; 95% CI, 1.59-14.92; P =.006), and increased time to complete the Chair Stand Test (OR, 1.11; 95% CI, 1.01-1.20; P =.02).

Study limitations included the reliance of falls on self-report by patients, low follow-up response rates for the Short FES-I questionnaire, and the inability to determine disease severity of patients.

“Patients [with RA] who report high [fear of falling] may benefit from fall prevention measures whether or not they have previously fallen, and exercise interventions to reduce [fear of falling] should be considered,” the researchers wrote.

Reference

Stanmore EK, Oldham J, Skelton DA, O’Neill T, Pilling M, Todd C. Fear-of-falling and associated risk factors in persons with rheumatoid arthritis: a 1 year prospective study. BMC Musculoskelet Disord. 2021;22(1):260. doi:10.1186/s12891-021-04068-0