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Fall Risk and Utilization of Balance Training for Adults With Symptomatic Knee Osteoarthritis

Secondary Analysis From a Randomized Clinical Trial

Anderson, Monica L., PT, DPT1; Allen, Kelli D., PhD2,3,4; Golightly, Yvonne M., PT, PhD2,5,6; Arbeeva, Liubov S., MS2,3; Goode, Adam, PT, DPT, PhD7; Huffman, Kim M., MD, PhD8,9; Schwartz, Todd A., DrPH10; Hill, Carla H., PT, DPT1

Journal of Geriatric Physical Therapy: April/June 2019 - Volume 42 - Issue 2 - p E39–E44
doi: 10.1519/JPT.0000000000000213
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Background and Purpose: Knee osteoarthritis (KOA) is a common disease that hinders activity participation in older adults. Associated symptoms and physiological changes can increase risk of falling in individuals with KOA. Balance training can decrease fall risks in older adults. Limited evidence exists regarding utilization of balance training in physical therapy (PT) for this population. This secondary data analysis investigated the proportion of participants at high risk for falling in the PhysicAl THerapy vs. INternet-based Exercise Training for Patients with Osteoarthritis (PATH-IN) study and the frequency with which balance training was utilized as an intervention in PT.

Methods: PATH-IN study participants (N = 344) performed the Four-Stage Balance Test and the Timed Up and Go (TUG) test during baseline assessment. Participants were randomly allocated to PT, an Internet-based exercise program, or a control group. Participants were classified as being at high risk for falling if they did not progress to the single-leg stance (SLS) during the Four-Stage Balance Test, were unable to maintain SLS for 5 seconds, or took longer than 13.5 seconds to complete the TUG test. The proportion of participants at high risk for falling was calculated for all participants and separately for those allocated to PT. In addition, PT notes were coded for balance training and the frequency of balance training utilization was calculated.

Results and Discussion: Upon enrollment, 35.5% (N = 122) of all participants and 36.2% (N = 50) of those allocated to PT were at high risk for falling. Of participants allocated to PT with documentation available for coding (N = 118), 35.5% (N = 42) were at high risk for falling. Balance training was provided to 62.7% (N = 74) during at least one PT session. Of those classified as being at high risk for falling, 33.3% (N = 14) did not receive balance training.

Conclusions: The finding of high fall risks in more than one-third of all participants with KOA is consistent with previous reports of a higher risk of falling in this population. Many PT participants did receive some balance training; however, one-third of participants at high risk for falling did not. Balance training for individuals with KOA at high risk for falling may be underutilized.

1Division of Physical Therapy, Department of Allied Health Sciences, University of North Carolina at Chapel Hill.

2Thurston Arthritis Research Center, University of North Carolina at Chapel Hill.

3Department of Medicine, University of North Carolina at Chapel Hill.

4Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, North Carolina.

5Injury Prevention Research Center, University of North Carolina at Chapel Hill.

6Department of Epidemiology, University of North Carolina at Chapel Hill.

7Division of Physical Therapy, Department of Orthopedic Surgery, Duke University Medical Center, Durham, North Carolina.

8Division of Rheumatology and Immunology, Department of Medicine, Duke University Medical Center, Durham, North Carolina.

9Physical Medicine and Rehabilitation Service, Durham VA Medical Center, Durham, North Carolina.

10Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill.

Address correspondence to: Carla H. Hill, PT, DPT, OCS, Cert MDT, Division of Physical Therapy, Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Campus Box 7135, Chapel Hill, NC 27599 (Carla_Hill@med.unc.edu).

This study was funded through a Patient-Centered Outcomes Research Institute Award (CER-1306-02043). K.D.A., L.S.A., Y.M.G., and T.A.S. receive support from National Institute of Arthritis and Musculoskeletal and Skin Diseases Multidisciplinary Clinical Research Center (P60 AR062760). K.D.A. receives support from the Center for Health Services Research in Primary Care, Durham VA Health Care System (CIN 13-410).

The statements presented in this article are solely the responsibility of the authors and do not necessarily represent the views of the Patient-Centered Outcomes Research Institute, its Board of Governors, or Methodology Committee.

The authors declare there were no conflicts of interest.

Robert Wellmon was the Decision Editor.

© 2019 Academy of Geriatric Physical Therapy, APTA
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