Balance performance in older adults with hip osteoarthritis: A systematic review

Hip and trunk biomechanics and dynamic balance during steady-state stair walking in people with mild-to-moderate hip osteoarthritis

Stair walking is more demanding than level walking, and differences have been found between steady-state stair walking and gait-to-stair or stair-to-gait transition. However, there is limited knowledge on steady-state stair walking biomechanics in people with hip osteoarthritis (HOA) as all existing data were obtained during gait-to-stair transition. The aim of the present study was to investigate the effects of mild-to-moderate HOA on hip and trunk biomechanics and dynamic balance during steady-state stair walking. Hip and trunk biomechanics and dynamic balance during steady-state stair walking were assessed in 21 participants with mild-to-moderate HOA and 21 age-matched healthy controls using an optoelectronic motion capture system and a custom-built instrumented six-step staircase. Dynamic balance was assessed using the inverted pendulum model with an extrapolated centre of mass. Differences between the two groups were analysed with an independent t-test either on discrete parameters or on entire time curves using statistical parametric mapping. The HOA group showed longer stride and stance phase durations during stair ascent and descent, and lower peak vertical CoM acceleration during stair descent vs. the control group. Trunk kinematics did not differ between groups. Lower frontal plane hip range of motion and hip internal rotation moment, but greater anterior margin of stability were observed during stair ascent in the HOA vs. control group. Mild-to-moderate HOA reduced frontal hip mobility but did not affect mediolateral dynamic balance during steady-state stair walking. Despite a lack of alterations in sagittal hip or trunk kinematics or dynamics, greater anterior margin of stability in HOA vs. control participants showed a more stable but potentially less efficient motion during stair ascent. Lastly, lower vertical acceleration during stair descent might reduce impact and joint loading at initial contact. Future studies should analyse gait efficiency and joint loading, and the effect of HOA severity and muscle force capacity on steady-state stair walking biomechanics in people with HOA.

Biomechanical analysis of limits of stability using computerized posturography: correlations with functional mobility in elderly individuals with hip osteoarthritis - a cross-sectional study

Background

Hip osteoarthritis (OA) is a degenerative joint disease that predominantly affects the elderly, causing significant morbidity due to joint pain, stiffness, and loss of function. This study aimed to assess the limits of stability (LOS) using computerized posturography and evaluate the correlations with functional mobility in elderly individuals with hip OA.

Methods

This cross-sectional study included elderly individuals aged 65 years and above with a clinical diagnosis of hip OA and age-matched asymptomatic controls. The LOS was measured using a computerized dynamic posturography system, which quantified the maximum distance and angle participants could shift their center of gravity without losing balance. Functional mobility was assessed using the Timed Up and Go (TUG) test, which measures the time taken for participants to stand up, walk 3 m, turn around, walk back, and sit down.

Results

The study included 86 elderly individuals with hip OA and 86 age-matched asymptomatic controls. LOS assessments showed that individuals with hip OA had significantly lower stability scores across all directions compared to controls (p < 0.001). TUG test times were significantly slower for the OA group (10.50 ± 2.20 s) compared to controls (8.70 ± 2.00 s, p < 0.001). Positive correlations were found between LOS and functional mobility (r = 0.50, p = 0.009). Moderation analysis revealed that age and duration of OA significantly influenced the relationship between stability and mobility.

Conclusion

Hip OA significantly impacts stability and functional mobility in elderly individuals. Enhanced stability is associated with improved mobility, and demographic and clinical variables such as age and duration of OA play crucial roles in these relationships. These findings underscore the importance of targeted therapeutic interventions to improve stability and mobility in this population.

The reliability and validity of the cone evasion walk test in patients with hip osteoarthritis

Background

Hip osteoarthritis (OA) can result in joint pain, stiffness, compromised balance, hindered mobility, and decreased functional independence. The Cone Evasion Walk Test (CEW) was designed for evaluating balance by evaluating the capacity to evade obstacles. Consequently, the study's objective was to assess the validity and reliability of the CEW in hip OA patients.

Methods

A total of 24 patients with hip OA were enrolled. Patients performed trials for the CEW and the timed up and go test (TUG). Between the trials, patients rested for an hour. The falls within the previous 12-month period were reported.

Results

The analysis showed that the CEW has excellent reliability and high validity in hip OA. (p < 0.001). The relative (intraclass correlation [ICC] coefficient) and absolute (SEM and SRD95) reliability of the CEW were 0.96 (0.88-0.98 95% CI), 0.56, and 1.54, respectively. The Spearman correlation coefficient between the CEW and the TUG was 0.74 (p < 0.001) and between the CEW and the falls in the last 12 months was 0.51 (p > 0.05).

Conclusions

The CEW is effective for evaluating the function, dynamic balance, and mobility in patients with hip OA and could be a more accurate measure of the dynamic balance activities in the community.

Short-Term Cast Immobilization of a Unilateral Lower Extremity and Physical Inactivity Induce Postural Instability during Standing in Healthy Young Men

Previous studies have reported an increased postural sway after short-term unilateral lower limb movement restriction, even in healthy subjects. However, the associations of motion limitation have not been fully established. The question of whether short-term lower limb physical inactivity and movement restriction affect postural control in the upright position remains. One lower limb of each participant was fixed with a soft bandage and medical splint for 10 h while the participant sat on a manual wheelchair. The participants were instructed to stand still for 60 s under eyes-open (EO) and eyes-closed (EC) conditions. Using a single force plate signal, we measured the center of pressure (COP) signal in the horizontal plane and calculated the total, anterior-posterior (A-P), and medial-lateral (M-L) path lengths, sway area, and mean COP displacements in A-P and M-L directions. The COP sway increased and the COP position during the upright stance shifted from the fixed to the non-fixed side after cast removal, compared to before the cast application, under both EO and EC conditions. These findings indicated that 10 h of unilateral lower limb movement restriction induced postural instability and postural control asymmetry, suggesting the acute adverse effects of cast immobilization.

Effects of core strengthening on balance in patients with hip osteoarthritis: a randomised controlled trial

Osteoarthritis is a condition commonly present in the elderly, with many having altered balance, aggravated with weak lower limb and core musculature predisposing them to falls. Despite the knowledge about the link between balance and core stability, studies investigating the importance of core stability exercise and their impact on balance are limited. Therefore, the authors aimed to explore whether core strengthening exercises in combination with hip exercises, when compared to a hip exercise programme and a control group, led to better improvements in balance in patients with hip osteoarthritis. In order to meet these aims, this paper reports the outcomes of a randomized, three-arm parallel, assessor-blinded, controlled clinical trial. Fifty-one participants awaiting a total hip replacement were recruited into this study. All patients were randomly allocated to a control, hip exercise group and hip and core exercise group. All participants were assessed for core muscle strength using a pressure biofeedback unit and balance using the four-stage balance test. The control group had no intervention. A 12-week hip and core exercise programme did not result in improvements over and above the hip exercise group in balance scores. However an improvement in core stability was noted for the hip and core exercise group ( P  = 0.001). Therefore, this study concluded that both exercise groups are resulted in improved balance with the core and hip exercise group noted to have added improvements, but the difference between the groups was not statistically significant.

Effects of exercise therapy on the balance and gait after total hip arthroplasty: a systematic review and meta-analysis

The situation is such that there is a lack of research analyzing the effect of exercise therapy during the rehabilitation period of patients after total hip arthroplasty (THA). Therefore, the purpose of this systematic review and meta-analysis is to analyze the effects of exercise therapy on the balance and gait of patients after THA. The studies selected for this study were based on the PICO as follows: P (Patient)-patients after THA, I (Intervention)-exercise therapy, C (Comparison)-control and other therapy groups, O (Outcome)-balance and gait. Additional criteria for this study were study design (randomized controlled study), language (English), publication status (journal), and the year of publication were not limited. Eleven studies were included. The effects of exercise therapy on balance and gait in patients after THA were significantly different. Balance: standardized mean difference (SMD), 0.51; 95% confidence intervals (CI), 0.24-0.78; I2=22%. Gait: SMD, 0.39; 95% CI, 0.01-0.76; I2=66%. Rehabilitation specialists recommend that exercise therapy be included in rehabilitation programs to improve balance and gait in patients after THA. Further research is needed in the future, including more studies and a network meta-analysis that analyzes the effect size of each exercise therapy.

Individual muscle contributions to the acceleration of the centre of mass during gait in people with mild-to-moderate hip osteoarthritis

BACKGROUND

People with mild-to-moderate hip osteoarthritis (OA) exhibit hip muscle weakness, alterations in hip kinematics and kinetics and hip contact forces during gait compared to healthy controls. However, it is unclear if those with hip OA use different motor control strategies to coordinate the motion of the centre of mass (COM) during gait. Such information could provide further critical assessment of conservative management strategies implemented for people with hip OA.

RESEARCH QUESTION

Do muscle contributions to the acceleration of the COM during walking differ between individuals with mild-to-moderate hip OA and controls?

METHODS

Eleven individuals with mild-to-moderate hip OA and 10 healthy controls walked at a self-selected speed while whole-body motion and ground reaction forces were measured. Muscle forces during gait were obtained using static optimisation and an induced acceleration analysis was performed to determine individual muscle contributions to the acceleration of the COM during single-leg stance (SLS). Between-group comparisons were made using independent t-tests via Statistical Parametric Modelling.

RESULTS

There were no between-group differences in spatial-temporal gait parameters or three-dimensional whole-body COM acceleration. The rectus femoris, biceps femoris, iliopsoas and gastrocnemius muscles in the hip OA group contributed less to the fore-aft accelerations of the COM (p < 0.05), and more to the vertical COM acceleration with the gluteus maximus (p < 0.05), during SLS, compared to the control group.

SIGNIFICANCE

Subtle differences exist in the way people with mild-to-moderate hip OA use their muscles to accelerate the whole-body centre of mass during the SLS phase of walking relative to healthy controls. These findings improve understanding of the complex functional consequences of hip OA and enhance our understanding of how to monitor the effectiveness of an intervention on biomechanical changes in gait in people with hip OA.

Sarcopenia and Sarcopenic Obesity and Osteoarthritis: A Discussion among Muscles, Fat, Bones, and Aging

Aging is a physical procedure for people and nature. Our aging world is expanding because of the life span extension. Aging has a crucial relationship with our body composition (muscles, bones, and adipose tissue), which is characterized by an increase in fat mass and a gradual decrease in muscle mass and strength and bone density. These alterations affect physical performance and impact quality of life enhancing the risk for non-communicable diseases, immobilization, and disability. As far we know, osteoarthritis of lower limbs, sarcopenic obesity, and muscle mass and/or strength loss are treated separately. However, bones, muscles, adipose tissue, and aging appear to have an interconnection through a dialogue as they talk to each other. Health disorders are coming into the surface when this relationship is disrupted. The aim of our study is to search deeper into this interconnection, so that when adipose tissue increases, we have to take a look into the condition of muscle mass, bone, and connective tissue and vice versa, through the assessment of physical performance. Consequently, the triad muscle-bone-adipose tissue disorders by aging should be treated as a single entity.

Characteristics of Biomechanical and Physical Function According to Symptomatic and Asymptomatic Acetabular Impingement Syndrome in Young Adults

Femoroacetabular impingement (FAI) is caused by hip joint anomalies. Although asymptomatic and symptomatic FAI have been reported in young adults, information on biomechanical and functional characteristics of FAI is rare. We compared the subjective hip score, range of motion (ROM), dynamic balance, and hip strength between symptomatic FAI (FAIsym) and asymptomatic FAI (FAIasym) groups and healthy controls. Participants (n = 307; men: 155, women: 152) were classified according to morphological abnormalities and hip joint symptoms, comprising symptomatic FAI, asymptomatic FAI, and healthy controls. The Copenhagen Hip and Groin Outcome Score (HAGOS), hip ROM, Y-balance test (YBT), and isokinetic hip strength were measured. The types of FAI were not significantly differenent in both men and women. FAIsym exhibited significantly reduced HAGOS, whereas FAIasym showed no significant difference compared to the healthy group (men: healthy 91.7 vs. FAIasym 87.2 vs. FAIsym 49.9, women: healthy 91.7 vs. FAIasym 86.2 vs. FAIsym 53.9). Hip flexion, adduction, and internal and external rotation ROMs were only significantly reduced in symptomatic FAI. Asymptomatic and symptomatic FAI groups displayed significantly lower YBT scores than healthy controls (men healthy: 84.9 vs. FAIasym: 69.0 vs. FAIsym 58.7, women healthy 79.2 vs. FAIasym 64.0 vs. FAIsym 55.5). Isokinetic hip flexion, adduction, and abduction strengths were significantly lower in FAIsym. In conclusion, FAIasym showed no decrease in muscle strength but displayed reduced dynamic balance. Subjective satisfaction, ROM, muscle strength, and dynamic balance were lower in FAIsym compared to FAIasym and healthy groups.

Effects of Hip Bracing on Gait Biomechanics, Pain and Function in Subjects With Mild to Moderate Hip Osteoarthritis

Hip Osteoarthritis (HOA) is a common joint disease with serious impact on the quality of life of the affected persons. Additionally, persons with HOA often show alterations in gait biomechanics. Developing effective conservative treatment strategies is of paramount importance, as joint replacement is only indicated for end-stage HOA. In contrast to knee osteoarthritis, little is known about the effectiveness of hip bracing for the management of HOA. Studies analysing mechanically unloading hip braces partly showed beneficial results. However, methodological limitations of these studies, such as small sample sizes or lack of control groups, limit the applicability of the results. Additionally, mechanically unloading braces might impose restrictions on motion and comfort and thus, might not be suitable for people with only mild or moderate symptoms. The aim of this study was to comprehensively quantify the effects of unilateral HOA as well as functional hip bracing on gait biomechanics, pain, proprioception and functional capacity in people with mild to moderate HOA. Hip and pelvis biomechanics during walking were analysed in 21 subjects with mild to moderate HOA under three bracing conditions: unbraced, immediately after brace application and after 1 week of brace usage. Additionally, pain, hip proprioception and functional capacity were assessed. A matched group of 21 healthy subjects was included as reference. Kinematic and kinetic data were collected using a 16-camera infrared motion capturing system and two force plates. Visual analogue scales, an angle reproduction test and a 6-min walking test were applied to measure pain, hip proprioception and functional capacity, respectively. Subjects with HOA walked slower, with reduced step length, sagittal hip range of motion and peak extension angle and had a reduced functional capacity. After 1 week of brace application step length, walking speed and functional capacity were significantly increased. Additionally, pain perception was significantly lower in the intervention period. These results encourage the application of functional hip braces in the management of mild to moderate HOA. However, as key parameters of HOA gait such as a reduced peak extension angle remained unchanged, the underlying mechanisms remain partly unclear and have to be considered in the future.

The Impact of Pain on Functionality, Postural Control and Fall Risk in Woman Aged 45 to 64 Years Old

BACKGROUND

Ageing in women is associated with chronic degenerative pain leading to a functional decrease and therefore increase fall risk. It is therefore essential to detect early functional decreases in the presence of pain related to osteoarthritis.

OBJECTIVE

This cross-sectional study aimed to assess the impact of pain on functionality, postural control and fall risk in women aged between 45 to 64 years old.

METHODS

Twenty-one (21) women aged 45 to 64 were evaluated by clinical and functional measures such as a pain questionnaire (Lequesne Index), functional tests (Stair Step Test, 5 times sit-to-stand, 6MWD, Timed-up and Go) and postural performance (under force platform). Women were classified into 2 groups from the Lequesne Pain Index (PI): low pain (score ≤ 9) and strong pain (score ≥ 10) for subsequent comparisons on functionality (physical and postural control performance).

RESULTS

A significant impact was observed between the pain index (strong PI) and 3 of the 4 functional tests carried out including Stair Step Test (p = 0.001; g = 1.44), walking distance (p = 0.003; g = 1.31) and Timed-up and Go (p = 0.04; g = -0.93). The group with a strong PI score reported further poor postural control under force platform compared to the weak pain group.

CONCLUSION

Pain and severity based on the PI index negatively modulate physical and postural control performance in women aged 45 to 64 years old.

Balance is impaired in symptomatic ankle osteoarthritis: A cross-sectional study

BACKGROUND

Ankle osteoarthritis (OA) is associated with several physical impairments but investigations into balance impairments in this population are limited. Understanding balance impairments in ankle OA may help inform the management of this condition.

RESEARCH QUESTION

Does balance overall performance differ between individuals with symptomatic radiographic ankle OA, asymptomatic radiographic ankle OA and healthy controls? Are there any differences in mediolateral or anteroposterior balance, or confidence to perform balance tasks between these groups?

METHODS

Ninety-six volunteers (31 symptomatic radiographic ankle OA, 41 asymptomatic radiographic ankle OA and 24 healthy controls) completed six static balance tasks: bilateral stance on a firm surface, bilateral stance on foam, and tandem stance, all performed with eyes open and closed. Centre of pressure (COP) data were collected using force plates. Confidence to perform each balance task was collected using an 11-point numerical rating scale.

RESULTS

Compared to controls, participants with symptomatic radiographic ankle OA had greater COP area when standing on a firm surface, foam and in tandem with eyes closed (all p < 0.05) and greater total COP sway in both firm surface and tandem stance conditions (p < 0.04). Participants with symptomatic ankle OA had greater COP area (p < 0.04) and total COP sway (p = 0.01) than those with asymptomatic ankle OA during tandem stance. Total COP sway and area were similar between asymptomatic ankle OA and control participants. Some differences in mediolateral and anteroposterior balance were identified between groups. Individuals with symptomatic ankle OA had lower confidence to perform the tandem stance eyes closed task compared to controls.

SIGNIFICANCE

Balance impairments and decreased balance confidence were identified in those with symptomatic radiographic ankle OA compared to asymptomatic individuals with and without radiographic ankle OA. This suggests that balance deficits in ankle OA may be related to symptoms, rather than radiographic evidence of disease.

The Evaluation of Postural Stability and Fall Risk in Patients with Primary Hip Osteoarthritis

BACKGROUND

The hip is a significant weight-bearing joint and hip osteoarthritis (HOA) is one of the common musculoskeletal disorders. HOA may affect postural stability and fall risk by disrupting joint biomechanics.

METHODS

Fourty patients with unilateral primary HOA and a control group consisting of 41 healthy subjects were included in the study. HOA was radiographically graded by Kellgren Lawrence (KL) HOA classification. There were 26 patients with mild HOA (KL grade ≤ 2) and 14 patients with moderate-severe HOA (KL grade ≥ 3). The falls efficacy scale-international was used to assess fear of falling. Postural stability and the fall risk were evaluated by using the Biodex Stability System.

RESULTS

The postural stability and the fall risk indices were statistically significantly higher in the study group. Also, there was a positive correlation between the number of falls in the last 1 year, weight, and body mass index; and these correlations were statistically significant (r 0.686, p 0.003; r 0.477, p 0.002; r 0.444, p 0.004). There was no statistically significant difference in fall risk by the HOA was mild or moderate-severe.

CONCLUSIONS

Determining the deterioration in postural stability and the fall risk in patients with both mild and moderate-severe HOA may be a stimulus for early initiation of postural stability exercises in HOA.

Analysis of the Associations between Arthritis and Fall Histories in Korean Adults

(1) Background: the purpose of the present study was to analyze the associations between arthritis and fall histories in Korean adults. (2) Methods: data from the 2015 and 2017 Korean Community Health Survey were analyzed. In total, 322,962 participants aged ≥40 years were included. The participants were divided into two different groups. First, the participants were divided into the ‘arthritis (osteoarthritis or rheumatoid arthritis) for entire life’ and ‘nonarthritis for entire life (comparison I)’ groups. Subsequently, the participants were divided into the ‘current arthritis’ and ‘noncurrent arthritis (comparison II)’ groups. Afterwards, we analyzed the prevalence odds ratios (pORs) of the fall histories of the participants using a logistic regression analysis with the 95% confidence interval (CI). The variables of income, education level, region of residence, smoking status, alcohol consumption, obesity, subjective health status, stress level, physical activity, and sleep hours were adjusted for as covariates. (3) Results: both the arthritis for entire life and current arthritis groups had higher prevalence rates of falls than the comparison I and comparison II groups, respectively (each p < 0.001). The pORs of falling ≥1 time and ≥2 times per year in the arthritis for the entire life group were 1.42 (95% CI = 1.38–1.46) and 1.69 (95% CI = 1.62–1.76), respectively. The adjusted pORs for falling ≥1 time and ≥2 times per year in the current arthritis group were 1.35 (95% CI = 1.31–1.39) and 1.56 (95% CI = 1.50–1.63), respectively. (4) Conclusions: previous arthritis has a significant impact on the risk of falling.

Falls and fear of falling in older adults with total joint arthroplasty: a scoping review

BACKGROUND

Patients waiting or recovering from total joint arthroplasty (TJA) are at risk for falls which can lead to restriction of activity and negatively impact recovery. The objective of this scoping review is to critically appraise and synthesize the evidence in the reported number of falls, fear of falling, and risk factors associated with falls in older patients waiting for or recovering from TJA.

METHODS

Seven electronic databases were searched with no date limits and using language restriction (English). The inclusion criteria were 1) cohorts that included older adults 60+ years of age, 2) reported prevalence of falls, fear of falling, and/or risk factors for falls in patients who were waiting or recovering from TJA and 3) cross-sectional studies, cohort studies, and case control study designs. The quality assessment of selected articles was assessed using the SIGN Guidelines Checklist.

RESULTS

Of the 866 citations identified, 12 studies met the inclusion criteria and were reviewed. Prevalence of falls in pre-operative TJA patients and post-operative TJA patients ranged from 23 to 63%, and 13 to 42%, respectively. Of those five studies that examined fear of falling, pre-operative TJA patients reported greater fear of falling than post-operative patients. Modifiable risk factors for falls included fear of falling, joint range of motion, and depression.

CONCLUSIONS

An increased risk of falls in patients with TJA was reported both for patients waiting for and recovering from surgery. A number of modifiable risk factors were identified including fear of falling that could be targeted in fall prevention programs for TJA.

Impact of Function Focused Care and Physical Activity on Falls in Assisted Living Residents

Background

There continues to be a belief among nurses, patients, and families that physical activity increases the risk of falling.

Purpose

The purpose of this study was to test the hypothesis that controlling for age, function, cognition, medication use, gender, comorbidities, and cognition, residents who are exposed to Function Focused Care for Assisted Living (FFC-AL-EIT) and engage in moderate levels of physical activity would not be more likely to fall.

Methods

This was a secondary data analysis using data from the first two cohorts of a randomized trial testing FFC-AL-EIT in the United States.

Results

The study included 381 residents, the majority of whom were female (70%), white (97%), with a mean age of 87.72 (standard deviation = 7.47). Those who engaged in more moderate-intensity physical activity were 1% less likely to fall (odds ratio = .99, p = .03). There was no significant association between exposure to function focused care and falling (odds ratio = 1.58, p = .09).

Conclusion

There was no indication that those who were exposed to function focused care or those who engaged in moderate-level physical activity were more likely to fall. In fact, engaging in moderate-level physical activity was noted to be slightly protective of falling.

Retracted Article: PVT1 depletion protects cartilage ATDC5 cells against LPS-induced inflammatory injury by regulating the miR-24/ADAMTS5 axis

Osteoarthritis is a common chronic arthritis among adults and cartilage dysfunction is largely responsible for osteoarthritis development.