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Physio findings: pains and falls, joints and hearts, virtual cycling

Janet Wright looks at the latest physio research and clinical findings.

Pain comes before a fall

Pain is often overlooked as a possible risk factor for falls among older people, say the authors of a new paper.

‘This is surprising for a number of reasons,’ they comment. ‘First, pain is associated with mobility deficits, impaired gait and balance deficits, all of which are well-established internal risk factors for falls. Second, pain is very common in older people.’

So CSP member Brendon Stubbs, of the University of Greenwich, and colleagues set out to discover the connection between pain and falls in older people.

They looked through 1334 published papers to find ones that recorded the number of falls among adults over 60, with and without pain.

After excluding all those in which pain was caused by an earlier fall, or where participants had dementia or a neurological condition such as stroke, or had had a fracture or surgery in the preceding six months, they analysed 21 suitable studies.

Over one year, they discovered, 50.5 per cent of older people with pain reported at least one fall compared with just 25.7 per cent of pain-free participants. And those who fell were more likely to fall again in the future.

‘Foot and chronic pain were particularly strong risk factors for falls,’ say the researchers. ‘Clinicians should routinely inquire about these when completing falls risk assessments.’Stubbs B et al. Pain and the Risk for Falls in Community-Dwelling Older Adults: Systematic Review and Meta-Analysis. Archives of Physical Medicine and Rehabilitation 2013; doi.org/10.1016/j.apmr.2013.08.241 surgery

A new joint does your heart the world of good

Hip or knee replacement can reduce the risk of cardiovascular problems, researchers have found.

A Canadian team used data from the Ontario Hip/Knee Study on 153 well-matched pairs of patients with moderate to severe arthritis.

During seven years of follow-up, those who had a joint replacement ‘were significantly less likely than those who did not to experience a cardiovascular event’, say the authors.

The pain and stiffness of osteoarthritis make many people less active as they get older. This exacerbates risk factors for heart disease such as obesity, diabetes and metabolic syndrome (high blood pressure, blood sugar, cholesterol and waist measurement), they say.

Knee arthritis is often linked with metabolic syndrome, and knee replacement proved more cardioprotective than hip replacement.

Joint replacement surgery may also reduce the need for non-steroidal anti-inflammatory painkillers, which have been linkedwith cardiovascular problems.

‘Total joint arthroplasty may also reduce the risk for serious cardiovascular events by relieving pain, and thus psychosocial stress,’ the researchers add.
Ravi B et al. The relation between total joint arthroplasty and risk for serious cardiovascular events in patients with moderate-severe osteoarthritis: propensity score matched landmark analysis. BMJ 2013; 347 doi:10.1136/bmj.f6187 neurology

Virtual cyclist aids real world walking

People with chronic stroke often have difficulty getting enough exercise. So experts have developed a virtual-reality (VR) augmented cycling kit to help them work on their fitness and motor control.

A team of rehabilitation specialists set out to see whether the equipment could help improve patients’ cardiorespiratory fitness. They were looking at feasibility as well as safety and efficacy. Their four middle-aged subjects had limited walking ability after a stroke at least three years earlier.  

The exercise programme gave each of them a VR avatar, whose cycling speed was set by the patient’s heart rate.

During an eight-week programme, they managed between 90 and 125 minutes’ cycling each week.

Every one of them stayed the whole course. By the end, they had made significant cardiorespiratory fitness gains and improved their walking endurance. Deutsch JE et al. Feasibility of Virtual Reality Augmented Cycling for Health Promotion of People Poststroke. Journal of Neurologic Physical Therapy 2013; 37: 118-124, doi:10.1097/NPT.0b013e3182a0a078

Comments & Conclusions

  • The incidence of dementia in England has fallen markedly in the past 20 years, a Medical Research Council study shows.  Although people are living longer, the proportion of over-65s with dementia is nearly 25 per cent lower than predicted. ‘Later-born populations have a lower risk of prevalent dementia than those born earlier in the past century,’ say the authors. But in care homes the rate has increased from 56 to 70 per cent. Matthews FE et al. Lancet 2013; 382: 1405-1412, doi:10.1016/S0140-6736(13)61570-6
  • The Liverpool Care Pathway, developed to support patients nearing death, proved little better than standard hospital care for cancer patients in a randomised trial carried out in Italian hospitals. Costantini M et al. Lancet 2013; doi:10.1016/S0140-6736(13)61725-0
  • Less than a third of primary-care doctors in a US study recommended exercise for patients with osteoarthritis or sciatica, despite guidelines that support exercise.Maserejian NN et al. Arthritis Care & Research 2013; http://onlinelibrary.wiley.com/doi/10.1002/acr.22143/abstract
  • One night’s sleep deprivation made volunteers buy more food the next day, say researchers. Though lack of sleep increases production of the hunger-inducing hormone ghrelin, their ghrelin levels didn’t match the amount each participant bought, suggesting that decision-making was also affected. Chapman CD et al. Obesity 2013; doi:10.1002/oby.20579.

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