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      The association between whole body sagittal balance and risk of falls among elderly patients seeking treatment for back pain

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          Abstract

          Objectives

          The objective of this study was to assess the association between whole body sagittal balance and risk of falls in elderly patients who have sought treatment for back pain. Balanced spinal sagittal alignment is known to be important for the prevention of falls. However, spinal sagittal imbalance can be markedly compensated by the lower extremities, and whole body sagittal balance including the lower extremities should be assessed to evaluate actual imbalances related to falls.

          Methods

          Patients over 70 years old who visited an outpatient clinic for back pain treatment and underwent a standing whole-body radiograph were enrolled. Falls were prospectively assessed for 12 months using a monthly fall diary, and patients were divided into fallers and non-fallers according to the history of falls. Radiological parameters from whole-body radiographs and clinical data were compared between the two groups.

          Results

          A total of 144 patients (120 female patients and 24 male patients) completed a 12-month follow-up for assessing falls. A total of 31 patients (21.5%) reported at least one fall within the 12-month follow-up. In univariate logistic regression analysis, the risk of falls was significantly increased in older patients and those with more medical comorbidities, decreased lumbar lordosis, increased sagittal vertical axis, and increased horizontal distance between the C7 plumb line and the centre of the ankle (C7A). Increased C7A was significantly associated with increased risk of falls even after multivariate adjustment.

          Conclusion

          Whole body sagittal balance, measured by the horizontal distance between the C7 plumb line and the centre of the ankle, was significantly associated with risk of falls among elderly patients with back pain.

          Cite this article: J. Kim, J. Y. Hwang, J. K. Oh, M. S. Park, S. W. Kim, H. Chang, T-H. Kim. The association between whole body sagittal balance and risk of falls among elderly patients seeking treatment for back pain. Bone Joint Res 2017;6:–344. DOI: 10.1302/2046-3758.65.BJR-2016-0271.R2.

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          Most cited references26

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          Risk factors for falls among elderly persons living in the community.

          Mary E. Tinetti, Mark Speechley, Sandra F. Ginter (1988)
          To study risk factors for falling, we conducted a one-year prospective investigation, using a sample of 336 persons at least 75 years of age who were living in the community. All subjects underwent detailed clinical evaluation, including standardized measures of mental status, strength, reflexes, balance, and gait; in addition, we inspected their homes for environmental hazards. Falls and their circumstances were identified during bimonthly telephone calls. During one year of follow-up, 108 subjects (32 percent) fell at least once; 24 percent of those who fell had serious injuries and 6 percent had fractures. Predisposing factors for falls were identified in linear-logistic models. The adjusted odds ratio for sedative use was 28.3; for cognitive impairment, 5.0; for disability of the lower extremities, 3.8; for palmomental reflex, 3.0; for abnormalities of balance and gait, 1.9; and for foot problems, 1.8; the lower bounds of the 95 percent confidence intervals were 1 or more for all variables. The risk of falling increased linearly with the number of risk factors, from 8 percent with none to 78 percent with four or more risk factors (P less than 0.0001). About 10 percent of the falls occurred during acute illness, 5 percent during hazardous activity, and 44 percent in the presence of environmental hazards. We conclude that falls among older persons living in the community are common and that a simple clinical assessment can identify the elderly persons who are at the greatest risk of falling.
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            Risk factors for serious injury during falls by older persons in the community.

            Gregory J. Doucette, Jasper E Palmier-Claus, R Marottoli … (1995)
            Serious fall injury represents a little studied, yet common and potentially preventable, cause of morbidity and mortality among older persons. We determined the frequency of, and risk factors for, experiencing serious fall injury events among older persons in the community. A representative sample of 1103 community-living persons aged 72 years and older underwent comprehensive baseline and 1-year evaluations. During a median 31 months of follow-up, fall data were obtained using fall calendars. Injury data were obtained from telephone interviews and from surveillance of emergency room and hospital records. At least one fall was experienced by 546 (49%) participants. A total of 123 participants, representing 23% of fallers and 12% of the cohort, experienced 183 serious fall injury events. The factors independently associated with experiencing a serious injury during a fall included cognitive impairment (adjusted odds ratios 2.2; 95% confidence interval 1.5, 3.2); presence of at least two chronic conditions (2.0; 1.4, 2.9); balance and gait impairment (1.8; 1.3, 2.7); and low body mass index (1.8; 1.2, 2.5). In a separate analysis, including only subjects who fell, female gender (1.8; 1.1, 2.9) as well as most of the above factors were associated with experiencing a fall injury. Several readily identifiable factors appeared to distinguish the subgroup of older fallers at risk for suffering a serious fall injury. These factors should help guide who and what to target in prevention efforts.
            Article 0 comments Cited 158 times – based on 0 reviews     Review now
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              Falls in old age: a study of frequency and related clinical factors.

              J Reinken, David B. Allan, Ian G. Campbell … (1981)
              An analysis of falls experienced by a stratified population sample of 553 subjects, 65 years and over, was performed. It is estimated that one third of people 65 years and over experience one or more falls in a year. To analyse the association of physical and social variables with falls, the falls were divided into pattern falls and occasional falls. Pattern falls were those which, on history and examination, were assessed as arising from only minimal external upset and primarily from a disorder of balance or postural stability in the subject. Occasional falls were those which had arisen under circumstances which would be liable to cause a fit person to fall. Bivariate analysis showed those having pattern falls tended to have more functional disability, to have increased impairment of mobility, to use more aids to mobility, to be more depressed, to have lower mental test scores and to need more professional support. Women experiencing pattern falls also tended to be older and have poorer vision, while men had lower systolic blood pressure. Discriminant analysis showed that the principal effective 'predictors' of pattern falls in women were functional disability, the need for support services and informal help and the use of walking aids. In men they were functional disability and the need for support services and informal help.
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                Author and article information

                Contributors
                J. Kim: Role: Professor
                J. Y. Hwang: Role: Resident
                J. K. Oh: Role: Professor
                M. S. Park: Role: Professor
                S. W. Kim: Role: Professor
                H. Chang: Role: Professor
                T-H. Kim: Role: Professor
                Journal
                Journal ID (nlm-ta): Bone Joint Res
                Title: Bone & Joint Research
                ISSN (Electronic): 2046-3758
                Publication date Collection: May 2017
                Publication date (Electronic): 3 June 2017
                Volume: 6
                Issue: 5
                Pages: 337-344
                Affiliations
                [1 ]Department of Pediatrics, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
                [2 ]Spine Centre, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
                Author notes
                [*]T-H. Kim; email: paragon0823@ 123456gmail.com
                Article
                Publisher ID: 10.1302_2046-3758.65.BJR-2016-0271.R2
                DOI: 10.1302/2046-3758.65.BJR-2016-0271.R2
                PMC ID: 5457638
                PubMed ID: 28536117
                SO-VID: fd6532fd-bab1-4493-aca3-b53ca7befbee
                Copyright © © 2017 Kim et al.
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attributions licence (CC-BY-NC), which permits unrestricted use, distribution, and reproduction in any medium, but not for commercial gain, provided the original author and source are credited.

                History
                Date received : 11 October 2016
                Date accepted : 23 March 2017
                Categories
                Subject: Spine
                Subject: 5
                Subject: Whole Body Sagittal Balance
                Subject: Spinal Sagittal Balance
                Subject: Fall
                Subject: Elderly Patients
                Subject: Back Pain

                Keywords: whole body sagittal balance,spinal sagittal balance,fall,elderly patients,back pain
                Data availability:
                Keywords: whole body sagittal balance, spinal sagittal balance, fall, elderly patients, back pain

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