Low Back Pain as a Risk Factor for Recurrent Falls in People With Knee Osteoarthritis

Abstract

Objective. Knee osteoarthritis (OA) has been suggested to increase the risk of falls. Low back pain (LBP) is a potential risk factor for falls in people with knee OA, but this issue has not been addressed adequately in previous studies. The objective of this study was to investigate the relationship between LBP and falls in people with knee OA in a 12-month period. Methods. Participants with knee OA (Kellgren/Lawrence [K/L] grade ≥1) completed questionnaires for LBP and falls that occurred in the preceding 12 months. Binary and ordinal logistic regression analyses were performed to assess the relationship between LBP or moderate-to-severe LBP (numeric rating scale ≥4 points) and any fall (≥1 fall) or recurrent falls (≥2 falls) after adjustment for age, sex, K/L grade, knee pain severity, and quadriceps strength. Sensitivity analyses were performed excluding people with sciatica, nonchronic LBP, K/L grade 1, and those receiving pain medications. Results. We included 189 participants (ages 61-90 years, 78.3% women) in this study. Of these participants, 41 (21.6%) reported falls in the preceding 12 months. People with any LBP (n = 101) and those with moderate-to-severe LBP (n = 45) had 2.7-and 3.7-times higher odds of recurrent falls, respectively. Sensitivity analyses revealed a strong correlation between moderate-to-severe LBP and recurrent falls. Conclusion. Thorough investigation of LBP as a risk factor for recurrent falls in people with knee OA may provide a novel insight into the pathomechanics of recurrent falls in this population.

Osteoarthritis and Falls: Is there a Link?

“…However, they found this was not due to leg pain, but rather to mild-moderate low back pain, and possible opioid usage that impairs reflex responses. Nevitt et al [18] who examined whether knee instability contributes to the increased risk of falls and fractures observed in persons with knee osteoarthritis reported that those who experienced 'buckling' were more likely to incur recurrent falls, significant fall injuries, and fall injuries that limited activity tentatively supporting the findings of Iilima et al [17]. They also noted that fallers were almost four times more likely than not to have poor balance confidence.…”

“…Thirty percent of cases experienced a falls-based injury. Unsurprisingly, Iijima et al [17] found adults with knee osteoarthritis may well incur repeated falls. However, they found this was not due to leg pain, but rather to mild-moderate low back pain, and possible opioid usage that impairs reflex responses.…”

Current Knee Osteoarthritis and Non-Surgically Related Falls Injuries Studies: What Prevails, What is Needed, and Why

“…Current Knee Osteoarthritis and Non-Surgically Related Falls Injuries Studies: What Prevails, What is Needed, and Why Unsurprisingly, since recovery step kinematics may be impaired in knee osteoarthritis, especially if not intervened upon [10], adults with knee osteoarthritis may yet experience repeated falls [28]. However, rather than implicating any biomechanical explanation for this finding, Iilima et al [28] attributed their finding of the occurrence of multiple falls in their sample to the presence of mild-moderate low back pain, and possible opioid usage that impairs reflex responses.…”

“…Current Knee Osteoarthritis and Non-Surgically Related Falls Injuries Studies: What Prevails, What is Needed, and Why Unsurprisingly, since recovery step kinematics may be impaired in knee osteoarthritis, especially if not intervened upon [10], adults with knee osteoarthritis may yet experience repeated falls [28]. However, rather than implicating any biomechanical explanation for this finding, Iilima et al [28] attributed their finding of the occurrence of multiple falls in their sample to the presence of mild-moderate low back pain, and possible opioid usage that impairs reflex responses. Nevitt et al [12] who examined whether knee instability contributes to the increased risk of falls and fractures observed in persons with knee osteoarthritis felt however, that it was those knee osteoarthritis who experienced 'buckling' who seemed more likely than not to incur recurrent falls, significant fall injuries, and fall injuries that then limited activity tentatively.…”

“…Moreover, the role of muscle strength and proprioception problems sufficient to explain the prevailing falls rate among osteoarthritis knee cases also remains elusive [1,23], as does the role of comorbid health conditions [21], gender, and age [28,29], plus the inability to walk 500 m.…”