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  • From PTJ: Getting at the Risk Factors for Falls Post-TKA

    Up to a third of patients with total knee arthroplasty (TKA) experience a fall within 6 months to a year after surgery, but a new study suggests that physical therapists (PTs) can reduce this risk by targeting specific deficits for intervention.

    Researchers followed 134 individuals at a Hong Kong hospital for 6 months after TKA to determine falls frequency, circumstances, and risk factors. All patients had been referred for outpatient rehabilitation. The individuals were all between the ages of 50 and 85 with a primary diagnosis of knee osteoarthritis (OA). Results were published in the September issue of PTJ (Physical Therapy).

    Participants attended physical therapy 1-2 times per week for 8-10 weeks, beginning 2 weeks after surgery. Sessions included electrotherapy, mobilizing and strengthening exercises, and gait and balance training. At 4 weeks postsurgery, PTs evaluated knee proprioception, balance, knee pain, knee extension and flexion muscle strength, range of motion, and balance confidence. Patients also were given a log book to record any falls. After the evaluation, authors followed up monthly to ask participants about any falls they may have experienced.

    Researchers found that 23 (17.2%) participants had fallen at least once, with a total of 31 falls. Most occurred in the afternoon (58%) and while walking (67.7%). Most fallers (87.1%) were not using a walking aid when they fell. Falls were most frequently caused by slipping (35.5%) and tripping (35.5%).

    In contrast to previous research, nearly half of falls occurred at home, and nearly a third occurred in “another indoor environment.” These findings, write authors, “highlight the importance in reducing hazards in the home that could cause slipping or tripping, especially in the early stages of recovery from TKA.”

    Fallers were significantly more likely than non-fallers to have had more severe pain and reduced proprioception in the operated knee, and to have poorer sensory orientation prior to the fall. Authors write that “Deficits in knee proprioception, coupled with age-related declines in vestibular and somatosensory function, may challenge the ability to effectively reweight information from different sensory subsystems that maintain body equilibrium.”

    Surprisingly, fallers also were more likely to be younger. “Younger participants may have been more physically active and subsequently more likely to engage in risky behaviors than our older counterparts," authors write.

    Authors note that—outside of age—these factors are modifiable and “warrant greater attention” in falls risk assessment, education, prevention, and intervention for individuals with TKA.

    [Editor's note: for more on the PT's role in TKA, check out this clinical summary that includes sections on prehabilitation and accelerated rehabilitation.]

    Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.

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    • I think we have an opportunity and obligation to establish standardized evaluation and education of role of proprioception following TKA. it's likely patients start feeling stronger and more able without assistive devices leading up to a fall. They may be more mindful of fall risk and more compliant with fall risk reduction strategies if proprioception testing and training is emphasized during Rehab process. It would support a 6 month and 1year follow-up PT assessment for sensorimotor assessment and HEP.

      Posted by Karen Frederick -> ?KU]A on 1/14/2019 3:38 PM

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