Impact of Knee Pain on Fear of Falling, Changes in Instrumental Activities of Daily Living, and Falls Among Malaysians Age 55 Years and Above
Sumaiyah Mat, Shahrul Bahyah Kamaruzzaman, Ai‐Vyrn Chin, Maw Pin Tan
Abstract
Objectives: To determine the temporal relationship between the presence and severity of knee pain identified at baseline with fall risk, fear of falling and changes in instrumental activities of daily living at 12-month follow-up. Methods: This was a prospective study from the Malaysian Elders Longitudinal Research (MELoR) study involving community dwelling older persons aged 55 years and older. The presence of one fall in the preceding 12 months, knee pain, and functional capacity were determined at baseline (2013-2015) and follow-up (2015-2016). Function was determined as loss of at least one of seven instrumental activities of daily living (IADL). Physical performance was evaluated at baseline using the timed-up-and-go (TUG) test. Fear of falling (FoF) was determined using the single question, “Are you afraid of falling?”. Results: Data were available for 605 participants, mean (SD) age=69.10 (7.24) years. Knee pain was present in 30.2% at baseline. Neither the presence nor severity of knee pain at baseline was associated with falls at follow-up. Knee pain was significantly associated with FoF at follow-up (aRR (95%CI) = 1.76 (1.02-3.04)) but not changes in IADL. Among individuals with no falls at baseline, the presence of knee pain was protective of falls at follow-up after adjustment for baseline physical performance (adjusted rate ratio, aRR (95% confidence interval, CI) = 0.35 (0.13-0.97)). Conclusion: Knee pain was associated with increased FoF at 1.5-year follow-up within a multi-ethnic population aged 55 years and above residing in an urban location in a middle-income South East Asian nation. After differences in muscle strength was accounted for, knee pain was protective against falls at follow-up. Our findings challenge previous assumptions on joint pain and falls and highlight the importance of large prospective studies and further mechanistic research incorporating psychological factors in this area of increasing prominence.