The Relationship of Cervicothoracic Mobility Restrictions to Fall Risk and Fear of Falling in Ankylosing Spondylitis

Overview

Journal Front Med (Lausanne)

Specialty General Medicine

Date 2023 Jul 13

PMID 37441687

Authors

Janine L Johnston

Shane L Harms

Glen T D Thomson

Affiliations

Soon will be listed here.

Abstract

Objective: The objective of this study is to determine whether restricted cervical mobility in ankylosing spondylitis (AS) is associated with increased fall frequency or fear of falling.

Methods: A total of 134 AS patients and 199 age- and gender-matched control subjects (CS) with soft-tissue cervicothoracic pain were prospectively evaluated for fall risk. Subjects were divided into non-fallers, single fallers, and multiple fallers. Dynamic cervical rotations and static cervicothoracic axial measurements were compared between the groups. In total, 88 AS patients were reviewed more than once; Kaplan-Meier plots were constructed for fall risk as a function of cervical rotation amplitudes. Falls Efficacy Scale-International (FES-I) questionnaire measured the fear of falling.

Results: In total, 34% of AS patients and 29% of CS fell ( = 0.271) in the year prior to evaluation. In AS, static anatomical measurements were unrelated to fall occurrence. The trends of multiple AS fallers to greater flexed forward postures and reduced dynamic cervical rotations were not statistically significant. Cervicothoracic pain ( = 0.0459), BASDAI ( = 0.002), and BASFI ( = 0.003) scores were greater in multiple fallers. FES-I scores were greater in fallers ( = 0.004). Of the 88 AS patients reviewed (or seen) on more than one occasion, 46.5% fell over the 9-year observation period, including all multiple fallers and 71.4% of single fallers. Survival curves showed increased fall risk as cervical rotational amplitudes decreased.

Conclusion: In AS, decreased cervical rotations increase fall risk and fear of falling. In multiple fallers, falls were associated with greater disease activity. Cervical muscle stiffness in AS may cause non-veridical proprioceptive inputs and contribute to increased fall frequency similar to individuals with soft-tissue cervicothoracic pain.

References

Tinetti M, Speechley M, Ginter S . Risk factors for falls among elderly persons living in the community. N Engl J Med. 1988; 319(26):1701-7. DOI: 10.1056/NEJM198812293192604. View

Johnston J, Daye P, Thomson G . Inaccurate Saccades and Enhanced Vestibulo-Ocular Reflex Suppression during Combined Eye-Head Movements in Patients with Chronic Neck Pain: Possible Implications for Cervical Vertigo. Front Neurol. 2017; 8:23. PMC: 5278258. DOI: 10.3389/fneur.2017.00023. View

Ogdie A, Duarte-Garcia A, Hwang M, Navarro-Compan V, van der Heijde D, Mease P . Measuring Outcomes in Axial Spondyloarthritis. Arthritis Care Res (Hoboken). 2020; 72 Suppl 10:47-71. DOI: 10.1002/acr.24266. View

Murray H, Elliott C, Barton S, Murray A . Do patients with ankylosing spondylitis have poorer balance than normal subjects?. Rheumatology (Oxford). 2000; 39(5):497-500. DOI: 10.1093/rheumatology/39.5.497. View

Thurman D, Stevens J, Rao J . Practice parameter: Assessing patients in a neurology practice for risk of falls (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2008; 70(6):473-9. DOI: 10.1212/01.wnl.0000299085.18976.20. View

Karlberg M, Johansson R, Magnusson M, Fransson P . Dizziness of suspected cervical origin distinguished by posturographic assessment of human postural dynamics. J Vestib Res. 1996; 6(1):37-47. View

Kavanagh J, Barrett R, Morrison S . The role of the neck and trunk in facilitating head stability during walking. Exp Brain Res. 2006; 172(4):454-63. DOI: 10.1007/s00221-006-0353-6. View

Uthaikhup S, Jull G, Sungkarat S, Treleaven J . The influence of neck pain on sensorimotor function in the elderly. Arch Gerontol Geriatr. 2012; 55(3):667-72. DOI: 10.1016/j.archger.2012.01.013. View

Johnston J, Featherstone G, Harms S, Thomson G . Cervicothoracic Mechanical Impairment as Part of Complete Neurological Fall Risk Appraisal. Can J Neurol Sci. 2020; 48(3):383-391. DOI: 10.1017/cjn.2020.186. View

10.

. Summary of the Updated American Geriatrics Society/British Geriatrics Society clinical practice guideline for prevention of falls in older persons. J Am Geriatr Soc. 2011; 59(1):148-57. DOI: 10.1111/j.1532-5415.2010.03234.x. View

11.

Dursun N, Sarkaya S, Ozdolap S, Dursun E, Zateri C, Altan L . Risk of falls in patients with ankylosing spondylitis. J Clin Rheumatol. 2015; 21(2):76-80. DOI: 10.1097/RHU.0000000000000216. View

12.

Ogrinc G, Davies L, Goodman D, Batalden P, Davidoff F, Stevens D . SQUIRE 2.0 (Standards for QUality Improvement Reporting Excellence): revised publication guidelines from a detailed consensus process. BMJ Qual Saf. 2015; 25(12):986-992. PMC: 5256233. DOI: 10.1136/bmjqs-2015-004411. View

13.

Acar Y, Ilcin N, Gurpinar B, Can G . Core stability and balance in patients with ankylosing spondylitis. Rheumatol Int. 2019; 39(8):1389-1396. DOI: 10.1007/s00296-019-04341-5. View

14.

Sawacha Z, Carraro E, Del Din S, Guiotto A, Bonaldo L, Punzi L . Biomechanical assessment of balance and posture in subjects with ankylosing spondylitis. J Neuroeng Rehabil. 2012; 9:63. PMC: 3517897. DOI: 10.1186/1743-0003-9-63. View

15.

Vuillerme N, Pinsault N . Experimental neck muscle pain impairs standing balance in humans. Exp Brain Res. 2008; 192(4):723-9. DOI: 10.1007/s00221-008-1639-7. View

16.

Aydog E, Depedibi R, Bal A, Eksioglu E, Unlu E, Cakci A . Dynamic postural balance in ankylosing spondylitis patients. Rheumatology (Oxford). 2005; 45(4):445-8. DOI: 10.1093/rheumatology/kei192. View

17.

Mewes K, Longo B, Campos A, Simioni J, Skare T . Balance and falls in axial Spondyloarthritis: a cross sectional study. Acta Reumatol Port. 2020; 44(4):248-253. View

18.

Gunduz O, Ozcan-Eksi E, Giray E, Yagci I . What Impairs Balance in Ankylosing Spondylitis? Posture or Disease Activity?. Arch Rheumatol. 2018; 32(3):221-226. PMC: 6190951. DOI: 10.5606/ArchRheumatol.2017.6222. View

19.

Swinkels A, Dolan P . Spinal position sense and disease progression in ankylosing spondylitis: a longitudinal study. Spine (Phila Pa 1976). 2004; 29(11):1240-5. DOI: 10.1097/00007632-200406010-00014. View

20.

van der Linden S, VALKENBURG H, Cats A . Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum. 1984; 27(4):361-8. DOI: 10.1002/art.1780270401. View