Physiotherapy Helps Fall Risk Even with Osteoarthritis of the Knee

Fall risk increases dramatically with age, and fall-related mortality is on the rise in New South Wales. Fall-injury costs have been estimated to reach as high as 1.5% of total healthcare expenditures. It is well established that strengthening and balance training can moderate fall risk among certain patients. However, the extent to which osteoarthritis of the knee can interfere with fall-prevention rehab is a subject of ongoing research. There is evidence that osteoarthritis of the knee independently contributes to fall risk. The pain of osteoarthritis is believed to interfere with muscle strength and proprioception. Earlier this year, Age and Ageing published the first systematic review and meta-analysis evaluating the effects of physiotherapy on fall risk in osteoarthritis of the knee.

 

Researchers included 15 randomised, controlled trials comparing physiotherapy interventions for 1,482 participants with osteoarthritis of the knee. Follow-up in the included studies spans up to 18 months. Three categories of physiotherapy emerge as providing statistically significant reductions in fall risk. Strengthening therapies, aerobic training, and a movement and balance protocol create a 55% improvement in fall-risk measures such as gait speed, the timed-up-and-go test, and the six-minute-walk test (reported as standardised mean difference). 

 

Two physiotherapy approaches did not independently create significant changes in fall risk for patients with osteoarthritis of the knee. These are phototherapy (890 nm radiation) and aquatic therapy. However, the aquatic therapy intervention did not include specific strengthening exercises and was of shorter duration than other review interventions. Aquatic therapy did create important changes in specific measures such as reaction time and contrast sensitivity, but these measures are not included as outcomes in the systematic review. For osteoarthritis of the knee, aquatic therapy should be researched as part of a longer rehab program including resistance training.

 

In conclusion, the presence of painful osteoarthritis of the knee does not prevent physiotherapy from reducing fall risk. Physiotherapy interventions can decrease pain, improve flexibility, and improve fall-risk measures 55% or more.