title: Computerized dynamic posturography in the objective assessment of balance in patients with intermittent claudication.
abstract: One-third of all elderly patients fall each year and impaired balance has been recognized as a specific risk factor. Intermittent claudication is common among the elderly population, affecting approximately 5% of the population over the age of 50. The aim of this proof-of-concept study was to assess the prevalence of impaired balance among elderly claudicants and to assess each patient's insight into their own risk of falling. A total of 58 claudicants (45 men), median age of 70 (interquartile range = 65-73) years, underwent objective balance assessment by using computerized dynamic posturography. As compared with 195 (5%) historic controls, 24 (41%) of the claudicants demonstrated abnormal balance when the Sensory Organization Test (SOT) was used. Vestibular dysfunction occurred in 52% of the claudicants. Abnormalities including somatosensory (22%), visual function (17%), and preferential reliance on inaccurate visual cues (17%) occurred less often. Prolonged Motor Control Test latency times were uncommon (n = 13) and were in most cases evenly distributed between those with normal (n = 7) and abnormal (n = 6) composite SOT scores. There was a significant difference in history of falling between claudicants with abnormal and normal SOT scores (p = 0.003), with a higher number of patients with abnormal SOT having experienced falling in the past year. However, no correlation between fear of falling and composite SOT score was found (Spearman rank correlation, r = 0.124; p = 0.381). Impaired balance, particularly secondary to vestibular problems, is very common among claudicants and may predispose to a high incidence of falls. Claudicants with abnormal balance are more likely to have a history of falls but not a fear of falling, thus potentially rendering these patients to be at a greater risk.
authors.affiliation: Academic Vascular Surgical Unit, Hull Royal Infirmary, Hull, UK. katherinemockford@hotmail.com
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Mockford
authors.forename: Fayyaz A K
authors.initials: FA
authors.lastname: Mazari
authors.forename: Alastair R
authors.initials: AR
authors.lastname: Jordan
authors.forename: Natalie
authors.initials: N
authors.lastname: Vanicek
authors.forename: Ian C
authors.initials: IC
authors.lastname: Chetter
authors.forename: Patrick A
authors.initials: PA
authors.lastname: Coughlin
mesh_terms: D000058:Accidental Falls; D000368:Aged; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D003463:Cues; D003936:Diagnosis, Computer-Assisted; D004739:England; D005239:Fear; D005260:Female; D006801:Humans; D007383:Intermittent Claudication / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology; D008297:Male; D009043:Motor Activity; D009483:Neuropsychological Tests; D004856:Postural Balance; D011237:Predictive Value of Tests; D011930:Reaction Time; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D014722:Vestibule, Labyrinth / Q000503:physiopathology; D014787:Vision Tests; D014785:Vision, Ocular