title: Physical therapies for improving balance and reducing falls risk in osteoarthritis of the knee: a systematic review.
abstract: BACKGROUND
  osteoarthritis (OA) of knee has been reported as a risk factor for falls and reduced balance in the elderly. This systematic review evaluated the effectiveness of physical therapies in improving balance and reducing falls risk among patients with knee OA.
  
  
  METHODS
  a computerised search was performed to identify relevant studies up to November 2013. Two investigators identified eligible studies and extracted data independently. The quality of the included studies was assessed by the PeDro score.
  
  
  RESULTS
  a total of 15 randomised controlled trials involving 1482 patients were identified. The mean PeDro score was 7. The pooled standardised mean difference in balance outcome for strength training = 0.3346 (95% CI: 0.3207-0.60, P = 0.01 < 0.00001, P for heterogeneity = 0.85, I(2) = 0%). Tai Chi = 0.7597 (95% CI: 0.5130-1.2043, P<=0.0014, P for heterogeneity = 0.26, I(2) = 0%) and aerobic exercises = 0.6880 (95% CI: 0.5704-1.302, P < 0.00001, P for heterogeneity = 0.71, I(2) = 0%). While pooled results for falls risk outcomes in, strength training, Tai chi and aerobics also showed a significant reduction in reduced risk of falls significantly with pooled result 0.55 (95% CI: 0.41-0.68, P < 0.00001, P for heterogeneity = 0.39, I(2) = 6%).
  
  
  CONCLUSIONS
  strength training, Tai Chi and aerobics exercises improved balance and falls risk in older individuals with knee OA, while water-based exercises and light treatment did not significantly improve balance outcomes. Strength training, Tai Chi and aerobics exercises can therefore be recommended as falls prevention strategies for individuals with OA. However, a large randomised controlled study using actual falls outcomes is recommended to determine the appropriate dosage and to measure the potential benefits in falls reduction.
authors.affiliation: Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Sumaiyah
authors.initials: S
authors.lastname: Mat
authors.affiliation: Department of Medicine, Faculty of Medicine University of Malaya, University of Malaya, Kuala Lumpur 50603, Malaysia.
authors.forename: Maw Pin
authors.initials: MP
authors.lastname: Tan
authors.affiliation: Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Shahrul Bahyah
authors.initials: SB
authors.lastname: Kamaruzzaman
authors.affiliation: Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Chin Teck
authors.initials: CT
authors.lastname: Ng
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control*; D001696:Biomechanical Phenomena; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D026741:Physical Therapy Modalities; D004856:Postural Balance; D055070:Resistance Training; D018570:Risk Assessment; D012307:Risk Factors; D026302:Tai Ji; D016896:Treatment Outcome
keywords: Tai Chi; elderly; exercises; falls; older people; osteoarthritis