title: Risk of falls in patients with ankylosing spondylitis.
abstract: BACKGROUND
  Risk of vertebral fractures is increased in patients with ankylosing spondylitis (AS). The underlying mechanisms for the elevated fracture risk might be associated with bone and fall-related risks. The aims of this study were to evaluate the risk of falls and to determine the factors that increase the risk of falls in AS patients.
  
  
  METHODS
  Eighty-nine women, 217 men, a total of 306 AS patients with a mean age of 40.1 ± 11.5 years from 9 different centers in Turkey were included in the study. Patients were questioned regarding history of falls within the last 1 year. Their demographics, disease characteristics including Bath AS Disease Activity Index, Bath AS Metrology Index (BASMI), Bath AS Functional Index (BASFI), and risk factors for falls were recorded. The Short Physical Performance Battery (SPPB) test was used for evaluation of static and dynamic balance. Erythrocyte sedimentation rate, C-reactive protein, and 25-hydroxyvitamin D levels were measured.
  
  
  RESULTS
  Forty of 306 patients reported at least 1 fall in the recent 1 year. The patients with history of falls had higher mean age and longer disease duration than did nonfallers (P = 0.001). In addition, these patients' BASMI and BASFI values were higher than those of nonfallers (P = 0.002; P = 0.000, respectively). We found that the patients with history of falls had lower SPPB scores (P = 0.000). We also found that the number of falls increased with longer disease duration and older age (R = 0.117 [P = 0.041] and R = 0.160 [P = 0.005]). Our results show that decreased SPPB scores were associated with increased number of falls (R = 0.183, P = 0.006). Statistically significant correlations were found between number of falls and AS-related lost job (R = 0.140, P = 0.014), fear of falling (R = 0.316, P = 0.000), hip involvement (R = 0.112, P = 0.05), BASMI (R =0.234, P = 0.000), and BASFI (R = 0.244, P = 0.000).
  
  
  CONCLUSIONS
  Assessment of pain, stiffness, fatigue, and lower-extremity involvement as well as asking for a history of falls will highlight those at high risk for further falls. In addition to the general exercise program adopted for all patients, we suggest that a balance rehabilitation program should be valuable for the patients with risk factors for fall. Exercise may improve fear of falling and BASFI and BASMI scores. However, further study is needed to investigate these hypotheses. We believe that clinicians should train and support the patients via reducing fear of falls and maintaining good posture and functional capacity.
authors.affiliation: From the *Department of Physical Medicine and Rehabilitation, Kocaeli University Faculty of Medicine, Kocaeli; †Department of Physical Medicine and Rehabilitation, Bulent Ecevit University Faculty of Medicine, Zonguldak; ‡Department of Physical Medicine and Rehabilitation, Çanakkale Onsekiz Mart University Faculty of Medicine, Çanakkale; §Department of Physical Medicine and Rehabilitation, Uludag University Faculty of Medicine, Bursa; ‖Department of Physical Medicine and Rehabilitation, Trakya University Faculty of Medicine, Edirne; and ¶Department of Physical Medicine and Rehabilitation, Istanbul University Cerrahpaşa Faculty of Medicine; #Department of Physical Medicine and Rehabilitation, Bezmialem University Faculty of Medicine; **Physical Medicine and Rehabilitation Clinic, Fatih Sultan Mehmet Teaching and Research Hospital; and ††Department of Physical Medicine and Rehabilitation, Acibadem University Faculty of Medicine, Istanbul, Turkey.
authors.forename: Nigar
authors.initials: N
authors.lastname: Dursun
authors.forename: Selda
authors.initials: S
authors.lastname: Sarkaya
authors.forename: Senay
authors.initials: S
authors.lastname: Ozdolap
authors.forename: Erbil
authors.initials: E
authors.lastname: Dursun
authors.forename: Coskun
authors.initials: C
authors.lastname: Zateri
authors.forename: Lale
authors.initials: L
authors.lastname: Altan
authors.forename: Murat
authors.initials: M
authors.lastname: Birtane
authors.forename: Kenan
authors.initials: K
authors.lastname: Akgun
authors.forename: Aylin
authors.initials: A
authors.lastname: Revzani
authors.forename: İlknur
authors.initials: İ
authors.lastname: Aktas
authors.forename: Nurettin
authors.initials: N
authors.lastname: Tastekin
authors.forename: Reyhan
authors.initials: R
authors.lastname: Celiker
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data*; D000328:Adult; D000367:Age Factors; D016022:Case-Control Studies; D005239:Fear; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D012307:Risk Factors; D013167:Spondylitis, Ankylosing / Q000150:complications* / Q000503:physiopathology* / Q000523:psychology; D014421:Turkey