title: Clinical Tests of Standing Balance in the Knee Osteoarthritis Population: Systematic Review and Meta-analysis.
abstract: BACKGROUND
  People with knee osteoarthritis (OA) have a high prevalence of falls. Poor standing balance is one risk factor, but the extent of standing balance deficits in people with knee OA is unknown.
  
  
  OBJECTIVE
  The primary purpose of this study was to summarize available data on standing balance in people with knee OA compared with people without knee OA. A secondary purpose was to establish the extent of balance impairment across disease severity.
  
  
  METHODS
  A literature search of the MEDLINE, EMBASE, CINAHL, and Web of Science databases through November 19, 2014, was conducted.
  
  
  METHODS
  Studies on individuals with knee OA containing clinical, quantifiable measures of standing balance were included. Methodological quality was assessed by 2 reviewers using a 16-item quality index developed for nonrandomized studies. Studies scoring >50% on the index were included.
  
  
  METHODS
  Participant characteristics (age, sex, body mass index, OA severity, compartment involvement, unilateral versus bilateral disease) and balance outcomes were extracted by 2 reviewers. Standardized mean differences were pooled using a random-effects model.
  
  
  RESULTS
  The search yielded 2,716 articles; 8 met selection and quality assessment criteria. The median score on the quality index was 13/17. People with knee OA consistently performed worse than healthy controls on the Step Test, Single-Leg Stance Test, Functional Reach Test, Tandem Stance Test, and Community Balance and Mobility Scale. The pooled standardized mean difference was -1.64 (95% confidence interval=-2.58, -0.69). No differences were observed between varying degrees of malalignment, or between unilateral versus bilateral disease.
  
  
  CONCLUSIONS
  No studies compared between-knee OA severities. Thus, expected changes in balance as the disease progresses remain unknown.
  
  
  CONCLUSIONS
  Few studies compared people with knee OA and healthy controls, but those that did showed that people with knee OA performed significantly worse. More research is needed to understand the extent of balance impairments in people with knee OA using easy-to-administer, clinically available tests.
authors.affiliation: G.L. Hatfield, PT, PhD, Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Gillian L
authors.initials: GL
authors.lastname: Hatfield
authors.affiliation: A. Morrison, PT, Department of Physical Therapy, University of British Columbia.
authors.forename: Adam
authors.initials: A
authors.lastname: Morrison
authors.affiliation: M. Wenman, PT, Department of Physical Therapy, University of British Columbia.
authors.forename: Matthew
authors.initials: M
authors.lastname: Wenman
authors.affiliation: C.A. Hammond, BSc, Department of Physical Therapy, University of British Columbia.
authors.forename: Connor A
authors.initials: CA
authors.lastname: Hammond
authors.affiliation: M.A. Hunt, PT, PhD, Department of Physical Therapy, University of British Columbia, 212 Friedman Bldg, 2177 Wesbrook Mall, Vancouver, British Columbia, Canada V6T 1Z3. michael.hunt@ubc.ca.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Hunt
mesh_terms: D000058:Accidental Falls; D004185:Disability Evaluation; D018450:Disease Progression; D006801:Humans; D020370:Osteoarthritis, Knee / Q000503:physiopathology*; D004856:Postural Balance / Q000502:physiology*; D012307:Risk Factors; D012720:Severity of Illness Index