title: Foot and ankle characteristics associated with falls in adults with established rheumatoid arthritis: a cross-sectional study.
abstract: BACKGROUND
  People with rheumatoid arthritis (RA) have an increased risk of falls. The foot is a common site of pathology in RA and foot problems are reported in up to 90% of patients with established disease. The aim of this study was to determine whether foot and ankle characteristics are associated with falls in people with RA.
  
  
  METHODS
  Adults with RA were recruited from rheumatology outpatient clinics in Auckland, New Zealand. Participants reported whether they had fallen in the preceding year, and the number of falls. Clinical characteristics, common fall risk factors, and foot and ankle variables were measured. Univariate parametric and non-parametric analysis compared fallers and non-fallers on all variables to determine significant differences. Logistic regression analysis identified variables independently associated with falls.
  
  
  RESULTS
  Two hundred and one participants were prospectively recruited. At least one fall in the preceding 12-months was reported by 119 (59%) participants. Univariate analysis showed that fallers had significantly longer mean disease duration, more co-morbid conditions, an increase in lower limb tender joints, higher midfoot peak plantar pressures and were more likely to have a history of vascular disease than non-fallers. Fallers also reported greater difficulty with activities of daily living, increased fear of falling and greater self-reported foot impairment. Logistic regression analysis revealed that increased midfoot peak plantar pressures (odds ratio (OR) 1.12 [for each 20 kPa increase], 95% confidence interval (CI) 1.00-1.25), self-reported foot impairment (OR 1.17 [for each three point increase], 95% CI 1.05-1.31) and history of vascular disease (OR 3.22, 95% CI 1.17-8.88) were independently associated with a fall in the preceding 12 months.
  
  
  CONCLUSIONS
  Elevated midfoot peak plantar pressures, self-reported foot impairment and vascular disease are associated with falls in people with RA. Assessment of foot deformity, foot function and self-reported foot impairment may be of benefit when considering falls prevention strategies in people with RA.
  
  
  BACKGROUND
  Australia New Zealand Clinical Trial Registry (trial ACTRN12612000597897).
authors.affiliation: AUT University, Private Bag 92006, Auckland, 1142, New Zealand. abrenton@aut.ac.nz.
authors.forename: Angela
authors.initials: A
authors.lastname: Brenton-Rule
authors.affiliation: University of Auckland, Private Bag 92-019, Auckland, New Zealand.
authors.forename: Nicola
authors.initials: N
authors.lastname: Dalbeth
authors.affiliation: La Trobe University, Melbourne, Victoria, 3086, Australia.
authors.forename: Hylton B
authors.initials: HB
authors.lastname: Menz
authors.affiliation: AUT University, Private Bag 92006, Auckland, 1142, New Zealand.
authors.forename: Sandra
authors.initials: S
authors.lastname: Bassett
authors.affiliation: AUT University, Private Bag 92006, Auckland, 1142, New Zealand.
authors.forename: Keith
authors.initials: K
authors.lastname: Rome
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control; D000328:Adult; D000368:Aged; D000842:Ankle / Q000033:anatomy & histology / Q000473:pathology; D016512:Ankle Injuries / Q000175:diagnosis* / Q000453:epidemiology; D001172:Arthritis, Rheumatoid / Q000175:diagnosis* / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005528:Foot / Q000033:anatomy & histology / Q000473:pathology*; D018409:Foot Injuries / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D011795:Surveys and Questionnaires