title: Biomechanical balance response during induced falls under dual task conditions in people with knee osteoarthritis.
abstract: People with knee osteoarthritis (OA) are at twice the risk of falling compared to older people without knee OA, however the mechanism for this is poorly understood. This study investigated the biomechanical response of the trunk and lower limb joints during a forward induced fall under different task conditions in people with and without knee OA.
  
  
  
  Twenty-four participants with OA (68.6±6.2 years) and 15 asymptomatic controls (72.4±4.8 years) participated in the study. Forward fall was induced by releasing participants from a static forward leaning position. Participants were required to recover balance during three conditions: normal, physical (obstacle clearance) and cognitive dual tasks (counting backwards). Spatiotemporal parameters, lower limb joint kinematics and kinetics of the recovery limb were compared between the two groups and across the three task conditions.
  
  
  
  The OA group demonstrated slower spatio-temporal characteristics and reduced hip and knee flexion angles, joint moments/powers and reduced muscle negative work at the knee and ankle (p<0.05). Cognitive dual task resulted in reduced centre of mass velocity and step length (p=0.03) compared to the physical dual task condition. Reduced knee (p=0.02) and hip joint powers (p=0.03) were demonstrated in the OA group in the physical task condition.
  
  
  
  When simulating a forward fall, participants with OA demonstrated difficulty in absorbing the impact and slowing down the forward momentum of the body during a recovery step. Moreover, poor dynamic postural control was demonstrated as task complexity increased.
authors.affiliation: Institute of Sport, Exercise and Active Living (ISEAL), Victoria University, Melbourne, VIC, Australia. Electronic address: Pazit.levinger@vu.edu.au.
authors.forename: Pazit
authors.initials: P
authors.lastname: Levinger
authors.affiliation: Institute of Sport, Exercise and Active Living (ISEAL), Victoria University, Melbourne, VIC, Australia.
authors.forename: Hanatsu
authors.initials: H
authors.lastname: Nagano
authors.affiliation: Institute of Sport, Exercise and Active Living (ISEAL), Victoria University, Melbourne, VIC, Australia.
authors.forename: Calum
authors.initials: C
authors.lastname: Downie
authors.affiliation: Institute of Sport, Exercise and Active Living (ISEAL), Victoria University, Melbourne, VIC, Australia.
authors.forename: Alan
authors.initials: A
authors.lastname: Hayes
authors.affiliation: Institute of Health and Ageing, Australian Catholic University, VIC, Australia.
authors.forename: Kerrie M
authors.initials: KM
authors.lastname: Sanders
authors.affiliation: Faculty of Medicine, Nursing & Health Sciences, Monash University, VIC, Australia.
authors.forename: Flavia
authors.initials: F
authors.lastname: Cicuttini
authors.affiliation: Institute of Sport, Exercise and Active Living (ISEAL), Victoria University, Melbourne, VIC, Australia.
authors.forename: Rezaul
authors.initials: R
authors.lastname: Begg
mesh_terms: D000058:Accidental Falls; D000368:Aged; D001696:Biomechanical Phenomena / Q000502:physiology; D016022:Case-Control Studies; D003071:Cognition / Q000502:physiology; D005260:Female; D006621:Hip Joint / Q000503:physiopathology; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology; D008297:Male; D020370:Osteoarthritis, Knee / Q000503:physiopathology*; D011434:Proprioception / Q000502:physiology*
keywords: Balance recovery; Falls; Knee osteoarthritis