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Clinical Tests of Standing Balance in the Knee Osteoarthritis Population: Systematic Review and Meta-analysis

Gillian L. Hatfield, Adam Morrison, Matthew Wenman, Connor A. Hammond, Michael A. Hunt
DOI: 10.2522/ptj.20150025 Published 1 March 2016
Gillian L. Hatfield
G.L. Hatfield, PT, PhD, Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada.
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Adam Morrison
A. Morrison, PT, Department of Physical Therapy, University of British Columbia.
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Matthew Wenman
M. Wenman, PT, Department of Physical Therapy, University of British Columbia.
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Connor A. Hammond
C.A. Hammond, BSc, Department of Physical Therapy, University of British Columbia.
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Michael A. Hunt
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.
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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.

Purpose 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.

Data Sources A literature search of the MEDLINE, EMBASE, CINAHL, and Web of Science databases through November 19, 2014, was conducted.

Study Selection 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.

Data Extraction 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.

Data Synthesis 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.

Limitations 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.

Footnotes

  • Dr Hatfield and Dr Hunt provided concept/idea/research design and writing. Dr Hatfield, Mr Morrison, Mr Wenman, and Dr Hunt provided data collection. Dr Hatfield, Mr Wenman, Mr Hammond, and Dr Hunt provided data analysis. Dr Hunt provided project management.

  • Salary support was provided by the Canadian Institutes of Health Research (G.L.H.) and the Michael Smith Foundation for Health Research (M.A.H.).

  • Received January 18, 2015.
  • Accepted July 5, 2015.
  • © 2016 American Physical Therapy Association
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Vol 96 Issue 3 Table of Contents
Physical Therapy: 96 (3)

Issue highlights

  • Physical Therapists and Transformative Practice and Population Management
  • Patients' Perceptions of Physical Therapists' Messages
  • Single- and Dual-Task TUG Performance in Middle-Aged and Older Adults
  • Characteristics of Foreign-Educated Physical Therapists
  • “Red Flags” and Causes of Back Pain in Older Adults
  • Older Adult Responses to Balance Tasks
  • Clinical Balance Tests in the Knee Osteoarthritis Population
  • Reactive Balance in Individuals With Chronic Stroke
  • Enhanced Postural Control in Children
  • “Stepping Up” Activity Poststroke
  • Perceptions of Physical Activity
  • Study of Hyperkyphosis, Exercise and Function (SHEAF) Protocol
  • Pilates for Chronic Low Back Pain
  • Development and Initial Testing of Playskin Lift
  • Diabetic Complications and Balance and Falls
  • Promoting Community Health Through Community-Based Research
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Clinical Tests of Standing Balance in the Knee Osteoarthritis Population: Systematic Review and Meta-analysis
Gillian L. Hatfield, Adam Morrison, Matthew Wenman, Connor A. Hammond, Michael A. Hunt
Physical Therapy Mar 2016, 96 (3) 324-337; DOI: 10.2522/ptj.20150025

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Clinical Tests of Standing Balance in the Knee Osteoarthritis Population: Systematic Review and Meta-analysis
Gillian L. Hatfield, Adam Morrison, Matthew Wenman, Connor A. Hammond, Michael A. Hunt
Physical Therapy Mar 2016, 96 (3) 324-337; DOI: 10.2522/ptj.20150025
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Subjects

  • Musculoskeletal System/Orthopedic
    • Injuries and Conditions: Knee
    • Osteoarthritis
  • Systematic Reviews/Meta-analyses
  • Geriatrics
    • Osteoarthritis
    • Falls and Falls Prevention
  • Neurology/Neuromuscular System
    • Balance
  • Examination/Evaluation
    • Examination/Evaluation: Other

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