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

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.