ReviewBalance performance in older adults with hip osteoarthritis: A systematic review
Introduction
By 2050, older adults (aged 60 years or over) are estimated to account for 21% of the worldwide population [1]. Trends in population ageing are expected to be associated with increased healthcare costs and prevalence of age-related diseases, such as osteoarthritis (OA). OA commonly affects weight-bearing joints of the lower limb [2,3], with hip OA reported to affect up to 15% of adults aged 55 years and over [3].
Falls are another serious health concern associated with ageing, which can lead to injury, hospitalisation, loss of independence, and even fatality [4,5]. Lower limb OA (which can affect the ankles, knees or hips) is one key risk factor for falls in older people [6]. Symptoms and physical impairments associated with lower limb OA, including joint pain and stiffness, muscle weakness, and altered sensory function, can be detrimental to balance performance and increase the likelihood of falling [[7], [8], [9]]. Further, alterations in joint structure, such as cartilage degeneration and osteophyte formation, may alter weight-bearing and movement patterns [10], which in turn may negatively affect balance.
While a number of studies have investigated balance in hip OA, there has not yet been a synthesis of the literature. Many aspects of balance, including static, dynamic and functional balance, have been studied in this population. Therefore, it is timely to systematically review and synthesise data to enhance current understanding of balance impairments in older adults with hip OA. The aim of this systematic review is to determine whether balance performance is altered in older people with unilateral and/or bilateral hip OA. It is important to understand what specific aspects of balance are impaired in hip OA and how balance impairments may vary with disease progression and severity. Such information will be used to inform the advancement of more effective and tailored balance training strategies and falls prevention programs for older individuals with hip OA.
Section snippets
Search strategy
The systematic review protocol was developed in consultation with guidelines provided by the Preferred Reporting of Systematic Reviews and Meta-Analyses (PRISMA) statement [11]. Two authors independently (AP, MS) searched five electronic databases (Pubmed, Cinahl, Web of Science, Cochrane and Embase) from inception to 30th January 2017, without language restriction, to identify articles related to balance performance in older adults with hip OA. Three sets of entry strings were combined with
Selection of studies
The search strategy retrieved 5407 articles. Fig. 1 outlines a description of the studies excluded at each stage of the selection process. Following the removal of duplicates and the sequential review of titles, abstracts and full texts, 14 studies met the eligibility criteria for inclusion in the review and underwent quality assessment.
Methodological quality assessment
Percentage agreement between authors across the 34 items was 85.7%. Consensus was obtained by discussion between the two raters (AP, EG), and consultation with
Discussion
The primary purpose of this study was to summarise the available data on balance performance in older adults with hip OA compared with those without hip OA, or between the affected and unaffected limbs in individuals with (unilateral) hip OA. While the range of balance tests and outcome measures across studies did not allow pooling of data for meta-analyses, medium and large effects were identified for some individual studies. Data from this systematic review suggest that individuals with hip
Conflicts of interest
The author(s) declared no potential conflicts of interested.
Funding support
This systematic review did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. AMAP is supported by an International Postgraduate Research Scholarship. EMG was supported by an Australian Government Research Training Program Scholarship.
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