Falling and fall risk in adult patients with severe haemophilia

Summary

The objective of this study was to define fall rates and to identify possible fall risk factors in adult patients with severe haemophilia. Patients, material, methods: 147 patients with severe haemophilia A and B were evaluated using a standardized test battery consisting of demographic, medical and clinical variables and fall evaluation. Results: 41 (27.9 %) patients reported a fall in the past 12 months, 22 (53.7 %) of them more than once. Young age, subjective gait insecurity and a higher number of artificial joints seem to be risk factors for falling. Conclusion: Falls seem to be a common phenomenon in patients with severe haemophilia. Fall risk screening and fall prevention should be implemented into daily practice.

Zusammenfassung

Ziel der Untersuchung war es, die Häufigkeit von Sturzereignissen bei erwachsenen Hämophilie-Patienten zu untersuchen sowie mögliche Sturzrisikofaktoren zu identifizieren. Patienten, Material, Methoden: 147 Patienten mit schwerer Hämophilie A und B wurden mittels einer standardisierten Testbatterie, bestehend aus demografischen, medizinischen und klinischen Variablen sowie der Sturzanamnese, untersucht. Ergebnisse: 41 (27.9 %) Patienten stürzten in den letzten 12 Monaten, 22 (53.7 %) davon mehr als ein Mal. Junges Alter, subjektive Gangunsicherheit und eine höhere Anzahl an endoprothetisch versorgten Gelenken scheinen Risikofaktoren für einen Sturz zu sein. Schlussfolgerung: Stürze waren ein häufiges Phänomen unter den Studienteilnehmern. Es erscheint sinnvoll, Screeningmaßnahmen sowie prophylaktische Maßnahmen zu etablieren, um Patienten mit besonders hohem Sturzrisiko zu identifizieren und Sturzereignisse zu vermeiden.

Keywords

haemophilia - fall risk - adult

Schlüsselwörter

Hämophilie - Sturzrisiko - Erwachsene

^* share senior authorship

• Literature

• 1 Mauser-Bunschoten EP, Fransen DEVan De Putte, Schutgens REG. Co-morbidity in the ageing haemophilia patient: the down side of increased life expectancy. Haemophilia 2009; 15: 853-863.
• 2 Masud T, Morris RO. Epidemiology of falls. Age Ageing 2001; 30 (Suppl. 04) 3-7.
• 3 Tinetti ME, Speechley M, Ginter SF. Risk factors for falls among elderly persons living in the community. N Engl J Med 1988; 319: 1701-1707.
• 4 Rubenstein LZ. Falls in older people: epidemiology, risk factors and strategies for prevention. Age Ageing 2006; 35 (Suppl. 02) ii37-ii41.
• 5 WHO Europe. What are the main risk factors for falls among older people and what are the most effective interventions to prevent these falls (March strength can lead to gait impairments and risk factors specific for PWH a prospective 2004)?. http://www.euro.who.int/data/assets/pdf_file/0018/74700/E82552.pdf (access on 9th September 2016)
• 6 Forsyth AL, Quon DV, Konkle BA. Role of exercise and physical activity on haemophilic arthropathy, fall prevention and osteoporosis. Haemophilia 2011; 17: 870-876.
• 7 Fearn M, Hill K, Williams S. et al. Balance dysfunction in adults with haemophilia. Haemophilia 2010; 16: 606-614.
• 8 Sammels M, Vandesande J, Vlaeyen E, Peerlinck K, Milisen K. Falling and fall risk factors in adults with haemophilia: an exploratory study. Haemophilia 2014; 20: 836-845.
• 9 Hilliard P, Funk S, Zourikian N, Bergstrom BM. et al. Hemophilia joint health score reliability study. Haemophilia 2006; 12: 518-525.
• 10 Lamb SE, Jørstad ECStein, Hauer KA, Becker C. Development of a common outcome data set for fall injury prevention trials: the Prevention of Falls Network Europe Consensus. J Am Geriatr Soc 2005; 53: 1618-1622.
• 11 Dias N, Kempen GIJM, Todd CJ. et al. The German version of the Falls Efficacy Scale-International Version (FESI). Z Gerontol Geriatr 2006; 39: 297-300.
• 12 van Genderen FR, Westers P, Heijnen L. et al. Measuring patients’ perceptions on their functional abilities: validation of the Haemophilia Activities List. Haemophilia 2006; 12: 36-46.
• 13 Ware JE, Sherbourne CD. The MOS 36-item shortform health survey (SF-36). I. Conceptual framework and item selection. Med Care 1992; 30: 473-483.
• 14 Podsiadlo D, Richardson S. The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 1991; 39: 142-148.
• 15 Flaherty LM, Josephson NC. Screening for fall risk in patients with haemophilia. Haemophilia 2013; 19: 103-109.
• 16 Swinkels A, Newman JH, Allain TJ. A prospective observational study of falling before and after knee replacement surgery. Age and Ageing 2009; 38: 175-181.
• 17 Levinger P, Menz HB, Wee E. et al. Physiological risk factors for falls in people with knee osteoarthritis before and early after knee replacement surgery. Knee Surg Sports Traumatol Arthrosc 2011; 19: 1082-1089.
• 18 Silva M, Luck JV. Long-term results of primary total knee replacement in patients with hemophilia. J Bone Joint Surg Am 2005; 87: 85-91.
• 19 Habermann B, Eberhardt C, Hovy L. et al. Total hip replacement in patients with severe bleeding disorders. Int Orthop 2007; 31: 17-21.
• 20 Strauss AC, Schmolders J, Friedrich MJ. et al. Outcome after total knee arthroplasty in haemophilic patients with stiff knees. Haemophilia 2015; 21: 300-305.
• 21 Pap G, Meyer M, Weiler HT. et al. Proprioception after total knee arthroplasty: a comparison with clinical outcome. Acta Orthop Scand 2000; 71: 153-159.
• 22 Fuchs S, Thorwesten L, Niewerth S. Proprioceptive function in knees with and without total knee arthroplasty. Am J Phys Med Rehabil 1999; 78: 39-45.
• 23 de Kleijn P, van Genderen FR, van Meeteren NLU. Assessing functional health status in adults with haemophilia: towards a preliminary core set of clinimetric instruments based on a literature search in Rheumatoid Arthritis and Osteoarthritis. Haemophilia 2005; 11: 308-318.
• 24 Rao SS. Prevention of falls in older patients. Am Fam Physician 2005; 72: 81-88.
• 25 Cummings SR, Nevitt MC, Kidd S. Forgetting falls. The limited accuracy of recall of falls in the elderly. J Am Geriatr Soc 1988; 36: 613-616.