Studies are demonstrating the success of fall prevention programs in senior centers and group exercise (including Tai Chi) programs. Current research includes a study of the effectiveness of a fall prevention program delivered by community pharmacists, a study of the impact of the fear of falling and patient willingness to actively engage in fall prevention activities such as exercise, and studies on the use of hip protectors among older adults.
For patients with rheumatoid disease, exercise activities should focus on balance and mobility.
Evidence-based Strategies
Rheumatologists should first determine what assessment scale to use to measure fall risk for the RA/OA patient. Dr. Rose and her colleagues developed the Fullerton Advanced Balance Scale (FAB). It includes 10 measurements developed to assess multiple dimensions of balance such as sensory and motor impairments. It is most appropriate for higher-functioning, community-dwelling older adults, says Dr. Rose. The Berg Balance Scale and Timed Up and Go Test are more appropriate for lower-functioning patients. The Berg scale includes 14 items, such as sitting and standing in different positions and transfers. Both the FAB and Berg scale have been studied to determine effectiveness. Published results for the use of FAB in older, higher-functioning adults state, “A practitioner can be confident in more than seven of 10 cases that an older adult who scores 25 or lower is at high risk for falls and in need of immediate attention.”1 A review of 17 studies on functional balance test published in 2007 says, “The Berg Balance Scale and Timed up and Go Test have published reliability and validity.”2
The Centers for Disease Control and Prevention (CDC) has supported a number of grants through a partnership with the Administration on Aging (AoA) that focus on models of fall prevention programs. Ten states have implemented the Matter of Balance program, a small-group model that includes eight two-hour sessions. It is designed to reduce fear, increase self-efficacy and a sense of control in relation to fall risk, and increase physical and social activity. Exercises include foot circles to improve ankle joint strength and range of motion, seated knee raises to improve hip stability and range of motion, toe stands, and alternating marching steps to improve balance and physical endurance.3
The CDC also reports on the Otago Exercise Program, a home-based program done by a physical therapist or nurse who visits the patient four times over a two-month period. This program was tested in four randomized controlled trials and one controlled multicenter trial with results showing a 35% reduction in falls rates. The exercises are tailored for muscle strengthening and balance of increasing difficulty, depending on the patient, and also include walking. Tai Chi is an exercise that is growing in popularity, say Drs. Rose and Davis. It works best in patients who are at low risk of falling. Dr. Rose cautions that Tai Chi should be modified for patients with rheumatoid disease. Researchers at the Oregon Research Institute led by Fuzhong Li, PhD, recently studied the effectiveness of a six-month, small-group program of Tai Chi in RA/OA patients. Participants had a 55% decrease in falls.4 The CDC also funded a study led by Li and colleagues to determine the effectiveness of Tai Chi taught in community senior centers by nonmedical instructors.5 Participants improved health outcome measures, including balance and fall risk reduction, and increased functional independence.
