Background. Early mobilization after total joint arthroplasty decreases postoperative complications and optimizes future functional outcomes. The purpose of this study was to evaluate the effectiveness of a supervised patient ambulation program following total joint arthroplasty. Methods. In 2014, our institution initiated a mandatory supervised patient ambulation program termed “No One Walks Alone” (NOWA). The program requires that all patients who mobilize are accompanied by a nurse or physical therapist. Gait belts are worn whenever a patient ambulates. Bed and chair alarms are utilized to alert if a patient tries to ambulate alone. If a patient experiences a fall, he or she is immediately evaluated by the nursing staff, and details regarding the fall and any injury sustained are documented. A retrospective review of patients undergoing total knee or hip arthroplasty between 2011–2017 was conducted. Patients who had surgery between 2011–2013, before the program, were included in the pre-implementation group (N= 3,069) and those having surgery between 2016–2017, after the program started, were included in the post-implementation group (N=3,947). The incidence of patient falls, fall-related complications were compared between groups. Results. The number of patient falls was 23 in the pre-implementation group (0.7%) and 9 in the post-implementation group (0.2%). Fall-related complications occurred in 14 of 23 falls in the pre-implementation group (0.5% overall) and 2 of 9 falls in the post-implementation group (0.05% overall) (p<0.001). Patients who experienced a fall were more likely to have undergone total knee arthroplasty (81.3%) compared to those who did not fall (58%) (p=0.008). Conclusion. A supervised patient ambulation program can be successful at reducing the incidence of patient falls and complications related to falls in the immediate postoperative setting

Aims. Falls are a common occurrence among hospital inpatients and can lead to injury, prolonged hospitalisation and delayed rehabilitation. There is major economic burden associated with this. Post operative orthopaedic patients have certain risk factors that predispose them to falls including decreased mobility, use of opioids and, in some cases, history of previous falls. Methods. A Prospective cohort study with a historical control group was performed looking at falls before and after implementation of a Falls Prevention Program (FFP). A cost analysis of the intervention was then undertaken. Patient data, HIPE data and fall-incident report data were reviewed to identify fall-related injuries and related costs. Results. A total of 415 falls occurred over a 5 year period pre-intervention. The fall rate of 3.49/1000 bed days pre-intervention was significantly higher than the fall rate post-intervention (2.68/1000 bed days) (p=0.0348). There was a significant decrease in falls relating to elimination (p=0.0025). Elective patients also fell less in the post-intervention period (p=0.0115). 85 falls occurred in the 12 months pre-intervention. 15.29% (13/85) of falls resulted in minor injuries, and 9.42% (8/85) resulted in major injuries. The total cost incurred during this period as a result of falls was €84,285.74. Over 95% of total costs related to patients who sustained a hip fracture (n=4). The total cost of implementing the FFP was €11,234.25. In the 12 months post-intervention, 52 falls occurred. 25% (13/52) of falls resulted in minor injuries, and 5.76% (2/52) resulted in major injuries (no hip fractures). The total costs accrued during this period as a result of falls was €510.60. Conclusion. Following the implementation of a FPP the incidence of falls and consequent costs decreased significantly. The large proportion of saving results from preventing hip fractures

Introduction. Patients who undergo total joint arthroplasty (TJA) are at a high risk for the development of thromboembolic complications. The rate at which venous thromboembolism occurs following TJA has been reported to be between 1.3–9.4%. As a result, the utilization of prophylactic therapies is considered standard of care in this patient population. The primary purpose of the current study was to 1) evaluate patient satisfaction with the use of intermittent compression devices 2) evaluate the risk of self-reported falls secondary to the use of these devices following TJA. Methods. This is a single institution, prospective study on patients who underwent TJA at an urban, academic orthopedic specialty hospital. Patients were surveyed using an electronic patient rehabilitation application regarding their use and satisfaction with their home intermittent compression devices with a battery and power cord attachment that the patient must wear while using the devices. They were also asked if any falls or near-falls they may have experienced. Surveys were administered on postoperative Day 14, and patients were given 10 days to submit their responses. Using our institutions data warehouse, patient demographics were also collected (Table 1). Results. Survey responses were collected from 479 patients who underwent TJA between August 2018 and October 2018. Of the respondents, 278 were female and 201 were male. Approximately 79% of patients in the cohort were satisfied with their use of their compression devices compared to 21% of patients who were unsatisfied. During this time, 16% of patients (75 pts) also reported at least one tripping episode at home and 11 patients (2.3%) had at least one fall at home. Conclusion. These results suggest that patients are generally satisfied with their home intermittent compression devices. There are a significant number of trips or falls after surgery and further study examining the potential role of these devices and their cords in these falls is needed. For figures, tables, or references, please contact authors directly

Introduction. Patients with hip osteoarthritis have a substantial loss of muscular strength in the affected limb compared to the healthy limb preoperatively, but there is very little quantitative information available on preoperative muscle atrophy and degeneration and their influence on postoperative quality of life (QOL) and the risk of falls. The purpose of the present study were two folds; to assess muscle atrophy and degeneration of pelvis and thigh of patients with unilateral hip osteoarthritis using computed tomography (CT) and to evaluate their impacts on postoperative QOL and the risk of falls. Methods. We used preoperative CT data of 20 patients who underwent primary total hip arthroplasty. The following 17 muscles were segmented with our developed semi-automated segmentation method: iliacus, gluteus maximus, gluteus medius, gluteus minimus, rectus femoris, tensor facia lata, adductors, pectinus, piriformis, obturator externus, obturator internus, semimenbranosus, semitendinosus, vastus medialis and vastus lateralis/intermedius (Fig. 1). Volume and radiological density of each muscle were measured. The ratio of those of affected limb to healthy limb was calculated. At the latest follow-up, the WOMAC score was collected and a history of falls after surgery was asked. The average follow- up period was 6 years. Comparison of the volume and radiological density of each muscle between affected and healthy limbs was performed using the Wilcoxon signed rank test. Correlations between the volume and radiological density of each muscle and each score of the WOMAC were evaluated with Spearman's correlation coefficient. The volume and radiological density of each muscle between patients with and without a history of falls were compared using Mann-Whitney U test. Results. 13 of 17 muscles showed significant decrease in muscle volume in affected limb compared to healthy limb. The mean muscle atrophy ratio was 18.6±7.1 (SD) % (0–28.3%). Iliacus, psoas, adductors and piriformis showed a significant volume reduction more than 25 %. All 17 muscles showed reduced radiological density along the affected limb compared to the healthy side. The difference was 8.7±4.2 (SD) Hounsfield units (3.2 to 16.4). Gluteus medius and gluteus minimus showed a significant decrease of radiological density more than 15 HU. The radiological density of gluteus minimus showed higher correlation (R>0.7) with physical function scores of WOMAC for descending stairs, rising from sitting, walking on flat surface, going shopping and rising from bed. Seven of 20 patients had a history of falls, who showed significant reduced radiological density of gluteus minimus and obturator internus compared to the 13 patients without a history of falls. Conclusion. Almost all muscles of pelvis and thigh along the affected limb showed marked atrophy and fatty degeneration compared to the healthy side. Especially, the degree of fatty degeneration of gluteus minimus showed significant impacts on postoperative physical function and the risk of falls of patients

Background: Falls are a major concern in the elderly population both from a clinical perspective and that of health resource provision. This study evaluates the incidence of falls in patients awaiting hip or knee replacement and the impact of joint replacement surgery 2 years later. Method: Patients aged 65-80 years listed for primary hip or knee arthroplasty for osteoarthritis (OA) were invited to participate. Patients completed a questionnaire including Western Ontario and McMaster University OA Index (WOMAC) scores 0-100, 100 best, history of falls and fractures. Function was measured using Timed Up and Go (TUG) walk test. All tests were repeated at two years. Results: One hundred and ninety-nine patients (84 hips, 115 knees) were recruited with a mean age of 72 years (standard deviation 4.0) and predominantly female (57 %). At two years 144 patients were reviewed of whom 128 had undergone arthroplasty. After surgery, 29/128 (23%) reported falling compared to 55 of these 128 (43%) falling at baseline; only 13/128 (11%) had fallen more than once. Fifteen patients sustained minor injuries and one patient reported a fractured wrist. Of the patients who had undergone joint replacement and fell at baseline 36/55 (66%) patients reported no falls at follow-up, whilst there were 11 new fallers. Patients reporting falls had significantly lower WOMAC pain and function scores, and slower TUG scores at both baseline and two-year review. Conclusion: Patients with severe hip and knee OA awaiting arthroplasty reported a higher incidence of falls compared to the normal population but reported fewer falls after surgery. However, almost one in four patients were still reporting falling at the two-year review. Injury including periprosthetic fractures can have serious clinical and economic consequences. This study highlights the need to evaluate a falls prevention programme in arthroplasty management

Introduction and Objectives: Lesions due to falls cause a combination of skeletal lesions that require specific treatment. The aim of this study is to determine the epidemiological and evolutionary profile of a group of patients with severe trauma due to falls. Materials and Methods: We carried out an analysis of the register of the Hospital Trauma Service. The variables we studied were: demographic; scores: the Injury Severity Score (ISS), the New Injury Severity Score (NISS), the Revised Trauma Score (RTS); probability of survival, type of lesion and evolution data. Results: Between 2003 and 2008, 190 patients were admitted due to falls. Mean age was 39 years. And 85.3% were men, 100% of the falls were at work and 62% were suicide attempts. Mean ISS: 27.3; mean NISS: 34.1. The severity expressed by ISS and NISS was higher in the group of patients that had suffered falls than in those with lesions due to other causes. Mean probability of survival was 81%, 65% for suicide attempts. The main causes of falls were work-related 40%, accidental 24.7% and attempted suicide 22%. There was a greater incidence of attempted suicides in women and foreigners. The mean height of the falls was 9.7 m. The most frequently affected bone was the tibia, with 56 fractures. There were 51 pelvis fractures. The most frequent combined lesion was lesion of the pelvic bone together with a lesion of a long bone of the leg, 13 cases. Global mortality was 14.2%, with 17.1% in the worker group and 21% in the suicide group. Discussion and Conclusions: In our environment there is a high rate of lesions due to falls. The severity of the lesions scored by ISS and NISS is greater than for lesions due to other causes that are not falls

Objectives: The development of effective fall prevention programs requires understanding of underlying causes of falls. Measurement tools are needed that predict the risk of falling and give objective assessment of balance function needed for daily life performance. The ultimate goal of the activities within this work package is to combine the expertise of different disciplines for the development of balance assessment tools that meet the requirements for large-scale intervention studies and routine-use in clinical settings. The knowledge needed to develop these instruments and measures is scattered over a wide range of disciplines (ranging from physiology to electrical engineering). The objectives of this work package are to combine expertise from different disciplines to transfer knowledge between disciplines, to co-operate in designing research and provide an intellectual environment for interdisciplinary projects and dissemination of knowledge into disciplines working in the clinical field. Description of work: Recent technological developments allow for the measurement of human movement under real-life conditions by means of lightweight ambulatory equipment. This novel approach to the analysis of human movement can potentially fill the need for objective field instruments. However, suitable methods for balance assessment need to be developed. Activities of this work package are aimed at co-ordinating the development of methods that can be used in the clinical field for assessment of posture and gait. The work encompasses the organization of workshops, the co-ordination of research, and dissemination of knowledge through publications, teaching and training. Members co-ordinate their individual research efforts in such a way that the different research lines support and reinforce each other. The coordination of research will involve joint experiments and the definition of assessment protocols that can be used in the individual studies of all participating groups. The work focuses on the analysis of kinematic patterns during walking and standing in a natural environment by means of ambulatory equipment. Appropriate methods for signal acquisition and analysis are being developed. Protocols are being designed which specifically address different aspects of balance control (i.e. mental load, sensory dependence, and effects of mechanical manipulations). Laboratory tasks, which have proven to be sensitive for balance dysfunction, will be translated into valid, reliable and easy-to-use procedures for field use. These field instruments are based upon a sound theoretical framework against which the results can be understood and interpreted. In order to address the validity and predictive value of field instruments, longitudinal studies need to be performed that are in accordance with the work in other work packages. Apart from balance assessment procedures, activity levels, history of falls, and future falls need to be assessed. We expect this novel approach to give insight in the relation between objective measures of balance function, activity level and number of falls. Thus, the occurrence of falls can be related to (changes in) activity level

Background: ProFaNE is an EC-funded network supporting collaboration between researchers in the field of falls injury prevention. One component of ProFaNE concerns psychosocial aspects of falls prevention, which include assessment of fear of falling and attitudes to falls prevention programmes. Findings from members’ collaborative qualitative research on attitudes to falls prevention will be presented. Methods: We conducted interviews with older people, assessing their beliefs and attitudes regarding falls prevention programmes. Interviews were structured around the Theory of Planned Behaviour, were carried out in the UK, the Netherlands, Germany, Switzerland, Norway, Greece and Italy. The thematic analysis reported here compares the beliefs of those who had taken part in a falls prevention programme and those who had not been offered this option. Findings: Whilst many may reject the notion that falls are anything to do with them, participants reported being motivated to take part in programmes that are designed to improve strength and balance chiefly by a desire for, and experiences of, immediate benefits (including improved functioning and mobility, enjoyment and increased self-confidence) rather than by fear of falling. The main reported barriers to participation included lack of familiarity with such programmes, concern about exertion, transport and financial obstacles, and lack of motivation. Conclusions: Falls prevention has negative connotations for many older people. Participation in falls prevention programmes may be enhanced by maximising and promoting their immediate benefits rather than their potential for reducing falls, by removing practical barriers, and by providing opportunities to sample programmes in order to demonstrate their immediate benefits. A focus on exercise as promoting health, fitness and independence may have wider acceptability

BACKGROUND AND PURPOSE: Previous studies using the Timed Up & Go (TUG) as a predictor of falls have primarily been based on retrospective data, while no prospective studies using the TUG to predict falls in hip fracture patients are available. The purpose of this study was to determine if the TUG could predict falls in hip fracture patients during six months follow up. SUBJECTS: Seventy nine elderly consecutive unselected hip fracture patients being able to perform the TUG when discharged directly to their own home or assisted living facilities from a special acute orthopedic hip fracture unit, with 59 (75 %) being able to participate in the follow-up interview. METHODS: In a prospective study all patients were contacted for a six months follow up interview about falls since discharge from the hospital and the TUG performed at discharge was compared with the New Mobility Score describing functional level before fracture, mental status on admission, gender, fracture type, residence and walking aids before and after fracture. All patients followed a well-defined care plan with multimodal fast track rehabilitation including an intensive physiotherapy program comprising two daily sessions and discharge was according to standardized criteria. Analyses and correlations of all variables were examined for prediction of falls and sensitivity, specificity, predictive values and likelihood ratios were calculated. Falls were classified as none vs. one or more. RESULTS: Among the 59 patients in the follow up group, 19 patients (32 %) had experienced one ore more falls in the period since discharge, four of which resulted in new hip fractures. The TUG at discharge using a cutoff point of 24 seconds was the only parameter that significantly (P =.01) predicted falls within six months follow up, resulting in a sensitivity of 95%, a negative predictive value of 93%, and a negative likelihood ratio of 0.1. DISCUSSION and CONCLUSION: The results suggest that the TUG is a sensitive measure for identifying hip fracture patients in risk of new falls, and it should be part of future outcome measures to decide in whom falls preventative measures should be instigated

Purpose. Femoral nerve blockade (FNB) can provide prolonged postoperative analgesia and facilitate rehabilitation following major knee surgery while minimizing opioid-related adverse effects. However, anecdotal data have implicated FNB in post-operative falls, presumably due to a block-related reduction in quadriceps strength. Age, gender and knee replacement surgery have also been previously identified as risk factors for falls in the acute postoperative orthopaedic inpatient setting. We hypothesized that the use of FNB would be an independent predictor of an inpatient fall following total knee replacement (TKR). Method. We examined a cohort of 2,197 patients who underwent TKR in a single academic institution between October 2003 and March 2010. The start date was based on the separate initiation of both a comprehensive regional anesthesia database and an orthopaedic ward Falls Surveillance Program. Patients undergoing revision TKR or unicompartmental arthroplasty were excluded. Age, simultaneous bilateral TKR, gender, body mass index (BMI), and various regional nerve blocks were considered predictors of post-operative falls in a logistic regression model. The database allowed resolution of the type (i.e. femoral, sciatic) and duration (i.e. single-bolus, indwelling continuous perineural catheter) of nerve blockade. Hospital-standard dosing and insertion techniques were employed. Results. The total number of falls was 60 (rate 2.7%), 40 of which occurred within 48 hours of surgery. When compared to patients who did not fall, those who fell were significantly older (699 years vs 6611 years; p=0.03), obese [BMI >30kg/m2] (75% vs 59%; p=0.01) and had continuous catheter FNB (97% vs 86%; p=0.02). The odds ratio of having a fall was 1.04 (1.0–1.07; p=0.008) for each one-year increase in age above the mean age of 66 years, 2.4 (1.3–4.5; p=0.005) for a BMI >30kg/m2 and 4.4 (1.04–18.2; p=0.04) for continuous catheter FNB. Gender, simultaneous bilateral TKR, any sciatic nerve block or spinal anesthetic did not predict an increased risk of acute-care post-operative falls. Conclusion. This is the first study to demonstrate an increased risk of post-operative falls in obese patients and with the use of continuous catheter FNB following TKR. Careful consideration of the use of continuous catheter FNB may be warranted in patients with additional risk factors for falls such as advanced age and obesity

ProFaNE, Prevention of Falls Network Europe, is a four year project, funded by the European Community Framework 5. It is a thematic network, coordinated by the University of Manchester, UK, with 25 partners across Europe. There are also Network Associates from a number of EU and non-EU countries who give their advice and experience at meetings, seminarsand conferences. The aim is to bring together workers from around Europe to focus on a series of tasks aimed at developing multi-factorial prevention programmes to reduce the incidence of falls and fractures amongst elderly people. The work of ProFaNE is practical, both in terms of developing the evidence base for implementation of effective interventions and encouraging best practice across Europe. The task of each work package is to convene workshops, undertake personnel exchanges and set up collaborative studies, data sharing in order to develop evidence based protocols and publications which can be used to implement change. Work Package 1 - Fall prevention trials - Taxonomy of interventions and agreed set of outcomes. An agreed and standardised set of outcome definitions and measures is important to improve the robustness of data from intervention studies, will enable comparison across studies, good quality measurement in multi-centre trials, and facilitate meta-analysis of trial results. A taxonomy of interventions will facilitate comparisons between studies, help to determine the most effective components or sub-components of interventions, and aid the decision making process of policy makers and health insurance plans. A Consensus taxonomy and outcome measures statement, Trial design statement, Meta - analysis protocol and Self help materials will be produced. Work Package 2 - Clinical Assessment and Outcomes. Aims to gain an understanding of the current issues surrounding falls prevention across Europe and to embrace at national and international level, the different political and health service agendas in each country such that recommendations can ultimately be translated into working models of practice. They will establish a robust network of key members across Europe to facilitate the effective and efficient promulgation of evidence likely to influence service developments at national and local level and derive a consensus approach to assessment and management of older people at risk of falling in a variety of clinical settings using the existing evidence base as well as inviting expert opinions in the field. Work Package 3 - Assessment of balance function and prediction of falls. Measurement tools are needed that predict the risk of falling and give objective assessment of balance function needed for daily life performance. The ultimate goal of the activities within this work package is to combine the expertise of different disciplines for the development of balance assessment tools that meet the requirements for large-scale intervention studies and routine-use in clinical settings. The knowledge needed to develop these instruments and measures is scattered over a wide range of disciplines (ranging from physiology to electrical engineering). Work Package 4 - Psychological aspects of falling. We need to understand the psychosocial factors which affect the benefit of falling prevention programmes for older people. These include attitudes to falling (such as fear) and factors that promote or reduce uptake of and adherence to a range of falling-related interventions, including exercise. Understanding of attitudes and behaviour will inform guidelines for the design of interventions, and development of measures to assess relevant attitudes. We also co-ordinate development of self-test indices that older people can use to evaluate their own risk of falling, together with guidance as to the actions they should take to prevent falling

Axial loading of the wrist results in carpal pronation, which loads the scapholunate ligament (SLL). ECRL and FCR are carpal supinators and ECU is a carpal pronator. In this study we aim to show differential activity in the ECRL and ECU as a protective mechanism for the SLL in simulated falls. Eight healthy volunteers were recruited for a simulated fall situation. Surface EMG was used to record muscle activity in the six major muscles that control wrist movement (FCU, FCR, ECRL, ECU, APL, ECRB) in the right forearm. The forearm skin was prepared in a standard fashion and the electrodes placed following an established protocol. Recordings were made using zero wire (Noraxon) surface EMG equipment. The data was exported and analysed using MyoResearch XP. Recordings were rectified and mean value, peak value, area under the curve and frequency were compared. Recordings were divided into five time periods from rest to post-impact. ECRL has the most predictable and consistent response to impact of the wrist on the ground. Immediately following impact there is inhibition of the extensors and no change in flexor activity. The next phase is characterised by a ‘spike’ in ECRL activity with a less marked increase in ECRB and minimal change in ECU activity. There is decrease activity in the flexors during the ECRL peak. The pre-peak period lasts between 5 to 10 ms. The ECRL peak period lasts between 20 to 30 ms. We have identified that ECRL is active post fall and this response takes less than 10 ms from the time of impact. The time response is in the order of a spinal proprioceptive reflex. We were unable to identify a stretch response in the flexors that could act to trigger the ECRL response

PURPOSE: Patients who sustain fall-related distal forearm fractures are at risk to sustain new fractures later in life. Risk factors for falls such as low physical activity, impaired gait and neuromuscular function, and comorbidity are well known, as well as risk factors for fractures such as female gender, old age, low body mass index (BMI) and low mobility. Fracture prevention is often directed toward bone mass density treatment, but there is evidence that high level of physical activity reduces falls and therefore also reduces fractures. Health related quality of life (HRQoL) has become an important additional measure. The aims of this study were to evaluate the HRQoL, reported with EQ-5D and SF-12, in women who had sustained fall-related distal forearm fracture one year earlier and compare with Swedish normative data, and to physical performance and self-reported comorbidity. PARTICIPANTS: Sixty women with a fall-related distal forearm fracture were invited to examine health-related quality of life and physical performance at a mean time of 13 months after they had sustained their fracture (S.D. 1.6, range 10–17). The inclusion criteria were that they should be able to perform the physical tests and to understand verbal and written Swedish. Forty three women (72%), mean age 68 (SD 8.4, range 50–84), agreed to participate. METHODS: The women filled in two generic HRQoL-questionnaires; EQ-5D and SF-12. They self-rated their physical activity and reported ailments, which were regularly examined by a doctor, and intake of prescribed medication. They reported problems or difficulties from the locomotor system and depressive symptoms during the three last months. All women underwent physical performance tests; handgrip strength, one leg standing (OLS) and walking speed. Fisher’s exact test, Mann Whitney U test and Spearman’s rank correlation coefficient were used in the statistical analyses. RESULTS: In the younger women (age 50–59) the HRQoL was lower compared to Swedish normative data. The EQ-5D index and VAS scores correlated moderately to the physical component summary (PCS-12) of the SF-12 (rs=0.73 and rs=0.69, respectively). The correlation to the mental component summary (MCS-12) of the SF-12 was lower (rs=0.32 and rs=0.22, respectively). Women who reported comorbidity and low physical activity scored lower in the corresponding items of health in both questionnaires. CONCLUSIONS: Low results in HRQoL questionnaires in apparently healthy older women with fall-related distal forearm fracture may indicate underlying comorbidity, not captured by physical performance tests. We suggest that HRQoL questionnaires should be used in additional to physical outcome measures for this patient group. The use of HRQoL questionnaires to find patients for preventive measures of falls and fractures should be further explored

Renal Osteodystrophy is a type of metabolic bone disease characterized by bone mineralization deficiency due to electrolyte and endocrine abnormalities. Patients with chronic kidney disease (CKD) are more likely to experience falls and fractures due to renal osteodystrophy and the high prevalence of risk factors for falls. Treatment involves medical management to resolve the etiology of the underlying renal condition, as well as management (and prevention) of pathological fractures. A 66-year-old female patient, with severe osteoporosis and chronic kidney disease undergoing haemodialysis, has presented with multiple fractures along the years. She was submitted to bilateral proximal femoral nailing as fracture treatment on the left and prophylactically due to pathological bone injury on the right, followed by revision of the left nail with a longer one after varus angulation and fracture distal to the nail extremity. Meanwhile, the patient suffered a pathological fracture of the radial and cubital diaphysis and was submitted to conservative treatment with cast, with consolidation of the fracture. Posteriorly, she re-fractured these bones after a fall and repeated the conservative treatment. Clinical management: There is a multidisciplinary approach to manage the chronic illness of the patient, including medical management to resolve the etiology and consequences of her chronic kidney disease, pain control, conservative or surgical fracture management and prevention of falls. The incidence of chronic renal disease is increasing and the patients with this condition live longer than previously and are more physically active. Thus, patients may experience trauma as a direct result of increased physical activity in a setting of weakened pathologic bone. Their quality of life is primarily limited by musculoskeletal problems, such as bone pain, muscle weakness, growth retardation, and skeletal deformity. A multidisciplinary approach is required to treat these patients, controlling their chronic diseases, managing fractures and preventing falls

Falls in adults are a major problem and can lead to injuries and death. In order to better understand falls and successful recoveries, identifying kinematics, kinetics, and muscle forces during recovery from loss of balance is crucial. To obtain reactive gait patterns, participants must be subjected to unexpected perturbations such as trips and slips. Previous researchers have reported kinetics recovery data following stumbling; however, the muscle force recovery patterns remain unknown. To better target exercises to reduce the risk of falls, we must first understand which muscles, their magnitude, and their coordination patterns, play a role in a successful recovery from a trip and a slip. Additionally, knowing the successful patterns of lower limb function can help with the diagnosis of faulty movements. A total of 20 healthy adults in their twenties with similar athletic backgrounds were perturbed on a split-belt treadmill using Computer-Assisted Rehabilitation Environment (Motkforce Link) at a preset speed of 1.1m/s. Two kinds of perturbations were administered: slip and trip. Slips were simulated by accelerating one belt, whereas trips were simulated by decelerating one belt. Both perturbations had similar intensity and only differed in the direction. Computational modeling was used to obtain lower-limb function during the compensatory step. SPM paired t-test was used to compare differences in recovery strategies between slip and trip through magnitude and patterns of joints. There were no significant differences in joint angles post tripping vs post-slipping. Results of net joint moments showed that compensating for the loss of balance due to tripping required a higher ankle plantarflexion moment than slipping (at 22-52%; 1.2± 0.3vs0.4±0.2, p<0.001). Additionally, larger gluteus maximus (at 40-50%;8.7±3.8vs2.7±1.1N/kg, p=0.001), gluteus medius (at23~33%; 22.6±5.7vs6.8±3.6N/kg, p<0.001) were generated than post-slipping, respectively. These findings suggested that greater GMAX and GMED forces are required post-trip recovery than slip. Future analysis of trip recovery showed the importance of ankle joint in recovering from forward and backward fall. These results can be used as references in remote diagnosis of joint and muscle weakness and assessment of the risk of falls with the use of accelerometers

Slip and fall injuries represent a significant burden to the Canadian general public and healthcare system; the annual financial cost of these accidents in Canada is estimated to be $2 billion (2014). Interestingly, slip and fall accidents are not evenly distributed across the provinces, with the rate of hospitalization due to falls in Alberta being nearly three times greater than the rate in Ontario. Our research aim was to create the Alberta Slip and Fall Index (ASFI) – a simple scale like the UV or Air Quality index – that could be used to warn the general public about the presence of slippery conditions. The ASFI could be paired with interventions proven to prevent outdoor slips and falls, like promoting the use of ice cleats. Eleven years (January 2008 - December 2018) of emergency room presentations to the four adult hospitals in Calgary, Alberta were filtered based on the ICD-10 diagnostic code W00 (slip and fall due to ice and snow). Multivariable dispersion-corrected Poisson regression models were used to analyze the weather conditions and time of year most predictive of slip and fall injuries. A slip and fall risk calculator (the ASFI) was designed using output from statistical modelling. To validate the ASFI we compared model predicted slip and fall risk to real presentations using retrospective weather and patient data. The final dataset included 14,977 slip and fall incidents. The three months with the most emergency room presentations were January(n = 3591), February(n = 2997), and March(n = 2954); each of these predicted increased slip and fall accidents(p < 0 .001). Same day ice was significantly associated with more slip and fall accidents, as was the presence of ice one, two, and three days prior(p < 0 .001). Snow one day prior was mildly protective against slip and fall accidents, but this effect was not significant(p = 0.861). Snow, ice, and time of year variables can be input into the ASFI calculator, which computes the likelihood of slip and fall accidents on a 0-40 point scale, with 40 indicating maximum fall risk. Upon validation of the ASFI, we generally found days with the highest raw frequency of slip and fall accidents had higher ASFI scores. Although the ASFI can theoretically result in a score of 40, when we entered realistic weather conditions it was impossible to create a score higher than 20. The ASFI represents a tool that can be used to prevent slip and fall accidents due to icy and snowy conditions. As demonstrated by our inability to maximize the risk score when using realistic weather conditions, the ASFI is imperfect. Despite its shortcomings, the ASFI is a preliminary step towards effectively disseminating information about the weather conditions likely to lead to falls. Ideally, a refined ASFI will help people better understand when to use protective equipment and take extra precaution outdoors. If implementing the ASFI led to even a 1% decrease in injuries caused by falls, the annual Canadian healthcare savings would be roughly $2 million

Purpose and background. To evaluate the clinical and cost-effectiveness of a physical and psychological group intervention (BOOST programme) compared to physiotherapy assessment and advice (best practice advice [BPA]) for older adults with neurogenic claudication (NC) which is a debilitating spinal condition. Methods and results. A randomised controlled trial of 438 participants. The primary outcome was the Oswestry Disability Index (ODI) at 12 months. Data was also collected at 6 months. Other outcomes included Swiss Spinal Stenosis Questionnaire (symptoms), ODI walking item, 6-minute walk test (6MWT) and falls. The analysis was intention-to-treat. We collected the EQ5D and health and social care use to estimate cost-effectiveness. Participants were, on average, 74.9 years old (SD 6.0). There was no significant difference in ODI scores between groups at 12 months (adjusted mean difference (MD): −1.4 [95% Confidence Intervals (CI) −4.03,1.17]), but, at 6 months, ODI scores favoured the BOOST programme (adjusted MD: −3.7 [95% CI −6.27, −1.06]). Symptoms followed a similar pattern. The BOOST programme resulted in greater improvements in walking capacity (6MWT MD 21.7m [95% CI 5.96, 37.38]) and ODI walking item (MD −0.2 [95% CI −0.45, −0.01]) and reduced falls risk (odds ratio 0.6 [95% CI 0.40, 0.98]) compared to BPA at 12 months. Probability that the BOOST programme is cost-effective ranged from 67%–89% across cost-effectiveness thresholds. Conclusions. The BOOST programme improves mobility and reduces falls in older adults with NC compared to BPA at 12 months follow-up. It is good value for the NHS. Future iterations of the programme will consider ways to reduce symptoms and disability long-term. Conflicts of interest: No conflicts of interest. Sources of funding: National Institute of Health Research – Programme for Applied Research NIHR - PTC-RP-PG-0213-20002: Better Outcomes for Older people with Spinal Trouble (BOOST). Publication and presentations: The clinical effectiveness paper has just been accepted for publication in the Journal of Gerontology Series A. The health economic analysis is not yet published. It was presented at the Physiotherapy UK conference and the International Back and Neck Pain Forum in 2021

Abstract. Objectives. Falling studies have been conducted in controlled environments but not in field studies for ethical reasons; this limits the validity and applicability of previous studies. We performed field studies on existing YouTube © videos of skateboarders falling. The aims were to measure the wrist angle at impact on videos of real unprotected falls and to study the dynamics of the upper limbs when falling. Methods. Youtube © videos of skateboarders falling were studied assessing the direction of the fall, the positions of both upper limbs and especially the wrists on impact. This study would not be ethical by other means. Results. In study one (the more quantitative study) there were 48 men and 50 falls. The mean elbow flexion was 300 (range 00 to 800) and the mean maximal wrist extension was 800 (range 500 to 1100). The secondary wrist extended less or the same in > 90%. The second wrist only one (of 31) extended > 900 which should minimise the risk of toppling. Falls onto only one wrist gave significantly greater maximal wrist extension. In the second more qualitative study we observed the “upper limb falling reflex” where the response to falling is for the upper limb(s) to align with the direction of falling of the body with the elbow mostly but not fully extended. Initially the wrists extend c. 400–500 with the fingers held mildly flexed. Immediately before impact the fingers hyper-extend with some compensatory wrist flexion to c. 300. The fingertips impact the ground first followed by the hand. Conclusion. These studies confirm wrist extension at impact around 800 but the wrist(s) may hyper-extend risking toppling. Falls on both wrists minimise the risk of toppling. The “upper limb falling reflex” is defined; it is a rapid dynamic response leading to the fingers impacting the ground first on falling. Declaration of Interest. (a) fully declare any financial or other potential conflict of interest

Dual mobility (DM) is most often used by surgeons to reduce instability in high risk patients. NJR data on DM has not demonstrated a reduction in all cause revision and has reported an increase in revision for peri-prosthetic fracture (PPF). The aim of our study was:. Report outcome of DM used in high-risk patients including non-revision re-operations (dislocation & PPF). Comparison with conventional bearing THA (cTHA) with local, national and NJR benchmarking data. Retrospective cohort assessment of falls risk for patients receiving DM. Prospective F/U of a DM implant since 2016 and enrolled into Beyond Compliance (BC). Primary outcome measure all-cause revision with secondary outcome including any re-operation and Oxford Hip Score (OHS). All patients were risk stratified and considered high risk for instability. Complications were identified via hospital records, clinical coding linkage, NJR and BC. Benchmarking data for comparison was obtained from same data sources we also considered all B type PPF that occurred with cemented polished taper stem (PTS). 159 implants in 154 patients with a mean age 74.0 years and a maximum F/U of 6.7 years. Survivorship for all-cause revision 99.4% (95% CI 96.2–99.8). One femoral only revision. Mean gain in OHS 27.4. Dislocation rate 0.6% with a single event. Patients with a PTS rate of Type B PPF 2.1% requiring revision/fixation. Compared to cTHA this cohort was significantly older (74.0 vs 68.3 years), more co-morbidity (ASA 3 46.5% vs 14.4%) and more non-OA indications (32.4% vs 8.5%). Relative risks for dislocation 0.57 (95%CI 0.08–4.1) and PPF 1.75 (95%CI 0.54–5.72). Every patient had at least one risk factor for falling and >50% of cohort had 4 or more risk factors using NICE tool. The selective use of DM in high-risk patients can reduce the burden of instability. These individuals are very different to the “average” THA patient. A “perfect storm” is created using a high-risk implant combination (DM & PTS) in high-risk falls risk population. This re-enforces the need to consider all patient and implant factors when deciding bearing selection

The risk of falls in patients undergoing orthopedic procedures is particularly significant in terms of health and socioeconomic effects. The literature analyzed closely this risk following procedures performed on the lower limb, but the implications following procedures on the upper limb remain to be investigated. Interestingly, it is not clear whether the increased risk of falling in patients undergoing shoulder surgery is due to preexisting risk factors at surgery or postoperative risk factors, such as anesthesiologic effects, opioid medications used for pain control, or brace use. Only one prospective study examined gait and fall risk in patients using a shoulder abduction brace (SAB) after shoulder surgery, revealing that the brace adversely affected gait kinematics with an increase in the risk of falls. The main purpose of the study was to investigate the influence of SAB on gait parameters in patients undergoing shoulder surgery. Patients undergoing elective shoulder surgery (arthroscopic rotator cuff repair, reverse total shoulder arthroplasty, and Latarjet procedure), who used a 15° SAB in the postoperative period, were included. Conversely, patients age > 65 years old, with impaired lower extremity function (e.g., fracture sequelae, dysmorphism, severe osteo-articular pathology), central and peripheral nervous system pathologies, and cardiac/respiratory/vascular insufficiency were excluded. Participants underwent kinematic analysis at four different assessment times: preoperative (T0), 24 hours after surgery (T1), 1 week after surgery (T2), and 1 week after SAB removal (T3). The tests used for kinematic assessment were the Timed Up and Go (TUG) and the 10-meter test (10MWT), both of which examine functional mobility. Agility and balance were assessed by a TUG test (transitions from sitting to standing and vice versa, walking phase, turn-around), while gait (test time, cadence, speed, and pelvic symmetry) was evaluated by the 10MWT. Gait and functional mobility parameters during 10MWT and TUG tests were assessed using the BTS G-Walk sensor (G-Sensor 2). One-way ANOVA for repeated measures was conducted to detect the effects of SAB on gait parameters and functional mobility over time. Statistical analysis was performed with IBM®SPSS statistics software version 23.0 (SPSS Inc., Chicago, IL, USA), with the significant level set at p<0.05. 83% of the participants had surgery on the right upper limb. A main effect of time for the time of execution (duration) (p=0.01, η2=0.148), speed (p<0.01, η2=0.136), cadence (p<0.01, η2=0.129) and propulsion-right (R) (p<0.05, η2=0.105) and left (L) (p<0.01, η2=0.155) in the 10MWT was found. In the 10MWT, the running time at T1 (9.6±1.6s) was found to be significantly longer than at T2 (9.1±1.3s, p<0.05) and at T3 (9.0±1.3s, p=0.02). Cadence at T1 (109.7±10.9steps/min) was significantly lower than at T2 (114.3 ±9.3steps/min, p<0.01) and T3 (114.3±9.3steps/min, p=0.02). Velocity at T1 (1.1±0.31m/s) was significantly lower than at T2 (1.2± 0.21m/s, p<0.05). No difference was found in the pelvis symmetry index. No significant differences were found during the TUG test except for the final rotation phase with T2 value significantly greater than T3 (1.6±0.4s vs 1.4±0.3s, p<0.05). No statistically significant differences were found between T0 and T2 and between T0 and T3 in any of the parameters analyzed. Propulsion-R was significantly higher at T3 than T1 (p<0.01), whereas propulsion-L was significantly lower at T1 than T0 (p<0.05) and significantly higher at T2 and T3 than T1 (p<0.01). Specifically, the final turning phase was significantly higher at T2 than T3 (p<0.01); no significant differences were found for the duration, sit to stand, mid-turning and stand to sit phases. The results demonstrated that the use of the abduction brace affects functional mobility 24 hours after shoulder surgery but no effects were reported at longer term observations