RESEARCH - Obstacle avoidance in persons with RA walking on a treadmill

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Clin Exp Rheumatol. 2009 Sep-Oct;27(5):779-85.

Obstacle avoidance in persons with rheumatoid arthritis walking on a treadmill.

Smulders E, Schreven C, van Lankveld W, Duysens J, Weerdesteyn V.

Research, Development and Education, Sint Maartenskliniek, Nijmegen,

The Netherlands.

Abstract

OBJECTIVE: Patients with rheumatoid arthritis (RA) are at increased

risk of falling. In healthy elderly persons with a history of falling,

a reduced ability to avoid obstacles while walking has been shown to

relate to increased fall risk. The aim of this study was to determine

whether this potential risk factor for falls would also be present in

persons with RA.

METHODS: Twelve RA patients and twelve controls performed an obstacle

avoidance task on a treadmill. The obstacle was released during three

different phases of the gait cycle (late stance, early swing and mid

swing) to create increasing difficulty levels. The primary outcome

measure was failure rate.

RESULTS: Overall, the RA patients had significantly higher obstacle

avoidance failure rates. To avoid an obstacle, a long or a short

stride strategy can be used, the choice of which depends on the phase

of obstacle release. There were no significant group differences in

the distribution of obstacle avoidance strategies. However, the RA

patients made significantly more failures when performing a short

stride strategy in mid swing obstacle release trials (the condition

which gave the patients the least time to react; available response

time). In addition, compared to the controls, the RA group approached

the obstacle more closely prior to obstacle crossing (shorter toe

distance), thereby increasing the risk of stumbling.

CONCLUSION: Obstacle avoidance performance in persons with RA is

significantly deteriorated compared to age- and gender-matched

controls, especially when available response time is low. This deficit

may contribute to their higher fall risk.

PMID: 19917160

http://www.ncbi.nlm.nih.gov/pubmed/19917160

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