Chinese Journal of Tissue Engineering Research ›› 2023, Vol. 27 ›› Issue (29): 4690-4695.doi: 10.12307/2023.650

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Analysis of influencing factors of fear of falling in patients with knee osteoarthritis and construction of nomogram model

Ma Wei1, 2, Pang Jian1, 2, Zhang Jiefan1, 2, Xu Kun1, 2, Wang Yongyu1, 2, Zhang Min1, 2, Chen Bo1, 2, Shi Ying1, 2, Zhan Hongsheng1, 2   

  1. 1Shi's Center of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China; 2Institute of Traumatology & Orthopedics, Shanghai Academy of Traditional Chinese Medicine, Shanghai 201203, China
  • Received:2022-06-30 Accepted:2022-08-05 Online:2023-10-18 Published:2022-12-02
  • Contact: Pang Jian, Chief physician, Shi's Center of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China; Institute of Traumatology & Orthopedics, Shanghai Academy of Traditional Chinese Medicine, Shanghai 201203, China
  • About author:Ma Wei, Master candidate, Physician, Shi's Center of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China; Institute of Traumatology & Orthopedics, Shanghai Academy of Traditional Chinese Medicine, Shanghai 201203, China
  • Supported by:
    the National Natural Science Foundation of China, No. 81674003 (to PJ); National Natural Science Foundation of China, No. 81774340 (to CB); National Natural Science Foundation of China, No. 81973875 (to ZM); a Project of Shanghai Clinical Research Center for Chronic Musculoskeletal Diseases, No. 20MC1920600 (to ZHS); Shanghai Key Clinical Specialty “Traditional Chinese Medicine Orthopedics” Project, No. shslczdzk03901 (to ZHS); The Second Round of Construction Project of “Shi’s Traumatology” National Traditional Chinese Medicine School Inheritance Studio, No. SHDC2020CR1051B (to SY); Clinical Three-Year Action Plan Project of Development Center of Shanghai Shenkang Hospital, No. SHDC2020CR3090B (to ZHS)

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Abstract: BACKGROUND: Fear of falling will aggravate the instability of the knee joint in patients with knee osteoarthritis, leading to the reduction of activities and the decline of the overall body function. Therefore, screening the factors affecting the fear of falling in patients with knee osteoarthritis and constructing a nomogram model can reduce the injury caused by the fear of falling and provide a reference for the formulation of individualized diagnosis and treatment plans. 
OBJECTIVE: To explore the influencing factors and conditions of fear of falling in patients with knee osteoarthritis, and to establish a predictive model for the risk of fear of falling in patients with knee osteoarthritis. 
METHODS: A cross-sectional study method was used to enroll 560 patients with knee osteoarthritis who visited Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from September 2019 to February 2021. Among them, 469 were in the falling fear group and 91 were in the non-falling fear group. The general information of patients, the Western Ontario and McMaster Universities Arthritis Index, and the Hospital Anxiety and Depression Scale scores were analyzed and compared between the two groups to determine the influencing factors of the fear of falling in knee osteoarthritis patients. Receiver operating characteristic curves of the influencing factors were drawn to obtain the Youden’s index with diagnostic value for the fear of falling. The maximum value of the Youden index of each factor was the best diagnostic value (cutoff value) of the knee osteoarthritis fear of falling. A nomogram was drawn to establish the knee predictive model for the fear of falling in patients with knee osteoarthritis. 
RESULTS AND CONCLUSION: (1) Logistic regression analysis showed that height and male were the protective factors for the fear of falling in patients with knee osteoarthritis, and age, unemployment, Western Ontario and McMaster Universities Arthritis Index stiffness scale score, and anxiety scale score were the risk factors for the fear of falling in patients with knee osteoarthritis. (2) Receiver operating characteristic curve results showed that Western Ontario and McMaster Universities Arthritis Index had a significant diagnostic value for knee osteoarthritis patients (Youden’s index=0.733), followed by age, anxiety, and gender. (3) The results of the nomogram showed that the maximum score of the Western Ontario and McMaster Universities Arthritis Index stiffness scale (8 points) could account for 41.6% of the predictors of knee osteoarthritis fear of falling. (4) It is concluded that there is a high incidence of fear of falling among patients with knee osteoarthritis, and joint stiffness and female gender may be risk factors for fear of falling, while low height may be a protective factor for fear of falling, and there is a need to focus on fear of falling and the management of related factors in clinical treatment interventions. 

Key words: knee osteoarthritis, fear of falling, influencing factor, investigation, nomogram model

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