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Home / Regular Issue / JTAS Vol. 29 (S1) 2021 / JSSH(S)-1506-2021


Balance Comparison between Iranian Elderly with and without Knee Range of Motion Limitations

Ehsan Lohrasbipeydeh, Soh Kim Geok, Roxana Dev Omar Dev, Seyedali Ahrari, Ong Swee Leong, Siswantoyo and Jaka Sunardi

Pertanika Journal of Tropical Agricultural Science, Volume 29, Issue S1, December 2021


Keywords: Dynamic balance, elderly, falls, knee range of motion (rom), static balance

Published on: 14 April 2021

This study compares the static eye movement (eyes open and eyes closed) and dynamic balance amongst Iranian elderly with and without knee range of motion (ROM) limitations. The method used was a quasi-experimental before/after study. The participants consisted of 30 older Iranian adults, aged 60 or more (10 females and 20 males across two groups of 15 in each group) who were evaluated using the Sharpened Romberg (SR), Timed Up and Go (TUG) tests. An independent t-test was used to compare the descriptive characteristics of the two groups of the elderly. The findings showed substantial alterations in all the measured components between the subjects. The static balance with an open eye (p = 0.028) and closed eye (p = 0.021), as well as the dynamic balance (p = 0.009) between the elderly with and without the limitation of knee ROM, was substantially different. Moving forward, the findings of this study suggested that the balance of the elderly was directly linked to knee ROM, as the elderly without limitations of knee ROM displayed greater stability than the elderly with limitations of knee ROM. Health care practitioners should also understand the ROM of the knee, as individuals with ROM limitations of the knee are more likely to fall due to underlying disorders associated with their balance.

  • Afshar, P. F., Asgari, P., Shiri, M., & Bahramnezhad, F. (2016). A review of the Iran’s elderly status according to the census records. Galen Medical Journal, 5(1), 1–6.

  • Akbari Kamrani, A., Azadi, F., Foroughi, M., Siadat, S., & Keldi, A. (2006). Characteristics nursing home falls in nursing home residents. Iranian Journal of Ageing, 1(2), 101–105.

  • Anderson, K., & Behm, D. G. (2005). The impact of instability resistance training on balance and stability. Sports Medicine, 35(1), 43–53. doi: 10.2165/00007256-200535010-00004

  • Barry, G., Galna, B., & Rochester, L. (2014). The role of exergaming in Parkinson’s disease rehabilitation: A systematic review of the evidence. Journal of Neuroengineering and Rehabilitation, 11(1), 33. doi: 10.1186/1743-0003-11-3

  • Barzegari, M., Shojaedin, S. S., Tork, M. B., & Training, B. (2019). Research paper: The effect of 8-week strength training, balance training and combined training on the dynamic and static balance of the elderly inactive men. Physical Treatments-Specific Physical Therapy Journal, 9(1), 15–22. doi: 10.32598/ptj.9.1.15

  • Bijlsma, A. Y., Meskers, C. G. M., Ling, C. H. Y., Narici, M., Kurrle, S. E., Cameron, I. D., Westendorp, R. G. J., & Maier, A. B. (2013). Defining sarcopenia: The impact of different diagnostic criteria on the prevalence of sarcopenia in a large middle aged cohort. Age, 35(3), 871–881. doi: 10.1007/s11357-012-9384-

  • Cao, Z. B., Maeda, A., Shima, N., Kurata, H., & Nishizono, H. (2007). The effect of a 12-week combined exercise intervention program on physical performance and gait kinematics in community-dwelling elderly women. Journal of Physiological Anthropology, 26(3), 325–332.

  • Caudill, O. B., & Kaplan, A. I. (2005). Protecting privacy and confidentiality. Journal of Aggression, Maltreatment & Trauma, 11(1–2), 117–134.

  • Chan, A. C., Jehu, D. A., & Pang, M. Y. (2018). Falls after total knee arthroplasty: Frequency, circumstances, and associated factors—a prospective cohort study. Physical Therapy, 98(9), 767–778. doi: 10.1093/ptj/pzy07

  • Chiacchiero, M., Dresely, B., Silva, U., DeLosReyes, R., & Vorik, B. (2010). The relationship between range of movement, flexibility, and balance in the elderly. Topics in Geriatric Rehabilitation, 26(2), 148–155. doi: 10.1097/tgr.0b013e3181e854bc

  • Concha-cisternas, Y. (2019). Aging of balance and risk of falls in elderly. MOJ Gerontol, 4(6), 255‒257. doi: 10.15406/mojgg.2019.04.0021

  • Connelly, L. M. (2014). Ethical considerations in research studies. Medsurg Nursing, 23(1), 54–56.

  • Cuevas-Trisan, R. (2017). Balance problems and fall risks in the elderly. Physical Medicine and Rehabilitation Clinics, 28(4), 727–737. doi: 10.106/j.pmr.2017.06.006

  • Gauchard, C., Vanc, G., Meyer, P., Mainard, D., Perrin, P. P., & Poincare, H. (2010). On the role of knee joint in balance control and postural strategies: Effects of total knee replacement in elderly subjects with knee osteoarthritis. Gait & posture, 32(2), 155–160.

  • Gras, L. Z., Pohl, P. S., Epidy, J., Godin, B., & Hoessle, N. (2017). Use of the Sharpened Romberg as a screening for fall risk. Topics in Geriatric Rehabilitation, 33(2), 113–117. doi: 10.1097/tgr.000000000000014

  • Haegele, J. A., & Hodge, S. R. (2015). Quantitative methodology: A guide for emerging physical education and adapted physical education researchers. The Physical Educator, 72(5), 59–75. doi: 10.18666/tpe-2015-v72-i5-6133

  • Harris, A. D., McGregor, J. C., Perencevich, E. N., Furuno, J. P., Zhu, J., Peterson, D. E., & Finkelstein, J. (2006). The use and interpretation of quasi-experimental studies in medical informatics. Journal of the American Medical Informatics Association, 13(1), 16–23. doi: 10.1197/jamia.m174

  • Hornbrook, M. C., Stevens, V. J., Wingfield, D. J., Hollis, J. F., Greenlick, M. R., & Ory, M. G. (1996). Preventing falls among community-dwelling older persons: Results from a randomized trial. Journal of Safety Research, 2(27), 134–151. doi: 10.1016/0022-4375(96)86983-

  • Howe, T. E., Rochester, L., Neil, F., Skelton, D. A., & Ballinger, C. (2011). Exercise for improving balance in older people (Cochrane database of systematic reviews No. CD004963). John Wiley & Sons, Ltd.

  • Hsu, W. L., Chen, C. Y., Tsauo, J. Y., & Yang, R. S. (2014). Balance control in elderly people with osteoporosis. Journal of the Formosan Medical Association, 113(6), 334–339. doi: 10.1016/j.jfma.2014.02.006

  • Islamic Republic of Iran, Ministry of Health and Medical Education. (2001). Iranian patients’ bill of rights. Ministry of Health and Medical Education.

  • Justine, M., Hamid, T. A., Kamalden, T. F. T., & Ahmad, Z. (2010). A multicomponent exercise program’s effects on health-related quality of life of institutionalized elderly. Topics in Geriatric Rehabilitation, 26(1), 70-79. doi: 10.1097/TGR.0b013e3181cd6949

  • Kamalden, T. F. T., & Gasibat, Q. (2020). Muscle imbalance in badminton athletes: Preventive training programmes need to be designed. Sport Sciences for Health, 1-2. doi: 10.1007/s11332-020-00700-z

  • Kashiani, A. B., & Geok, S. K. (2019). Effects of 8 weeks single set versus multiple-set resistance training on upper and lower body muscular strength among untrained males in Iran. Malaysian Journal of Movement, Health & Exercise, 8(2), 153–163.

  • Kashiani, A. B., Geok, S. K., Soh, K. L., Ong, S. L., & Kittichottipanich, B. (2020). Comparison between two methods of variable resistance training on body composition, muscular strength and functional capacity among untrained males. Malaysian Journal of Movement, Health & Exercise, 9(1), 45–66.

  • Lang, T., Streeper, T., Cawthon, P., Baldwin, K., Taaffe, D. R., & Harris, T. B. (2010). Sarcopenia: Etiology, clinical consequences, intervention, and assessment. Osteoporosis International, 21(4), 543–559.

  • Lauretani, F., Maggio, M., Ticinesi, A., Tana, C., Prati, B., Gionti, L., Nouvenne, A., & Meschi, T. (2018). Muscle weakness, cognitive impairment and their interaction on altered balance in elderly outpatients: Results from the TRIP observational study. Clinical interventions in aging, 13, 1437–1443. doi: 10.2147/ca.s165085

  • Liikavainio, T. (2010). Biomechanics of gait and physical function in patients with knee osteoarthritis [Doctoral dissertation, University of Eastern]. Publication of the Universıty of Eastern.

  • Liu, C., Wan, Q., Zhou, W., Feng, X., & Shang, S. (2017). Factors associated with balance function in patients with knee osteoarthritis: An integrative review. International Journal of Nursing Sciences, 4(4), 402–409. doi: 10.1016/j.ijnss.2017.09.00

  • MacCulloch, P. A., Gardner, T., & Bonner, A. (2007). Comprehensive fall prevention programs across settings: A review of the literature. Geriatric Nursing, 28(5), 306–311. doi: 10.1016/j.gerinurse.2007.03.00

  • Macrae, P. R., Jones, R. D., Myall, D. J., Melzer, T. R., & Huckabee, M. L. (2013). Cross-sectional area of the anterior belly of the digastric muscle: Comparison of MRI and ultrasound measures. Dysphagia, 28(3), 375–380. doi: 10.1007/s00455-012-9443-

  • Manetta, J., Franz, L. H., Moon, C., Perell, K. L., & Fang, M. (2002). Comparison of hip and knee muscle moments in subjects with and without knee pain. Gait & posture, 16(3), 249-254. doi: 10.1016/s0966-6362(02)00009-

  • Manoochehry, S., & Rasouli, H. R. (2017). Iranian population policy and aging: New health concerns. International Journal of Travel Medicine and Global Health, 5(2), 70–71. doi: 10.15171/ijtmgh.2017.1

  • Mcphee, J. S., French, D. P., Jackson, D., Nazroo, J., Pendleton, N., & Degens, H. (2016). Physical activity in older age: Perspectives for healthy ageing and frailty. Biogerontology, 17(3), 567–580. doi: 10.1007/s10522-016-9641-

  • Moore, L., & Savage, J. (2002). Participant observation, informed consent and ethical approval. Nurse Researcher, 9(4), 58–69. doi: 10.7748/nr202.

  • Norheim, K. L., Samani, A., Bønløkke, J. H., Omland, Ø., & Madeleine, P. (2020). On the role of ageing and musculoskeletal pain on dynamic balance in manual workers. Journal of Electromyography and Kinesiology, 50, 102374. doi: 10.1016/j.jelekin.2019.102374

  • Nekooei, P., Majlesi, S., Sharifi, G., Kamalden, T. F. T., & Nekouei, P. (2016). Comparison of anthropometric parameters among Iranian and spanish water polo players. Russian Open Medical Journal, 5(2), e0204. doi: 10.15275/rusomj.2016.0204

  • Okubo, Y., Sturnieks, D. L., Brodie, M. A., Duran, L., & Lord, S. R. (2019). Effect of reactive balance training involving repeated slips and trips on balance recovery among older adults: A blinded randomized controlled trial. The Journals of Gerontology: Series A, 74(9), 1489–1496. doi: 10.1093/gerona/glz02

  • Osoba, M. Y., Rao, A. K., Agrawal, S. K., & Lalwani, A. K. (2019). Balance and gait in the elderly: A contemporary review. Laryngoscope Investigative Otolaryngology, 4(1), 143-153. doi: 10.1002/lio2.25

  • Qiao, M., Feld, J. A., & Franz, J. R. (2018). Aging effects on leg joint variability during walking with balance perturbations. Gait and Posture, 62, 27–33. doi: 10.1016/j.gaitpost.2018.02.02

  • Rafiaei, M., Bahramizadeh, M., Arazpour, M., Samadian, M., Hutchins, S. W., Farahmand, F., & Mardani, M. A. (2016). The gait and energy efficiency of stance control knee – ankle – foot orthoses: A literature review. Prosthetics and Orthotics International, 40(2), 202-214. doi: 10.1177/0309364615588346

  • Ravindran, R. M. (2017). The risk, risk factors and immediate consequences of falls among older persons in their home environment in Thiruvananthapuram. [Unpublished Doctoral dissertation]. The Sree Chitra Tirunal Institute for Medical Sciences And Technology, TRIVANDRUM Thiruvananthapuram.

  • Rose, J., & Gamble, G. J. (2006). Kinetics of normal walking; energetics of walking. Human walking. Lippincott Williams & Wilkins.

  • Rubenstein, L. Z. (2006). Falls in older people: Epidemiology, risk factors and strategies for prevention. Age and Ageing, 35(suppl_2), 37–41.

  • Sgarbieri, V. C., & Pacheco, M. T. B. (2017). Healthy human aging: Intrinsic and environmental factors. Brazilian Journal of Food Technology, 20, 1–23. doi: 10.1590/1981-6723.00717

  • Safikhani, H., Kamalden, T. F. B. T., Amri, S. B., & Megat Ahmad, M. M. H. (2011). Ground reaction force during walking with and without counterbalance load system. Australian Journal of Basic and Applied Sciences, 5(12), 2704-2708.

  • Sheykhi, M. T. (2004). A study of the elderly people living in nursing homes in Iran with a specific focus on Tehran. African and Asian Studies, 3(2), 103–118. doi: 10.1163/1569209041641822

  • Soh, K. G., Ruby, H., & Zaliha, O. (2003). Leg strength per body mass ratio among lite Malaysian netball players. Australian Council for Health, Physical Education and Recreation (ACHPER) Healthy Lifestyles Journal, 50(2), 27-29.

  • Soh, K. G., Japar, S., Ong, S. L., & Soh, K. L. (2018). Physical activity and health promoting lifestyle among bachelor of nursing students in Malaysia. Research Journal of Pharmacy and Technology, 11(7), 2906–2910.

  • Soh, K. G., Ruby, H., & Soh, K. L. (2006). Body fat comparison between basketball and netball players in Malaysia. Journal of Health and Translational Medicine, 9(1), 20-22. doi: 10.22452/jummec.vol9no1.5

  • Soh, K. G., Ruby, H., Soh, K. L., Sofian, M., & Marjohan, J. (2009). Physical profile comparison between basketball and netball players in Malaysia based on performance and playing position. Journal of Health and Translational Medicine, 12(1), 22-26. doi: 10.22452/jummec.vol12no1.4

  • Sotoudeh, G. R., Mohammadi, R., Mosallanezhad, Z., & Viitasara, E. (2018). The prevalence, circumstances and consequences of unintentional falls among elderly Iranians: A population study. Archives of Gerontology and Geriatrics, 79(May), 123–130. doi: 10.1016/j.archger.2018.08.001

  • Spink, M. J., Menz, H. B., & Lord, S. R. (2008). Efficacy of a multifaceted podiatry intervention to improve balance and prevent falls in older people: Study protocol for a randomised trial. BMC Geriatrics, 8(1), 1–16. doi: 10.1186/1471-2318-8-30

  • Turner, G., & Clegg, A. (2014). Best practice guidelines for the management of frailty: A British Geriatrics Society, Age UK and Royal College of General Practitioners report. Age and Ageing, 43(6), 744–747. doi: 10.1093/ageing/afu138

  • Vaillant, J., Rouland, A., Martigné, P., Braujou, R., Nissen, M. J., Caillat-Miousse, J. L., Vuillerme, N., Nougier, V., & Juvin, R. (2009). Massage and mobilization of the feet and ankles in elderly adults: Effect on clinical balance performance. Manual Therapy, 14(6), 661–664. doi: 10.1016/j.math.2009.03.004

  • Whittle, A. J., Carobbio, S., Martins, L., Slawik, M., Hondares, E., Vázquez, M. J., Morgan, D., Csikasz, R. I., Gallego, R., & Rodriguez-Cuenca, S., Dale, M., Virtue, S., Villarroya, F., Cannon, B., Rahmouni, K., Lopez, M., & Vidal-Puig, A. (2012). BMP8B increases brown adipose tissue thermogenesis through both central and peripheral actions. Cell, 149(4), 871–885. doi: 10.1016/j.cell.2012.02.066

  • Yuksel, E., Kalkan, S., Cekmece, S., Unver, B., & Karatosun, V. (2017). Assessing minimal detectable changes and test-retest reliability of the timed up and go test and the 2-minute walk test in patients with total knee arthroplasty. The Journal of Arthroplasty, 32(2), 426–430. doi: 10.1016/j.arth.2016.07.031

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