JOA - 2026-05-19 - Journal Article
Latent Classes of Fear of Falling Trajectories and Associated Factors Among Older Patients After Total Knee Arthroplasty: A Prospective Longitudinal Study.
Xia Y, Wang Y, Zhang G, Li X, Zhang Y, Xu S, Sun T
Topics
Key Takeaway
Latent class growth modeling identified three distinct fear-of-falling trajectories after TKA, with 26.7% of patients following a persistently high slow-declining course predicted by older age, lower positive psychology scores, lower distress disclosure, and higher VAS pain.
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Summary
This prospective longitudinal study characterized fear-of-falling (FOF) trajectories in 270 older TKA patients using latent class growth modeling across four postoperative time points. Three trajectories emerged: high-level slow-declining (C1, 26.7%), low-level stable (C2, 18.9%), and moderate-level increasing-then-decreasing (C3, 54.4%). Multinomial logistic regression identified older age, lower positive psychology (PPQ) scores, lower distress disclosure (DDI) scores, and higher VAS pain as independent predictors of the high-burden C1 trajectory; early mobilization was not a significant predictor of trajectory membership.
Key Limitation
Three-month follow-up is insufficient to determine whether the high-burden C1 trajectory resolves, persists, or predicts long-term functional outcomes such as falls, revision, or patient satisfaction.
Original Abstract
BACKGROUND
This study aimed to examine trajectories of fear of falling (FOF) and their associated factors in older patients who underwent total knee arthroplasty (TKA) and to provide evidence to tailor postoperative rehabilitation for different patient groups.
METHODS
This prospective longitudinal study enrolled 315 consecutive patients who underwent TKA at a tertiary hospital in China between March and May 2025. Baseline demographic and clinical variables were collected preoperatively. The Fear of Falling Questionnaire-revised (FFQ-R), Visual Analog Scale (VAS) pain score, Positive Psychological Questionnaire (PPQ), Distress Disclosure Index (DDI), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the shortened Chinese version of the Family Resilience Assessment Scale (FRAS-C) were assessed on postoperative day one (T1), one week (T2), one month (T3), and three months (T4). Of the 315 patients enrolled, 270 completed all four time-point assessments and were included in the analyses. A latent class growth model (LCGM) identified FOF trajectories, and multivariable multinomial logistic regression was used to determine independent predictors. The study followed the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) reporting guideline for observational studies.
RESULTS
Overall FOF decreased from T1 to T4. The LCGM identified three trajectories: high-level slow-declining (C1, n = 72, 26.7%), low-level stable (C2, n = 51, 18.9%), and moderate-level increasing-then-decreasing (C3, n = 147, 54.4%). Using the C2 group as a reference, predictors of membership in the C1 group were older age, lower PPQ scores, lower DDI scores, and a higher VAS pain score. Predictors of membership in the C3 group were older age, education level, and lower DDI scores.
CONCLUSIONS
Within three months after TKA, older patients followed three distinct trajectories of FOF. Age, education, psychological measures (PPQ and DDI), and pain intensity were key associated factors, whereas early postoperative mobilization was not significantly associated with trajectory membership. Clinicians should develop individualized interventions for different trajectory groups to promote early recovery and improve prognosis.