Feasibility of trial procedures for a randomised controlled trial of a community based group exercise intervention for falls prevention for visually impaired older people: the VIOLET study (original) (raw)
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BMC Geriatrics
Background: Fall prevention interventions with home-based exercise programmes are effective to reduce the number and the rate of falls, by reducing risk factors. They improve balance, strength, function, physical activity, but it is known that older adults' exercise adherence declines over time. However, it is unclear which delivery-modalities of the home-based exercise programmes show the best adherence and the largest effect. We created a new home-based exercise programme, the Test-and-Exercise (T&E) programme, based on the concepts of self-efficacy and empowerment. Patients learn to build their own exercise programme with a mobile application, a brochure and cards, as well as with eight coaching sessions by physiotherapists. The main objective of this study is to compare the T&E programme with the Otago Exercise Programme and the recommendation-booklet and exercise-cards of Helsana regarding incidence of falls. Other outcomes are severity of falls, functional capacities, quality of life and exercise-adherence. Methods: The design of this study is a Swiss multicentre assessor blind randomized controlled trial. A blockrandomization, stratified in groups for age and risk of fall categories, will be used to allocate the participants to three groups. The targeted study sample consists of 405 older adults, ≥ 65 years of age, living in the community and evaluated as at "risk of falling". Experimental group will receive the T&E programme (N = 162). Second group will receive the Otago programme (N = 162) and the third group will receive the Helsana programme (N = 81). All interventions last six months. Blinded assessors will assess participants three times: at baseline before the start of the intervention, after six months of intervention and a final assessment after twelve months (six months of follow up). Discussion: Although home-based exercises programmes show positive effects in fall prevention in elderly persons, existing programmes do often not include patients in the decision-making process about exercise selection. In our programme the physiotherapist and the older adult work together to select the exercises; this collaboration helps to increase health literacy, pleasure of exercising, and empowers patients to be more autonomy.
Geriatrics & Gerontology International, 2017
Aim: To investigate the effects of a simple home-based exercise program on falls, physical functioning, fear of falling and quality of life in a primary care setting. Methods: Participants (n = 439), aged ≥65 years with mild-to-moderate balance dysfunction were randomly assigned to an exercise (n = 219) or control (n = 220) group. The program consisted of five combined exercises, which progressed in difficulty, and a walking plan. Controls received fall prevention education. Physical functioning and other outcomes were measured at 3-and 6-month follow-up visits. Falls were monitored with fall diaries and phone interviews at 3, 6, 9, and 12 months respectively. Results: The 12 months of the home-based exercise program showed the incidence of falls was 0.30 falls per person year in the exercise group, compared with 0.40 in the control group. The estimated incidence rate ratio was 0.75 (95% CI 0.55-1.04), which was not statistically significant. The fear of falling (measured by the Thai fall efficacy scale) was significantly lower in the exercise than control group (24.7 vs 27.0, P = 0.003). Also, the trend of program adherence increased in the exercise group. (29.6% to 56.8%). Conclusions: This simple home-based exercise program showed a reduction in fear of falling and a positive trend towards exercise adherence. Further studies should focus on factors associated with exercise adherence, the benefits of increased home visits and should follow participants longer in order to evaluate the effects of the program.
BMC Geriatrics
Background Falls are a significant public health issue. There is strong evidence that exercise can prevent falls and the most effective programs are those that primarily involve balance and functional exercises, however uptake of such programs is low. Exercise prescribed during home visits by health professionals can prevent falls however this strategy would be costly to deliver at scale. We developed a new approach to teach home exercise through group-based workshops delivered by physiotherapists. The primary aim was to determine the effect of this approach on the rate of falls among older community-dwelling people over 12 months. Secondary outcomes included the proportion of people falling, fear of falling, physical activity, lower limb strength, balance and quality of life. Methods A randomised controlled trial was conducted among community-dwelling people aged ≥65 in New South Wales, Australia. Participants were randomised to either the intervention group (exercise targeting bal...
Age and Ageing, 2003
Background: recent studies have found that moderate intensity exercise is an effective intervention strategy for preventing falls in older people. However, research is required to determine whether supervised group exercise programmes, conducted in community settings with at-risk older people referred by their health care practitioner are also effective in improving physical functioning and preventing falls in this group. Objectives: to determine whether participation in a weekly group exercise programme with ancillary home exercises over one year improves balance, muscle strength, reaction time, physical functioning, health status and prevents falls in at-risk community-dwelling older people. Methods: the sample comprised 163 people aged over 65 years identified as at risk of falling using a standardised assessment screen by their general practitioner or hospital-based physiotherapist, residing in South Western Sydney, Australia. Subjects were randomised into either an exercise intervention group or a control group. Physical performance and general health measures were assessed at baseline and repeated 6-months into the trial. Falls were measured over a 12-month follow-up period using monthly postal surveys. Results: at baseline both groups were well matched in their physical performance, health and activity levels. The intervention subjects attended a median of 23 exercise classes over the year, and most undertook the home exercise sessions at least weekly. At retest, the exercise group performed significantly better than the controls in three of six balance measures; postural sway on the floor with eyes open and eyes closed and coordinated stability. The groups did not differ at retest in measures of strength, reaction time and walking speed or on Short-Form 36, Physical Activity Scale for the Elderly or fear of falling scales. Within the 12-month trial period, the rate of falls in the intervention group was 40% lower than that of the control group (IRR=0.60, 95% CI 0.36-0.99). Conclusions: these findings indicate that participation in a weekly group exercise programme with ancillary home exercises can improve balance and reduce the rate of falling in at-risk community dwelling older people.
Physiotherapy
Background Fall-related injuries are the leading cause of accident-related mortality for older adults, with 30% of those aged 65 years and over falling annually. Exercise is effective in reducing rate and risk of falls in community-dwelling adults; however, there is lack of evidence for the long-term effects of exercise. Objectives To assess the long-term effect of exercise interventions on preventing falls in community-dwelling older adults. Data Sources Searches were undertaken on MEDLINE, EMBASE, AMED, CINAHL, psycINFO, the Physiotherapy Evidence Database (PEDro) and The Cochrane Library from inception to April 2017. Study selection Randomised controlled trials (RCTs), cohort studies or secondary analyses of RCTs with long-term follow-up (>12 months) of exercise interventions involving community-dwelling older adults (65 and over) compared to a control group. Data extraction/Data synthesis Pairs of review authors independently extracted data. Review Manager (RevMan 5.1) was used for meta-analysis and data were extracted using rate ratio (RaR) and risk ratio (RR). Results Twenty-four studies (7818 participants) were included. The overall pooled estimate of the effect of exercise on rate of falling beyond 12-month follow-up was rate ratio (RaR) 0.79 (95% confidence interval (CI) 0.71 to 0.88) and risk of falling was risk ratio (RR) 0.83 (95% CI 0.76 to 0.92) Subgroup analyses revealed that there was no sustained effect on rate or risk of falling beyond two years postintervention. Conclusions Falls prevention exercise programmes have sustained long-term effects on the number of people falling and the number of falls for up to two years after an exercise intervention. Contribution of the paper: There is a shortage of data relating to the possible long-lasting effects of falls prevention exercise interventions for older adults. Previous systematic reviews have assessed the effect of falls prevention exercise programmes for up to 12-months; this review evaluates the sustained effect of falls prevention exercise programmes beyond a year. This review provides evidence of the long-term effect of certain falls prevention exercise interventions.
Follow-Up of a Virtual-Group-Exercise at Home Program to Reduce Fall Risks
Journal of the American Geriatrics Society
This is a follow-up study of a randomized controlled trial using the Virtual-Group Exercise at Home (V-GEAH) program in older adults with a history of falls. The program was delivered via video conference technology to convert solitary exercise to group exercise. 1 The V-GEAH program was successful in achieving high adherence during the 6-month intervention period; 100% of participants adhered to the program a minimum of 66.7% of 73 total sessions. In the current study, we followed up with the participants after 3 months to identify adherence to the exercise and lasting effects from the intervention, and to draw a conclusion about an effective home-exercise program that achieves high adherence. At the end of the intervention in the V-GEAH study, we provided the final 34-minute exercise instruction on YouTube to the treatment group and encouraged them to continue the exercise. The exercises were nonprogressive, low to moderate intensity, without monitoring, and a group exercise opportunity, available on https://www.youtube.com/watch?reload= 9&v=FZlqqm826gw&feature=youtu.be. Assuming not all the people in the treatment would continue the exercise, we hypothesized that at 3-month follow-up, the participants who continued the V-GEAH exercise (adherers) would maintain the fall risk status identified at the completion of the program (posttest), and they would show a significant improvement from the pretest (before the intervention), but the treatment participants who did not continue the exercise (nonadherers) would not. METHODS This study compared falls and 14 fall risks measured at pretest and posttest of the intervention period and follow-up for three groups (control group, non-adherers, and adherers).
Age and ageing, 2018
exercise therapy is highly recommended for falls prevention in older adults; however, poor exercise adherence may limit treatment effectiveness. to assess the effectiveness of interventions to improve exercise adherence for community-dwelling adults (aged over 65 years), at risk of falling. eight databases were searched to identify randomised/quasi-randomised trials. The Capability, Opportunity, Motivation model of behaviour (COM-B) was used to categorise the identified adherence interventions. Studies with similar interventions that provided adherence outcome data per group were analysed to establish pooled intervention effect. Protocol registration with Propsero: (CRD42016033677). of the 20 trials included (n = 4419), five provided data per group for adherence outcome. Meta-analysis of four studies (n = 482), containing interventions exploring the way exercise is delivered, demonstrated significantly better adherence in the intervention group (n = 166 experimental, n = 161 control...
BMC health services research, 2017
Falls and fall-related injuries in older adults are associated with great burdens, both for the individuals, the health care system and the society. Previous research has shown evidence for the efficiency of exercise as falls prevention. An understudied group are older adults receiving home help services, and the effect of a falls prevention programme on health-related quality of life is unclear. The primary aim of this randomised controlled trial is to examine the effect of a falls prevention programme on quality of life, physical function and falls efficacy in older adults receiving home help services. A secondary aim is to explore the mediating factors between falls prevention and health-related quality of life. The study is a single-blinded randomised controlled trial. Participants are older adults, aged 67 or older, receiving home help services, who are able to walk with or without walking aids, who have experienced at least one fall during the last 12 months and who have a Min...