Effectiveness of Impairment Specific Exercises for Balance and Fall Risk in Community-Living Older Adults at Risk: A Randomized Controlled Trial

Background Balance impairment is a key factor contributing to falls in older adults. Conceptually, clinicians may be able to prescribe targeted exercises if specific impairments can be identified. Objective Our objective was to use a model of balance subsystems to identify balance impairments and demonstrate the effectiveness of targeted (matched) exercises to improve balance and reduce fall risk in community-dwelling older adults. The investigators used the Balance Evaluation System Test (BESTest) as the model because it categorizes balance into 6 subsystems. Design Randomized, partially blinded, pretest-post-test clinical trial consisting of 2 Phases: 1. A comparison between impairment-matched exercises and a control, and 2. A comparison between impairment-matched and mismatched exercises. Setting Senior independent living community. Participants Adult volunteers (n = 40; aged 74-94) recruited as sample of convenience who met the criteria. Participants (n = 20) identified with impairment in the biomechanical (BC) constraints subsystem and participants (n = 20) with impairment in anticipatory postural adjustment (APA) subsystem were enrolled and randomized into 2 subgroups (matched and control/delayed mismatched; n = 10 each subgroup). Intervention Phase 1: Participants in the matched subgroup received a 6-week exercise program matched to their impaired subsystem while the mismatched subgroup served as control. Phase 2: Following the delay, participants in the mismatched group received a 6-week exercise program mismatched to their impairment. Measurements Primary outcome variables were scores on the targeted subsystem (BC, APA), BESTest total, Berg Balance Scale, and fear of falling measure. Quality of life was a secondary outcome. Outcome data were collected by the tester blind to pretest scores and group allocation. Results The matched exercise subgroups demonstrated both statistical and clinical improvement in all outcome variables compared to the control; and showed greater improvement in balance impairments compared to the mismatched subgroup, but not in fall risk reduction. Limitations The therapist who administered the pretest knew the subgroup assignment and implemented the exercises. Conclusions Results provide preliminary evidence that using a balance assessment model to identify impairments in the BC and APA subsystems and prescribing targeted exercises reduces these balance impairments for older adults and may warrant future studies.

Study Overview

• Status: Completed
• Conditions: Exercise Therapy; Balance, Postural
• Intervention / Treatment: Other: Matched: Targeted (specific) balance exercise interventions; Other: Mismatched: Untargeted (non-specific) balance exercise interventions

• Study Type: Interventional
• Enrollment (Actual): 40
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Pennsylvania
    • Philadelphia, Pennsylvania, United States, 19102
      • Drexel University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 65 years to 99 years (Older Adult)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• individuals who met the criteria for a concurrent psychometric study (older adults aged 65 years and older, cognitively able to understand and follow simple instructions,and able to walk independently with or without an assistive device for more than 100 ft); and demonstrated
• elevated fracture risk
• elevated fall risk
• impaired balance in either the BC or APA subsystem of balance as identified with BESTest.

Exclusion Criteria:

• individuals who had:

  • a progressive diseases or unstable medical conditions
  • major surgery in the past 3 months
  • physician's orders not to participate in an exercise program for any reason
  • impairment in both BC and APA subsystems
  • impairments in more than a total of 3 subsystems
  • who were currently receiving treatment for balance or fall prevention.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Matched; Administer Targeted (specific) balance exercise interventions	Other: Matched: Targeted (specific) balance exercise interventions
Active Comparator: Mismatched; Administer Untargeted (non-specific) balance exercise interventions	Other: Mismatched: Untargeted (non-specific) balance exercise interventions

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
BESTest total	Balance	6 weeks
Targeted subsystem of BESTest (APA or BC subsystem)	Subsystem balance	6 weeks
Berg Balance Scale	Fall risk indicator	6 weeks
the University of Illinois at Chicago Fear of Falling Measurement (UIC FFM)	Fall risk indicator	6 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Short Form Health Survey (SF-12, Version 2; QualityMetric Inc.) questionnaire	Quality of Life indicator	6 weeks

Collaborators and Investigators

• Sponsor: Drexel University
• Investigators: Study Chair: Susan S Smith, PT, PhD, Drexel University

Study record dates

Study Major Dates

• Study Start: November 1, 2013
• Primary Completion (Actual): February 1, 2015
• Study Completion (Actual): February 1, 2015

Study Registration Dates

• First Submitted: November 24, 2015
• First Submitted That Met QC Criteria: November 25, 2015
• First Posted (Estimate): November 26, 2015

Study Record Updates

• Last Update Posted (Estimate): November 26, 2015
• Last Update Submitted That Met QC Criteria: November 25, 2015
• Last Verified: November 1, 2015

More Information

Terms related to this study

• Keywords: Older Adults, Falls
• Other Study ID Numbers: 1305002061