Reactive Balance Training Targeting Both Slip- and Trip-Induced Falls

Reactive Balance Training Targeting Both Slip- and Trip-Induced Falls Among Older Adults: a Pilot Randomized Controlled Trial

The goal of this study was to evaluate the effects of reactive balance training (RBT) targeting slipping and tripping on laboratory-induced slips and trips. In an effort to build upon prior work, the present study included: 1) a control group receiving an alternative balance training intervention; 2) separate training and assessment sessions; 3) alternative RBT methods that may be more amenable to work outside the lab compared to prior methods, and 4) older adult participants receiving individualized training to reduce drop-out. The investigators hypothesized that slips after RBT would result in improved reactive balance kinematics, and a lower incidence of falls, compared to either initial slips before any intervention or after a control intervention. The investigators also hypothesized that trips after RBT would result in improved reactive balance kinematics, and a lower incidence of falls, compared to either initial trips before any intervention or after a control intervention. Results were intended to contribute to knowledge regarding the efficacy of alternative methods for RBT, and provide additional evidence regarding its efficacy.

Study Overview

• Status: Completed
• Conditions: Accidental Fall
• Intervention / Treatment: Behavioral: Reactive balance training; Behavioral: Otago Balance Training

• Study Type: Interventional
• Enrollment (Actual): 34
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Virginia
    • Blacksburg, Virginia, United States, 24061
      • Virginia Tech - Department of Industrial and Systems Engineering

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 60 years to 80 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

1) pass a medical history and screening administered by a physician that excluded participants with osteoporosis of the lumbar spine or proximal femur as assessed by Dual Energy X-ray Absorptiometry (Lunar iDXA, GE Healthcare, Chicago, IL), or any unstable or progressive medical conditions that could contribute to imbalance or falls

Exclusion Criteria:

1. smoked
2. were in physical therapy
3. had a self-reported fragility fracture within the last 10 years
4. had an acute lower extremity injury within the last 3 months
5. had lower extremity surgery within the last six months
6. had an ankle arthroplasty
7. had a knee or hip arthroplasty within the last 12 months

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Non-Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Reactive balance training; Four training sessions, conducted twice a week for two weeks in groups of 1-2 participants. Each session was 0.5-1 hours, with an active training time of 30 minutes for each participant. Reactive balance training involved both slip and trip training. Slip training involved repeatedly stepping onto a low-friction interface (nylon fabric placed over a 0.9 × 0.9 meter polycarbonate sheet) while practicing controlling/decelerating the slipping foot and properly positioning the non-slipping foot under the pelvis. Trip training involved repeatedly practicing recovery from simulated trips on a modified treadmill. While standing on a modified treadmill, the treadmill belt was quickly accelerated posteriorly to elicit a forward loss of balance that mimicked a trip while walking. Participants attempted to step to avert a fall, and to establish a stable gait on the treadmill, after which the treadmill speed was slowed to zero to complete the trial.	Behavioral: Reactive balance training; Participants were exposed to simulated trips and slips under safe, controlled conditions in order to practice their reactive response to these common balance perturbations.
Active Comparator: Control balance training; Four training sessions, conducted twice a week for two weeks in groups of 1-2 participants. Each session was 0.5-1 hours, with an active training time of 30 minutes for each participant. The control intervention involved general balance exercises adapted from the Otago Exercise program. Briefly, all four sessions involved balance exercises and strength exercises using ankle weights, and were progressively increased as performance improved by increasing ankle weights or the difficulty of the balance exercises (e.g., not holding onto a wall or support).	Behavioral: Otago Balance Training; Balance exercises and strength exercises using ankle weights, and were progressively increased as performance improved by increasing ankle weights or the difficulty of the balance exercises (e.g., not holding onto a wall or support).

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Peak Slip Speed	highest instantaneous speed of slipping foot during actual slip	during week 1, before the intervention that spanned weeks 2 and 3
Peak Slip Speed	highest instantaneous speed of slipping foot during actual slip	during week 4, after the intervention that spanned weeks 2 and 3
Trunk Angle at Touchdown After Tripping	anterior-posterior trunk angle relative to vertical at instant of touchdown of initial recovery step over tripping obstacle	during week 1, before the intervention that spanned weeks 2 and 3
Trunk Angle at Touchdown After Tripping	anterior-posterior trunk angle relative to vertical at instant of touchdown of initial recovery step over tripping obstacle	during week 4, after the intervention that spanned weeks 2 and 3

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Slip Distance	distance moved by slipping foot during actual slip	during week 1, before the intervention that spanned weeks 2 and 3
Slip Distance	distance moved by slipping foot during actual slip	during week 4, after the intervention that spanned weeks 2 and 3
Fall Incidence After a Laboratory-induced Slip	the outcome of each slip was categorized as either a: fall, recovery, or harness-assisted	during week 1, before the intervention that spanned weeks 2 and 3
Fall Incidence After a Laboratory-induced Slip	the outcome of each slip was categorized as either a: fall, recovery, or harness-assisted	during week 4, after the intervention that spanned weeks 2 and 3
Recovery Step Length After Tripping	anterior-posterior step distance of first step over tripping obstacle	during week 1, before the intervention that spanned weeks 2 and 3
Recovery Step Length After Tripping	anterior-posterior step distance of first step over tripping obstacle	during week 4, after the intervention that spanned weeks 2 and 3
Fall Incidence After a Laboratory-induced Trip	the outcome of each trip was categorized as a: fall, recovery, or harness-assisted	during week 1, before the intervention that spanned weeks 2 and 3
Fall Incidence After a Laboratory-induced Trip	the outcome of each trip was categorized as a: fall, recovery, or harness-assisted	during week 4, after the intervention that spanned weeks 2 and 3

Collaborators and Investigators

• Sponsor: Virginia Polytechnic Institute and State University
• Investigators: Principal Investigator: Michael L Madigan, PhD, Virginia Polytechnic Institute and State University

Publications and helpful links

General Publications

• Allin LJ, Brolinson PG, Beach BM, Kim S, Nussbaum MA, Roberto KA, Madigan ML. Perturbation-based balance training targeting both slip- and trip-induced falls among older adults: a randomized controlled trial. BMC Geriatr. 2020 Jun 12;20(1):205. doi: 10.1186/s12877-020-01605-9.

Study record dates

Study Major Dates

• Study Start (Actual): June 1, 2018
• Primary Completion (Actual): July 1, 2019
• Study Completion (Actual): July 1, 2019

Study Registration Dates

• First Submitted: March 4, 2020
• First Submitted That Met QC Criteria: March 10, 2020
• First Posted (Actual): March 16, 2020

Study Record Updates

• Last Update Posted (Actual): May 18, 2020
• Last Update Submitted That Met QC Criteria: May 4, 2020
• Last Verified: March 1, 2020

More Information

Terms related to this study

• Keywords: aging; balance training; step training; perturbation-based balance training; dynamic balance
• Other Study ID Numbers: 18-486

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No