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- Ensayo clínico NCT02374463
Improving Balance and Mobility (MMBI)
Improving Balance and Mobility in Older Veterans
Descripción general del estudio
Estado
Intervención / Tratamiento
Descripción detallada
Background: Falls are currently the leading cause of injurious death and non-fatal injuries for adults over the age of 65. Older Veterans may be at greater risk for falls due to their high burden of medical co-morbidity. The VA has made research into fall prevention a high priority. Falls are complex with numerous deficits including impaired balance, decreased postural control, muscle weakness, and an inability to successfully negotiate environmental hazards. Tai Chi is currently considered to be one of the most effective fall prevention exercise interventions, with an endorsement from the Centers for Disease Control and Prevention (CDC) which widely influences health care policy. However, there are few studies comparing Tai Chi with another active intervention. Tai Chi may generally improve balance, decrease fall risk, and provides a general lower body strengthening. However, Tai Chi may not sufficiently improve gait and dynamic mobility and does little to target obstacle negotiation, one of the largest contributors to a fall. The majority of falls occur during walking, with slips and trips being the most common causes and targeted interventions focused on improving stepping and walking ability may be even more effective at improving balance and reducing falls.
The Investigators plan to enroll 56 older (age > 65 years) community dwelling Veterans with a history of a fall in the last year who are at high risk for a recurrent fall. After baseline testing participants will be randomized to either MMBI or a Tai Chi intervention modeled after the Tai Chi Moving for Better Balance Program. All participants will participate in a group exercise class in their assigned intervention for 1 hour, 3 times per week for 24 weeks. After the completion of 24 weeks of exercise group changes will be compared for 1) balance (4-square step test); 2) mobility and fall risk (functional gait assessment); 3) rate of falls; 4) lower extremity isometric strength testing (biodex); and 5) body composition. The investigators also plan for follow all participants for 6 months after completion of the intervention to examine differences in fall rates after the cessation of the program between the groups.
Impact: This research directly benefits Veterans as it may lead to new and effective interventions that could reduce fall risk, injury-related hospitalization and death in older Veterans. MMBI is also readily exportable to the community and with minimal resources could be widely implemented at other VAs as part of standard of care, similar to Managing Overweight and/or Obesity for Veterans Everywhere! (MOVE!). Results from this SPIRE grant will be used to power a larger randomized clinical trial that will examine the effectiveness of the two interventions to reduce rate of falls and risk of falling in older Veterans at high risk for falls.
Tipo de estudio
Inscripción (Actual)
Fase
- No aplica
Contactos y Ubicaciones
Ubicaciones de estudio
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Maryland
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Baltimore, Maryland, Estados Unidos, 21201
- Baltimore VA Medical Center VA Maryland Health Care System, Baltimore, MD
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Criterios de participación
Criterio de elegibilidad
Edades elegibles para estudiar
Acepta Voluntarios Saludables
Géneros elegibles para el estudio
Descripción
Inclusion Criteria:
- 65 years of age and older
- Mobility and balance limitations as demonstrated by a self-reported fall within the past year or requiring greater than 8 seconds to complete the 4-square step test
Exclusion Criteria:
- Cardiovascular Risks: Poorly controlled hypertension (>160/100); Class III or IV congestive heart failure (CHF); or patient report of: symptomatic angina at rest or during exercise, syncope without known resolution of cause, or a significant coronary event (such as a MI) in the past six months
- Chronic obstructive pulmonary disease (COPD) requiring home oxygen
- Contraindications to resistance training, including a self-reported history of intracranial or retinal bleeding in the last year or Diabetes with active proliferative retinopathy
- Patient report of significant spinal stenosis that would limit participation in the exercise intervention -Dementia (on medical record review or mini-mental status exam score <24).
- Non-ambulatory mobility status or a transtibial or transfemoral amputation
- Other severe medical illness or condition that would preclude safe participation in the study as determined by the study team
Plan de estudios
¿Cómo está diseñado el estudio?
Detalles de diseño
- Propósito principal: Prevención
- Asignación: Aleatorizado
- Modelo Intervencionista: Asignación paralela
- Enmascaramiento: Único
Armas e Intervenciones
Grupo de participantes/brazo |
Intervención / Tratamiento |
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Experimental: Multimodality Balance Intervention (MMBI)
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Multimodality Balance Intervention (MMBI): Our MMBI will be held 3-times a week for an hour and will consist of a group dynamic balance class (30 minutes), a supervised obstacle course (10 minutes), and lower extremity and core strengthening (20 minutes).
The group exercise classes will focus on dynamic weight shifts with an emphasis on the lateral and diagonal directions.
Over the 6 months of class, the exercises will gradually increase in difficulty to challenge balance.
A skilled instructor will lead each class and 1-2 assistants will be present to assist with fall risk prevention.
The supervised obstacle course will focus on obstacle negotiation, gait over challenging surfaces, and moving in lateral, diagonal, and backward directions.
Finally, strength training of the lower extremities and core will focus on strengthening major muscles of the lower extremity and core utilizing commonly available gym equipment, ankle weights and body weight.
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Comparador activo: Tai Chi
Tai Chi Intervention
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Tai Chi Intervention: The supervised Tai Chi class will be held 3-times a week for one hour.
All Tai Chi classes will be taught in a group setting by an experienced instructor.
The emphasis during the class will be on standing movements, body alignment, weight shift and changes of direction.
Movements will be adapted as the class progresses to increase the difficulty of weight shift and change in direction over time so that participants balance is continually challenged throughout the 6 months.
Chairs or hand rails will be available for the participants to use as needed for balance recovery.
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¿Qué mide el estudio?
Medidas de resultado primarias
Medida de resultado |
Medida Descripción |
Periodo de tiempo |
---|---|---|
Balance and Lateral Mobility Assessed by the Four Square Step Test
Periodo de tiempo: The FSST was assessed at 6 month (post) and at baseline (pre)
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the Four Square Step Test assesses dynamic balance and coordination through stepping forwards, sideways, and backwards in a timed fashion.
The four square step test is timed in seconds.
Higher scores are associated with worse outcome.
Individuals with higher scores are at increased risk of falling with some using a score of 15 seconds or higher as being at high risk for falls.
The minimum value one would see in young healthy populations for this test is 5 seconds.
The maximum value is 60 seconds.
If they are deemed unable to complete the value is not reported
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The FSST was assessed at 6 month (post) and at baseline (pre)
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Medidas de resultado secundarias
Medida de resultado |
Medida Descripción |
Periodo de tiempo |
---|---|---|
Functional Gait Analysis
Periodo de tiempo: FGA ws measured at 6 months (post) and at baseline (pre)
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The Functional Gait Assessment (FGA) is designed to assess postural stability during gait.
The measure is calculated by summing the scores for 10 gait related tasks.
Each task is scored from 3 to 0, where 3 is the best possible performance (normal) and 0 indicates severe impairment related to the task.
The best possible score is 30 and the worst possible score is 0. Higher values are associated with better outcome.
A value of 22/30 and below is associated with high risk of falling in the community.
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FGA ws measured at 6 months (post) and at baseline (pre)
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Change in Strength R Knee Biodex
Periodo de tiempo: Strength at the R knee was assessed at 6 months (post) and at baseline (pre)
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Change in isometric strength R knee assessed using the biodex measured before and after intervention.
Change was calculated as value at 6 months (post)-value at baseline (pre).Higher values are a better outcome
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Strength at the R knee was assessed at 6 months (post) and at baseline (pre)
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Number of Subjects Who Reported Falls
Periodo de tiempo: 6 months
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This is the number of subjects who self-reported at least one fall, and does not include trips or near falls.
This measure does not include the total number of falls as there were several participants who reported more than one fall.
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6 months
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Change in Strength R Hip Using Biodex
Periodo de tiempo: Strength in the R hip was assessed at 6 months (post) and at baseline (pre)
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Assessment of change in strength using biodex.
Higher values are associated with better outcome
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Strength in the R hip was assessed at 6 months (post) and at baseline (pre)
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Otras medidas de resultado
Medida de resultado |
Medida Descripción |
Periodo de tiempo |
---|---|---|
Percent Body Fat
Periodo de tiempo: 6 months
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change in total body fat measured using Dual-energy X-ray absorptiometry (DXA).
Value was calculated as value at 6 months (post) - value at baseline (pre)
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6 months
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Colaboradores e Investigadores
Patrocinador
Investigadores
- Investigador principal: Leslie Ira Katzel, MD PhD, Baltimore VA Medical Center VA Maryland Health Care System, Baltimore, MD
Publicaciones y enlaces útiles
Publicaciones Generales
- Dite W, Temple VA. A clinical test of stepping and change of direction to identify multiple falling older adults. Arch Phys Med Rehabil. 2002 Nov;83(11):1566-71. doi: 10.1053/apmr.2002.35469.
- Wrisley DM, Marchetti GF, Kuharsky DK, Whitney SL. Reliability, internal consistency, and validity of data obtained with the functional gait assessment. Phys Ther. 2004 Oct;84(10):906-18.
Enlaces Útiles
Fechas de registro del estudio
Fechas importantes del estudio
Inicio del estudio (Actual)
Finalización primaria (Actual)
Finalización del estudio (Actual)
Fechas de registro del estudio
Enviado por primera vez
Primero enviado que cumplió con los criterios de control de calidad
Publicado por primera vez (Estimar)
Actualizaciones de registros de estudio
Última actualización publicada (Actual)
Última actualización enviada que cumplió con los criterios de control de calidad
Última verificación
Más información
Términos relacionados con este estudio
Palabras clave
Términos MeSH relevantes adicionales
Otros números de identificación del estudio
- E1574-P
- 1I21RX001574-01A1 (Subvención/contrato del NIH de EE. UU.)
Plan de datos de participantes individuales (IPD)
¿Planea compartir datos de participantes individuales (IPD)?
Información sobre medicamentos y dispositivos, documentos del estudio
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Ensayos clínicos sobre MMBI
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VA Office of Research and DevelopmentReclutamiento
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Baltimore VA Medical CenterTerminadoEquilibrio posturalEstados Unidos
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VA Office of Research and DevelopmentTerminadoObesidad | DismovilidadEstados Unidos