Visual biofeedback training reduces quantitative drugs index scores associated with fall risk

Eric Anson, Elizabeth Thompson, Samuel C Karpen, Brian L Odle, Edith Seier, John Jeka, Peter C Panus, Eric Anson, Elizabeth Thompson, Samuel C Karpen, Brian L Odle, Edith Seier, John Jeka, Peter C Panus

Abstract

Objective: Drugs increase fall risk and decrease performance on balance and mobility tests. Conversely, whether biofeedback training to reduce fall risk also decreases scores on a published drug-based fall risk index has not been documented. Forty-eight community-dwelling older adults underwent either treadmill gait training plus visual feedback (+VFB), or walked on a treadmill without feedback. The Quantitative Drug Index (QDI) was derived from each participant's drug list and is based upon all cause drug-associated fall risk. Analysis of covariance assessed changes in the QDI during the study, and data is presented as mean ± standard error of the mean.

Results: The QDI scores decreased significantly (p = 0.031) for participants receiving treadmill gait training +VFB (- 0.259 ± 0.207), compared to participants who walked on the treadmill without VFB (0.463 ± 0.246). Changes in participants QDI scores were dependent in part upon their age, which was a significant covariate (p = 0.007). These preliminary results demonstrate that rehabilitation to reduce fall risk may also decrease use of drugs associated with falls. Determination of which drugs or drug classes that contribute to the reduction in QDI scores for participants receiving treadmill gait training +VFB, compared to treadmill walking only, will require a larger participant investigation. Trial Registration ISRNCT01690611, ClinicalTrials.gov #366151-1, initial 9/24/2012, completed 4/21/2016.

Keywords: Ambulatory; Biofeedback; Community; Covariate; Drug index; Elderly; Falls; Polypharmacy; Treadmill; Visual.

Figures

Fig. 1
Fig. 1
Scatterplot of the change in QDI scores for both the treadmill walking only participants (open squares) and treadmill gait training +VFB participants (open triangles), as a function of age. The horizontal line (score of zero), represents no change between the post- and pre- intervention QDI scores. The graph contains replicate change in QDI scores for several specific ages, in both treadmill walking only and treadmill gait training +VFB groups. These replicates may result in each icon representing more than a single response

References

    1. Fried TR, O’Leary J, Towle V, Goldstein MK, Trentalange M, Martin DK. Health outcomes associated with polypharmacy in community-dwelling older adults: a systematic review. J Am Geriatr Soc. 2014;62:2261–2272. doi: 10.1111/jgs.13153.
    1. Kojima T, Akishita M, Nakamura T, Nomura K, Ogawa S, Iijima K, Eto M, Ouchi Y. Association of polypharmacy with fall risk among geriatric outpatients. Geriatr Gerontol Int. 2011;11:438–444. doi: 10.1111/j.1447-0594.2011.00703.x.
    1. Sganga F, Vetrano DL, Volpato S, Cherubini A, Ruggiero C, Corsonello A, Fabbietti P, Lattanzio F, Bernabei R, Onder G. Physical performance measures and polypharmacy among hospitalized older adults: results from the CRIME study. J Nutr Health Aging. 2014;18:616–621. doi: 10.1007/s12603-014-0029-z.
    1. Anson E, Thompson E, Odle BL, Jeka J, Walls ZF, Panus PC. Influences of age, obesity, and adverse drug effects on balance and mobility testing scores in ambulatory older adults. J Geriatr Phys Ther. 2018;41:218–229. doi: 10.1519/JPT.0000000000000124.
    1. Gnjidic D, Cumming RG, Le Couteur DG, Handelsman DJ, Naganathan V, Abernethy DR, Hilmer SN. Drug burden index and physical function in older Australian men. Br J Clin Pharmacol. 2009;68:97–105. doi: 10.1111/j.1365-2125.2009.03411.x.
    1. Gnjidic D, Bell JS, Hilmer SN, Lonnroos E, Sulkava R, Hartikainen S. Drug burden index associated with function in community-dwelling older people in Finland: a cross-sectional study. Ann Med. 2012;44:458–467. doi: 10.3109/07853890.2011.573499.
    1. van der Velde N, Stricker BH, Pols HA, van der Cammen TJ. Risk of falls after withdrawal of fall-risk-increasing drugs: a prospective cohort study. Br J Clin Pharmacol. 2007;63:232–237. doi: 10.1111/j.1365-2125.2006.02736.x.
    1. van der Velde N, Stricker BH, Pols HA, van der Cammen TJ. Withdrawal of fall-risk-increasing drugs in older persons: effect on mobility test outcomes. Drugs Aging. 2007;24:691–699. doi: 10.2165/00002512-200724080-00006.
    1. Kouladjian L, Gnjidic D, Chen TF, Mangoni AA, Hilmer SN. Drug burden index in older adults: theoretical and practical issues. Clin Interv Aging. 2014;9:1503–1515. doi: 10.2147/CIA.S66660.
    1. By the American Geriatrics Society Beers Criteria Update Expert P: American Geriatrics Society Updated beers criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2015;2015(63):2227–2246. doi: 10.1111/jgs.13702.
    1. Anson E, Ma L, Meetam T, Thompson E, Rathore R, Dean V, Jeka J. Trunk motion visual feedback during walking improves dynamic balance in older adults: assessor blinded randomized controlled trial. Gait Posture. 2018;62:342–348. doi: 10.1016/j.gaitpost.2018.03.044.
    1. Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12:189–198. doi: 10.1016/0022-3956(75)90026-6.
    1. Powell LE, Myers AM. The activities-specific balance confidence (ABC) scale. J Gerontol A Biol Sci Med Sci. 1995;50A:M28–M34. doi: 10.1093/gerona/50A.1.M28.
    1. Field A. Discovering statistics using SPSS. 3. London: Sage; 2009.
    1. Seier E, Joplin K. Introduction to statistics in a biological context. North Charleston: CreateSpace; 2011.

Source: PubMed

Szponzorok és közreműködők

Egészségi állapot

Kábítószer-beavatkozások

3
Iratkozz fel