Christoforou Andrea, van der Linden Marietta L, Koufaki Pelagia
a Centre of Health Activity and Rehabilitation Research, School of Health Sciences , Queen Margaret University , Edinburgh , UK.
Disabil Rehabil. 2018 Oct;40(20):2466-2474. doi: 10.1080/09638288.2017.1337241. Epub 2017 Jun 13.
To evaluate the effectiveness of the 16-week evidence-based Steady Steps exercise referral scheme at improving physical function, balance confidence, and quality of life (QoL) of community-dwelling older adults at risk of falling.
A non-experimental, practice-based study involving a retrospective analysis of participant outcomes. Pre-post comparisons of three performance-based measures of gait and balance and of person-reported outcomes for balance confidence and QoL were performed. Effectiveness was evaluated in terms of statistically significant changes and relative to published fall-risk thresholds and minimal detectable changes (MDCs) or minimum clinically important differences.
One hundred and thirty-six participants completed the program over 19 months. Statistically significant differences were observed for all outcomes (p < 0.001), translating to an overall 42.6% reduction in falls-related risk. Approximately 63% of participants achieved an improvement ≥MDC in at least one of the performance-based tests. Greater than 55% achieved self-reported improvements in balance confidence ≥ MDC, while >40% reported clinically important improvements in QoL.
While the non-experimental design precludes conclusive evidence of causation, the highly significant and clinically meaningful improvements observed in individuals who completed the evidence-based Steady Steps program support its translation of evidence into effective practice. Continued implementation and evaluation of such practices and their longer-term effects are warranted. Implications for Rehabilitation Falls in older adults represent an escalating public health problem, and rehabilitation professionals are charged with developing and/or identifying feasible and effective evidence-based programs that target and reduce falls risk in this population. Our findings support Steady Steps as an effective third-sector referral rehabilitation service that successfully translates research evidence-based exercise interventions into effective practice, positively impacting physical function, balance confidence and quality of life (QoL) in community-dwelling older adults. Our study provides practice-based evidence of the effectiveness of exercise interventions that are progressively challenging, deliver a high dose of moderate to high intensity and target the main falls risk factors of muscle weakness and gait and balance impairment. In spite of their limitations, non-experimental, practice-based approaches provide rehabilitation professionals with feasible opportunities for evaluating existing services, such as Steady Steps, and contributing to the overall evidence-base for falls prevention and management.
评估为期16周的循证“稳健步伐”运动转诊计划在改善有跌倒风险的社区居住老年人的身体功能、平衡信心和生活质量（QoL）方面的有效性。
一项基于实践的非实验性研究，涉及对参与者结果的回顾性分析。对基于表现的三项步态和平衡测量指标以及个人报告的平衡信心和生活质量结果进行前后比较。根据统计学上的显著变化以及相对于已公布的跌倒风险阈值和最小可检测变化（MDCs）或最小临床重要差异来评估有效性。
136名参与者在19个月内完成了该计划。所有结果均观察到统计学上的显著差异（p < 0.001），相当于跌倒相关风险总体降低了42.6%。约63%的参与者在至少一项基于表现的测试中实现了≥MDC的改善。超过55%的参与者自我报告平衡信心改善≥MDC，而超过40%的参与者报告生活质量有临床意义的改善。
虽然非实验性设计排除了因果关系的确凿证据，但在完成循证“稳健步伐”计划的个体中观察到的高度显著且具有临床意义的改善支持将证据转化为有效实践。有必要继续实施和评估此类实践及其长期效果。对康复的启示老年人跌倒代表着一个不断升级的公共卫生问题，康复专业人员负责制定和/或确定可行且有效的循证计划，以针对并降低该人群的跌倒风险。我们的研究结果支持“稳健步伐”作为一项有效的第三部门转诊康复服务，它成功地将基于研究证据的运动干预转化为有效实践，对社区居住老年人的身体功能、平衡信心和生活质量产生积极影响。我们的研究提供了基于实践的证据，证明运动干预是有效的，这些干预具有逐步挑战性，提供高剂量的中等到高强度运动，并针对肌肉无力以及步态和平衡受损等主要跌倒风险因素。尽管存在局限性，但基于实践的非实验性方法为康复专业人员提供了可行的机会，以评估现有服务，如“稳健步伐”，并为跌倒预防和管理的总体证据基础做出贡献。
