Ambulatory and Primary Health Care, Illawarra Shoalhaven Local Health District, Wollongong.
Ambulatory and Primary Health Care, Illawarra Shoalhaven Local Health District, Wollongong; School of Public Health and Community Medicine, University of New South Wales, Sydney.
J Physiother. 2018 Apr;64(2):121. doi: 10.1016/j.jphys.2017.10.001. Epub 2018 Mar 28.
INTRODUCTION: Falling when older is a major public health issue. There is compelling evidence to show that specific exercise programs can reduce the risk and rate of falls in community-dwelling older people. Another major health issue for older people living in the community is upper limb dysfunction, including shoulder pain. Home-based exercise programs appeal to some older people, due to their convenience. RESEARCH QUESTIONS: This trial aims to determine the effectiveness and cost-effectiveness of a home-based lower limb exercise program compared with a home-based upper limb exercise program to prevent falls and upper limb dysfunction among community-dwelling people aged 65+ years. DESIGN: Randomised, controlled trial. PARTICIPANTS AND SETTING: A total of 576 community-dwelling people will be recruited from the Illawarra and Shoalhaven regions of New South Wales, Australia. INTERVENTION: Participants will be randomised to either a home-based lower limb exercise intervention or a home-based upper limb exercise intervention. The lower limb program is designed to improve balance and strength in the lower limbs. The upper limb program is designed to improve upper limb strength and mobility. Participants will attend three group-based instruction sessions to learn and progress the exercises, and will be instructed to perform the exercises three times per week at home for 12 months. OUTCOME MEASURES: The two primary outcomes will be fall rates, recorded with monthly calendars for a 12-month period, and upper limb dysfunction, measured with the Disability of the Arm, Shoulder and Hand questionnaire. Secondary outcomes will include: lower limb strength and balance; shoulder strength and mobility; physical activity; quality of life; attitudes to exercise; proportion of fallers; fear of falling; and health and community service use. The cost-effectiveness of both exercise programs from a health and community service provider perspective will be evaluated. ANALYSIS: Negative binomial regression models will be used to estimate the between-group difference in fall rates. Modified Poisson regression models will be used to compare groups on dichotomous outcome measures. Linear regression models will be used to assess the effect of group allocation on the continuously scored measures, after adjusting for baseline scores. Two economic evaluations will be conducted: the first will assess cost-effectiveness of the lower limb program compared with the upper limb program; and the second will assess cost-effectiveness of the upper limb program compared with the lower limb program. DISCUSSION: If effective, the trial will provide a model for both upper limb and lower limb exercise programs that can be performed at home and implemented at scale to community-dwelling older adults.
引言:老年人跌倒问题是一个重大的公共卫生问题。有确凿的证据表明,特定的运动方案可以降低社区居住的老年人跌倒的风险和发生率。社区老年人的另一个主要健康问题是上肢功能障碍,包括肩部疼痛。由于其便利性,基于家庭的运动方案吸引了一些老年人。 研究问题:本试验旨在确定与基于家庭的上肢运动方案相比,基于家庭的下肢运动方案预防社区居住的 65 岁及以上人群跌倒和上肢功能障碍的有效性和成本效益。 设计:随机对照试验。 参与者和设置:总共将从澳大利亚新南威尔士州伊拉瓦拉和肖尔黑文地区招募 576 名社区居住的人。 干预措施:参与者将被随机分配到基于家庭的下肢运动干预组或基于家庭的上肢运动干预组。下肢方案旨在改善下肢的平衡和力量。上肢方案旨在改善上肢力量和活动度。参与者将参加三次小组指导课程,以学习和推进练习,并被指示在家中每周进行三次练习,持续 12 个月。 结局测量:主要结局将是跌倒率,通过每月日历记录 12 个月的跌倒率;上肢功能障碍,使用手臂、肩部和手部残疾问卷进行测量。次要结局包括:下肢力量和平衡;肩部力量和活动度;身体活动;生活质量;对运动的态度;跌倒者比例;害怕跌倒;以及健康和社区服务的使用。将从卫生和社区服务提供者的角度评估这两种运动方案的成本效益。 分析:将使用负二项回归模型估计组间跌倒率的差异。将使用修正泊松回归模型比较两组的二分结局测量。线性回归模型将用于调整基线评分后,评估组分配对连续评分测量的影响。将进行两项经济评估:第一项将评估下肢方案与上肢方案相比的成本效益;第二项将评估上肢方案与下肢方案相比的成本效益。 讨论:如果有效,该试验将为社区居住的老年人提供一种可在家中进行的上下肢运动方案模型,并可大规模实施。
Front Aging. 2022-7-4