Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA.
Department of Neuroscience, Baylor College of Medicine, Houston, Texas, USA.
Gerontology. 2019;65(3):299-307. doi: 10.1159/000494114. Epub 2018 Nov 30.
Foot problems are prevalent in older adults, which may increase the risk and concern for falls. Ankle-foot orthoses (AFO) have been shown to be effective in the stabilization of lower extremities, but their long-term effectiveness in improving balance and their potential to encourage older adults to become more physically active are still debated.
This randomized controlled trial investigated the effectiveness of daily use of a custom-made AFO on balance, fear of falling, and physical activity in older adults.
Forty-four older adults with concern about or at risk for falling were randomly allocated to either the control group (CG; 77.3% female, age 75.6 ± 6.5 years, BMI 29.3 ± 6.4) or the intervention group (IG; 63.6% female, age 73.7 ± 6.3 years, BMI = 27.8 ± 4.8). The IG received walking shoes and bilateral custom-made AFO. The CG received only walking shoes. At the baseline and 6-month follow-ups, balance and physical activity were assessed using validated wearable instrumentation and fear of falling was assessed using the Fall Efficacy Scale-International (FES-I). Adherence and acceptability toward wearing the AFO were assessed using self-reported questionnaires at the 6-month follow-up.
No significant between-group difference was observed at baseline (p = 0.144-0.882). Compared to baseline and the CG, hip, ankle, and center-of-mass (COM) sways were significantly reduced at the 6-month follow-up in the IG while standing with the feet together during the eyes-open condition (p = 0.005-0.040). Within the IG, the FES-I was reduced significantly (p = 0.036) and there was an increasing trend in the number of walking bouts with a medium effect size (d = 0.52, p = 0.440) compared to baseline. However, there were no significant changes in FES-I and physical activity measures in the CG (p = 0.122-0.894). The reduction in COM sway in the IG was moderately correlated with adherence (r = -0.484, p = 0.047) and strongly correlated with baseline COM sway (r = -0.903, p < 0.001).
Results suggest that bilateral custom-made AFO plus walking shoes is effective in improving balance compared to walking shoes alone, and it significantly reduces the fear of falling, with a nonsignificant but noticeable positive trend in physical activity, compared to baseline. The results also suggest that older adults with poor balance at baseline and higher daily adherence to using the AFO will gain more benefit from the AFO intervention.
足部问题在老年人中很常见，这可能会增加他们跌倒的风险和担忧。踝足矫形器（AFO）已被证明可有效稳定下肢，但关于其长期改善平衡的效果以及促进老年人更多地参与身体活动的潜力仍存在争议。
本随机对照试验旨在研究老年人日常使用定制 AFO 对平衡、跌倒恐惧和身体活动的影响。
共有 44 名对跌倒有担忧或处于跌倒风险中的老年人被随机分配至对照组（CG；女性占 77.3%，年龄 75.6±6.5 岁，BMI 29.3±6.4）或干预组（IG；女性占 63.6%，年龄 73.7±6.3 岁，BMI=27.8±4.8）。IG 组接受步行鞋和双侧定制 AFO，CG 组仅接受步行鞋。在基线和 6 个月随访时，使用经过验证的可穿戴仪器评估平衡和身体活动，使用跌倒效能量表-国际版（FES-I）评估跌倒恐惧。在 6 个月随访时，通过自我报告问卷评估对 AFO 的依从性和可接受性。
基线时两组间无显著差异（p=0.144-0.882）。与基线和 CG 相比，IG 组在睁眼条件下双脚并拢站立时，髋部、踝关节和质心（COM）摆动显著减少（p=0.005-0.040）。在 IG 组中，FES-I 显著降低（p=0.036），且具有中等效应量的步行动作次数呈增加趋势（d=0.52，p=0.440），与基线相比。然而，CG 组的 FES-I 和身体活动测量均无显著变化（p=0.122-0.894）。IG 组 COM 摆动的减少与依从性呈中度相关（r=-0.484，p=0.047），与基线 COM 摆动呈强相关（r=-0.903，p<0.001）。
结果表明，与单独使用步行鞋相比，双侧定制 AFO 加步行鞋可有效改善平衡，且与基线相比，跌倒恐惧显著降低，身体活动呈非显著但明显的正向趋势。结果还表明，基线平衡较差且日常 AFO 使用依从性较高的老年人将从 AFO 干预中获益更多。
