Division of Neurotology, Department of Otorhinolaryngology, Complexo Hospitalario Universitario, Santiago de Compostela, Spain.
Department of Surgery and Medical-Surgical Specialities, University of Santiago de Compostela, Santiago de Compostela, Spain.
BMC Geriatr. 2019 Jan 3;19(1):1. doi: 10.1186/s12877-018-1019-5.
BACKGROUND: Accidental falls, especially for the elderly, are a major health issue. Balance disorders are one of their main causes. Vestibular rehabilitation (VR) has proven to be useful in improving balance of elderly patients with instability. Its major handicap is probably its cost, which has prevented its generalisation. So, we have designed a clinical trial with posturographic VR, to assess the optimum number of sessions necessary for a substantial improvement and to compare computerised dynamic posturography (CDP) (visual feedback) and mobile posturography (vibrotactile feedback). METHODS: Design: randomized controlled trial. It is an experimental study, single-center, open, randomized (balanced blocks of patients) in four branches in parallel, in 220 elderly patients with high risk of falls; follow-up period: twelve months. SETTING: Department of Otorhinolaryngology of a tertiary referral hospital. PARTICIPANTS: people over 65 years, fulfilling two or more of the following requirements: a) at least one fall in the last twelve months. b) take at least 16 s or require some support in perform the "timed up and go" test. c) a percentage of average balance in the sensory organization test (SOT) of the CDP < 68%. d) at least one fall in any of the conditions in SOT-CDP. e) a score in Vertiguard's gSBDT > 60%. INTERVENTION: Four differents protocols of vestibular rehabilitation (randomization of the patients). MAIN OUTCOME MEASURE: The percentage of average balance in the SOT-CDP. Secondary measures: time and supports in the "timed up and go" test, scores of the CDP and Vertiguard, and rate of falls. DISCUSSION: Posturographic VR has been proven to be useful for improving balance and reducing the number of falls among the aged. However, its elevated cost has limited its use. It is possible to implement two strategies that improve the cost-benefit of posturography. The first involves optimising the number of rehabilitation sessions; the second is based on the use of cheaper posturography systems. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT03034655. Registered on 25 January 2017.
背景：意外跌倒，尤其是老年人，是一个主要的健康问题。平衡障碍是其主要原因之一。前庭康复（VR）已被证明对改善不稳定的老年患者的平衡非常有用。其主要障碍可能是其成本，这阻碍了其普及。因此，我们设计了一项使用姿势描记 VR 的临床试验，以评估获得实质性改善所需的最佳疗程数，并比较计算机动态姿势描记法（CDP）（视觉反馈）和移动姿势描记法（振动反馈）。
方法：设计：随机对照试验。这是一项单中心、开放性、随机（患者分组平衡）的实验研究，分为四个平行分支，纳入 220 名有高跌倒风险的老年患者；随访期：十二个月。
地点：三级转诊医院耳鼻喉科。
参与者：年龄在 65 岁以上，符合以下两个或两个以上标准的人群：a）在过去 12 个月内至少跌倒一次。b）在“计时站起和行走”测试中至少需要 16 秒或需要一些支撑。c）CDP 中的感觉组织测试（SOT）中平均平衡的百分比<68%。d）在 CDP-SOT 的任何条件下至少跌倒一次。e）Vertiguard 的 gSBDT 评分>60%。
干预：四种不同的前庭康复方案（患者随机分组）。
主要观察指标：CDP-SOT 中的平均平衡百分比。次要观察指标：“计时站起和行走”测试中的时间和支撑，CDP 和 Vertiguard 的评分，以及跌倒率。
讨论：姿势描记 VR 已被证明对改善老年人的平衡和减少跌倒次数非常有用。然而，其高昂的成本限制了它的使用。有两种可能的策略可以提高姿势描记法的成本效益。第一种涉及优化康复疗程数；第二种基于使用更便宜的姿势描记系统。
试验注册：ClinicalTrials.gov 标识符：NCT03034655。于 2017 年 1 月 25 日注册。
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