Dartmouth-Hitchcock Medical Center, One Medical Center Dr, Lebanon, NH 03781 (USA), and Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.
Geisel School of Medicine at Dartmouth.
Phys Ther. 2020 Jul 19;100(7):1153-1162. doi: 10.1093/ptj/pzaa023.
Falls are the leading cause of injuries among older adults, and trips and slips are major contributors to falls.
The authors sought to compare the effectiveness of adding a component of surface perturbation training to usual gait/balance training for reducing falls and fall-related injury in high-risk older adults referred to physical therapy.
This was a multi-center, pragmatic, randomized, comparative effectiveness trial.
Treatment took place within 8 outpatient physical therapy clinics.
This study included 506 patients 65+ years of age at high fall risk referred for gait/balance training.
This trial evaluated surface perturbation treadmill training integrated into usual multimodal exercise-based balance training at the therapist's discretion versus usual multimodal exercise-based balance training alone.
Falls and injurious falls were assessed with a prospective daily fall diary, which was reviewed via telephone interview every 3 months for 1 year.A total of 211/253 (83%) patients randomized to perturbation training and 210/253 (83%) randomized to usual treatment provided data at 3-month follow-up. At 3 months, the perturbation training group had a significantly reduced chance of fall-related injury (5.7% versus 13.3%; relative risk 0.43) but no significant reduction in the risk of any fall (28% versus 37%, relative risk 0.78) compared with usual treatment. Time to first injurious fall showed reduced hazard in the first 3 months but no significant reduction when viewed over the entire first year.
The limitations of this trial included lack of blinding and variable application of interventions across patients based on pragmatic study design.
The addition of some surface perturbation training to usual physical therapy significantly reduced injurious falls up to 3 months posttreatment. Further study is warranted to determine the optimal frequency, dose, progression, and duration of surface perturbation aimed at training postural responses for this population.
跌倒 是老年人受伤的主要原因，而绊倒和滑倒 是导致跌倒的主要因素。
作者旨在比较在对转诊至物理治疗的高跌倒风险的老年人进行常规步态/平衡训练中增加表面扰动训练 成分与单独进行常规多模式基于运动的平衡训练相比，哪种方法在降低跌倒和跌倒相关伤害方面更有效。
这是一项多中心、实用、随机、对照效果试验。
治疗在 8 家门诊物理治疗诊所进行。
这项研究纳入了 506 名年龄在 65 岁及以上且有高跌倒风险的患者，他们因步态/平衡问题而被转诊至进行治疗。
本试验评估了表面扰动跑步机训练与常规基于多模式运动的平衡训练相结合，同时由治疗师决定是否进行表面扰动训练，与单独进行常规基于多模式运动的平衡训练进行比较。
通过前瞻性每日跌倒日记评估跌倒和伤害性跌倒，每 3 个月通过电话访谈进行回顾，为期 1 年。共有 253 名患者中的 211 名（83%）随机分配至扰动训练组，253 名中的 210 名（83%）随机分配至常规治疗组，他们在 3 个月随访时提供了数据。在 3 个月时，与常规治疗相比，扰动训练组发生跌倒相关伤害的几率显著降低（5.7% 比 13.3%；相对风险 0.43），但任何跌倒的风险没有显著降低（28% 比 37%，相对风险 0.78）。首次伤害性跌倒时间显示在前 3 个月内风险降低，但在整个第一年中没有显著降低。
该试验的局限性包括缺乏盲法以及根据实用研究设计，干预措施在患者之间的应用存在差异。
在常规物理治疗的基础上增加一些表面扰动训练可显著降低治疗后 3 个月内的伤害性跌倒。需要进一步研究确定针对该人群进行姿势反应训练的表面扰动的最佳频率、剂量、进展和持续时间。
