Department of Physical therapy, Maastricht University Medical Center+ (MUMC+), Peter Debyelaan 25, 6229 HX, Maastricht, the Netherlands.
Department of Epidemiology, Maastricht University, Peter Debyeplein 1, 6200 MD, Maastricht, the Netherlands.
BMC Geriatr. 2021 Jan 6;21(1):9. doi: 10.1186/s12877-020-01944-7.
Falls are a common cause of injuries and hospitalization among older adults. While conventional balance training appears effective in preventing falls, a relatively large number of training sessions are needed and retention of the effects after the training period is hard to accomplish. This may be because these interventions are not sufficiently task-specific for the mechanism of falls. Many falls in older adults occur due to unexpected external perturbations during gait, such as trips. Therefore, there is increasing interest in perturbation-based balance training (PBT), which is a more task-specific intervention to improve reactive balance control after unexpected perturbations. The literature suggests that PBT may be more effective and require fewer training sessions to reduce falls incidence in older adults, than conventional balance training. We aim to evaluate the effect of a three-session PBT protocol on balance control, daily life falls and fear of falling. Secondly, we will evaluate the acceptability of the PBT protocol.
This is a mixed-methods study combining a single-blind (outcome assessor) randomized controlled trial (RCT) using a parallel-group design, and qualitative research evaluating the acceptability of the intervention. The study sample consists of community-dwelling older adults aged 65 years and older who have recently fallen and visited the MUMC+ outpatient clinic. Subjects are randomized into two groups. The control group (n = 40) receives usual care, meaning referral to a physical therapist. The intervention group (n = 40) receives usual care plus three 30-min sessions of PBT in the Computer Assisted Rehabilitation Environment. Subjects' balance control (Mini-BESTest) and fear of falling (FES-I) will be assessed at baseline, and 4 weeks and 3 months post-baseline. Daily life falls will be recorded with falls calendars until 6 months after the first follow-up measurement, long-term injurious falls will be recorded at 2-years' follow-up via the electronic patient record. Acceptability of the PBT protocol will be evaluated with semi-structured interviews in a subsample from the intervention group.
This study will contribute to the evidence for the effectiveness of PBT using a training protocol based on the available literature, and also give much needed insights into the acceptability of PBT for older adults.
Nederlands Trial Register NL7680 . Registered 17-04-2019 - retrospectively registered.
跌倒在老年人受伤和住院中是一个常见的原因。虽然传统的平衡训练在预防跌倒方面似乎很有效，但需要进行相对大量的训练课程，并且很难在训练期后保持效果。这可能是因为这些干预措施对于跌倒机制来说不够特定于任务。老年人的许多跌倒都是由于行走过程中意外的外部干扰，如绊倒。因此，人们越来越感兴趣于基于扰动的平衡训练（PBT），这是一种更特定于任务的干预措施，可以改善意外扰动后的反应性平衡控制。文献表明，与传统平衡训练相比，PBT 可能更有效，需要更少的训练课程来降低老年人的跌倒发生率。我们旨在评估三个疗程的 PBT 方案对平衡控制、日常生活中的跌倒和跌倒恐惧的影响。其次，我们将评估 PBT 方案的可接受性。
这是一项混合方法研究，结合了单盲（结果评估者）随机对照试验（RCT），采用平行组设计，并进行定性研究评估干预措施的可接受性。研究样本由最近跌倒并访问 MUMC+门诊诊所的 65 岁及以上的社区居住老年人组成。受试者随机分为两组。对照组（n=40）接受常规护理，即转介给物理治疗师。干预组（n=40）在计算机辅助康复环境中接受常规护理加三次 30 分钟的 PBT 治疗。受试者的平衡控制（Mini-BESTest）和跌倒恐惧（FES-I）将在基线时、4 周和 3 个月时进行评估。日常生活中的跌倒将使用跌倒日历记录，直到第一次随访测量后 6 个月，长期受伤跌倒将在 2 年随访时通过电子患者记录进行记录。干预组的一个亚组将进行半结构化访谈，以评估 PBT 方案的可接受性。
这项研究将有助于基于现有文献的训练方案来证明 PBT 的有效性，并且还将为老年人对 PBT 的可接受性提供急需的见解。
荷兰试验注册 NL7680。于 2019 年 4 月 17 日注册 - 事后注册。
