Boright Lori E, Arena Sara K, Wilson Christopher M, McCloy Lauren
Physical Therapy, Oakland University, Rochester, USA.
Physical Therapy, Team Rehabilitation, St. Clair Shores, USA.
Cureus. 2022 Mar 31;14(3):e23713. doi: 10.7759/cureus.23713. eCollection 2022 Mar.
An alarming rate of injurious falls among older adults warrants proactive measures to reduce falls and fall risk. The purpose of this article was to examine and synthesize the literature as it relates to programmatic components and clinical outcomes of individualized fall prevention programs on community-dwelling older adults. A literature search of four databases was performed using search strategies and terms unique to each database. Title, abstract, and full article reviews were performed to assure inclusion and exclusion criteria were met. Data were analyzed for type of study, program providers, interventions and strategies used to deliver the program, assessments used, and statistically significant outcomes. Queries resulted in 410 articles and 32 met all inclusion criteria (19 controlled trials and 13 quasi-experimental). Physical therapists were part of the provider team in 23 (72%) studies and the only provider in 10 (31%). There was substantial heterogeneity in procedures and outcome measures. Most common procedures were balance assessments (n=30), individualized balance exercises (n=29), cognition (n=21), home and vision assessments (n=16), specific educational modules (n=15), referrals to other providers/community programs (n=8), and motivational interviewing (n=7). Frequency of falls improved for eight of 13 (61.5%) controlled trials and four of five (80%) quasi-experimental studies. Balance and function improved in six of 11 (54.5%) controlled trials and in each of the six (100%) quasi-experimental studies. Strength improved in three of seven (43%) controlled trials and four of five (75%) quasi-experimental studies. While many programs improved falls and balance of older adults, there was no conclusive evidence as to which assessments and interventions were optimal to deliver as individualized fall prevention programming. The skill of a physical therapist and measures of fall frequency, balance, and function were common among the majority of studies reviewed. Despite the variability among programs, there is emerging evidence that individualized, multimodal fall prevention programs may improve fall risk of community-dwelling older adults and convenient access to these programs should be emphasized.
老年人中令人担忧的伤害性跌倒发生率促使人们采取积极措施来减少跌倒及跌倒风险。本文的目的是研究和综合与针对社区居住老年人的个性化跌倒预防计划的计划组成部分和临床结果相关的文献。使用每个数据库特有的搜索策略和术语对四个数据库进行了文献检索。进行了标题、摘要和全文审查，以确保符合纳入和排除标准。对研究类型、计划提供者、用于实施计划的干预措施和策略、所使用的评估以及具有统计学意义的结果进行了数据分析。查询结果得到410篇文章，其中32篇符合所有纳入标准（19项对照试验和13项准实验）。在23项（72%）研究中，物理治疗师是提供者团队的一部分，在10项（31%）研究中是唯一的提供者。在程序和结果测量方面存在很大的异质性。最常见的程序是平衡评估（n = 30）、个性化平衡锻炼（n = 29）、认知（n = 21）、家庭和视力评估（n = 16）、特定教育模块（n = 15）、转介给其他提供者/社区计划（n = 8）以及动机访谈（n = 7）。在13项（61.5%）对照试验中的8项以及5项（80%）准实验研究中的4项中，跌倒频率有所改善。在11项（54.5%）对照试验中的6项以及6项（100%）准实验研究中的每一项中，平衡和功能都有所改善。在7项（43%）对照试验中的3项以及5项（75%）准实验研究中的4项中，力量有所改善。虽然许多计划改善了老年人的跌倒情况和平衡能力，但对于作为个性化跌倒预防计划应提供哪些评估和干预措施最为有效，尚无确凿证据。在大多数所审查的研究中，物理治疗师的技能以及跌倒频率、平衡和功能的测量方法很常见。尽管各计划之间存在差异，但越来越多的证据表明，个性化的多模式跌倒预防计划可能会降低社区居住老年人的跌倒风险，并且应强调方便获取这些计划。
