基于扰动的平衡训练对老年人平衡控制和跌倒恐惧的影响：一项单盲随机对照试验。
The effect of perturbation-based balance training on balance control and fear of falling in older adults: a single-blind randomised controlled trial.
机构信息
Department of Physiotherapy, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands.
Department of Epidemiology, Maastricht University, Maastricht, The Netherlands.
出版信息
BMC Geriatr. 2023 May 17;23(1):305. doi: 10.1186/s12877-023-03988-x.
BACKGROUND
Perturbation-based balance training (PBT) is an emerging intervention shown to improve balance recovery responses and reduce falls in everyday life in older adults. However, perturbation interventions were heterogeneous in nature and need improvement. This study aims to investigate the effects of a PBT protocol that was designed to address previously identified challenges of PBT, in addition to usual care, on balance control and fear of falling in older adults at increased risk of falling.
METHODS
Community-dwelling older adults (age ≥ 65 years) who visited the hospital outpatient clinic due to a fall incident were included. Participants received PBT in addition to usual care (referral to a physiotherapist) versus usual care alone. PBT consisted of three 30-minute sessions in three weeks. Unilateral treadmill belt accelerations and decelerations and platform perturbations (shifts and tilts) were applied during standing and walking on the Computer Assisted Rehabilitation Environment (CAREN, Motek Medical BV). This dual-belt treadmill embedded in a motion platform with 6 degrees of freedom is surrounded by a 180° screen on which virtual reality environments are projected. Duration and contents of the training were standardised, while training progression was individualised. Fear of falling (FES-I) and balance control (Mini-BESTest) were assessed at baseline and one week post-intervention. Primary analysis compared changes in outcome measures between groups using Mann-Whitney U tests.
RESULTS
Eighty-two participants were included (PBT group n = 39), with a median age of 73 years (IQR 8 years). Median Mini-BESTest scores did not clinically relevantly improve and were not significantly different between groups post-intervention (p = 0.87). FES-I scores did not change in either group.
CONCLUSIONS
Participation in a PBT program including multiple perturbation types and directions did not lead to different effects than usual care on clinical measures of balance control or fear of falling in community-dwelling older adults with a recent history of falls. More research is needed to explore how to modulate PBT training dose, and which clinical outcomes are most suitable to measure training effects on balance control.
TRIAL REGISTRATION
Nederlands Trial Register NL7680. Registered 17-04-2019 - retrospectively registered. https://www.trialregister.nl/trial/7680 .
背景
基于扰动的平衡训练（PBT）是一种新兴的干预措施，已被证明可改善老年人日常生活中的平衡恢复反应并减少跌倒。然而，扰动干预在本质上存在异质性，需要改进。本研究旨在探讨一种 PBT 方案的效果，该方案旨在解决 PBT 之前确定的挑战，除了常规护理外，还针对有跌倒风险的老年人的平衡控制和跌倒恐惧。
方法
因跌倒事件而到医院门诊就诊的社区居住的老年人（年龄≥65 岁）被纳入研究。参与者接受 PBT 加常规护理（转介给物理治疗师）与单独接受常规护理的对比。PBT 由三个 30 分钟的疗程组成，在三周内进行。在站立和在计算机辅助康复环境（CAREN，Motek Medical BV）上行走时，施加单侧跑步机带加速和减速以及平台扰动（移位和倾斜）。该双带跑步机嵌入具有 6 个自由度的运动平台中，并被投射虚拟现实环境的 180°屏幕包围。训练的持续时间和内容是标准化的，而训练进展是个体化的。在基线和干预后一周评估跌倒恐惧（FES-I）和平衡控制（Mini-BESTest）。使用 Mann-Whitney U 检验对组间的结局测量变化进行了主要分析。
结果
共纳入 82 名参与者（PBT 组 n=39），中位年龄为 73 岁（IQR 8 岁）。中位 Mini-BESTest 评分在干预后在组间没有临床显著改善，且无显著差异（p=0.87）。两组的 FES-I 评分均无变化。
结论
参与包括多种扰动类型和方向的 PBT 计划并未导致与常规护理在社区居住的近期有跌倒史的老年人的平衡控制或跌倒恐惧的临床测量结果上有不同的效果。需要进一步研究以探索如何调节 PBT 训练剂量，以及哪些临床结局最适合衡量平衡控制训练效果。
试验注册
荷兰试验注册 NL7680。2019 年 4 月 17 日注册-追溯注册。https://www.trialregister.nl/trial/7680。
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