Does modified Otago Exercise Program improves balance in older people? A systematic review

Effects of Otago Exercise Program and aquatic exercise on fall risk in older adults: A systematic review

BACKGROUND

The aim of this systematic review was to determine the processes and forms of participation in Otago Exercise Program (OEP) and Aquatic exercise(AE) for the prevention of falls in older adults, and to compare the effectiveness of the two exercises as interventions for the prevention of falls in older adults.

METHODS

Using electronic databases such as PubMed, Web of Science, Embase, Scopus, and Google Scholar, we searched for relevant domestic and foreign papers in the last 15 years, and evaluated the methodology and quality of the report by both AMSTAR 2 and PRISMA scales to evaluate the methodology and reporting quality.

RESULTS

A total of 33 papers were included by searching various literatures related to the topic of this study and carefully reviewed by the researcher.

CONCLUSION

This systematic review confirms that OEP and AE effectively prevent falls in older adults by improving cognitive function, lower limb muscle strength, and balance. OEP significantly enhances muscle strength, while AE shows slight superiority in improving balance-related abilities like gait stability. These findings highlight the need for optimized training cycles in OEP and AE to maximize muscle adaptation. Both programs are safe and effective, with potential to reduce falls and enhance physical and cognitive functions. Tailored interventions, aligned with home health care guidelines and specific living environments, can improve quality of life. Future research should explore the optimal exercise modalities and intensities, and conduct longitudinal studies to assess long-term outcomes, particularly for older adults with specific health conditions.

Effects of exercise programmes delivered using video technology on physical performance and falls in people aged 60 years and over living in the community: a systematic review and meta-analysis

OBJECTIVES

This systematic review and meta-analysis synthesised the evidence and evaluated the effect of exercise programmes delivered using instructional videos compared with control on physical performance and falls in community-dwelling older people aged 60 years and older.

DESIGN

A systematic review and meta-analysis conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

DATA SOURCES

MEDLINE, EMBASE, CINAHL, PsycINFO, The Cochrane Central Register of Controlled Trials, TRIP and PEDro. Grey literature sources included theses and dissertations from Ethos and ProQuest.

ELIGIBILITY CRITERIA

Studies were included if they involved community-dwelling older people (aged >60 years) participating in exercise programmes delivered through instructional videos.

DATA EXTRACTION AND SYNTHESIS

Treatment effects were estimated using a random-effects model, reporting 95% CIs, mean differences (MD) and standardised MDs (SMD, Hedges' g) for outcomes measured in different units. The risk of bias was assessed using ROB2, and the certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

RESULTS

A total of 7487 records were screened, with 16 studies (n=1910) meeting the inclusion criteria. Meta-analysis of 11 studies revealed significant effects of video-delivered exercise programmes in lower extremity strength (SMD=0.35, 95% CI 0.11 to 0.59; I2=70.35%, p<0.001, GRADE moderate quality), balance (SMD=0.45, 95% CI 0.07 to 0.83; I2=85.07%, p=0.02, GRADE low quality), mobility (MD=0.96, 95% CI 0.46 to 1.46; I2=53.31%, p<0.001, GRADE moderate quality) and physical performance SMD=0.36, 95% CI 0.17 to 0.56; I2=13.49%, p<0.001, GRADE moderate quality). No evidence of an effect of video-delivered exercise programmes on fear of falling was found (SMD=0.5, 95% CI -0.30 to 1.29; I2=95.48%, p=0.22, GRADE very low quality). There were insufficient data for reporting falls.

CONCLUSIONS

Video-delivered exercise programmes improved physical performance, particularly lower extremity strength, balance and mobility, with low to moderate quality evidence. There is uncertainty about the effect of video-delivered exercise programmes on the number of falls, number of fallers and fear of falling.

PROSPERO REGISTRATION NUMBER

CRD42023415530.

Strides towards healthy longevity: Harnessing the power of sports and elements of Kathak, an Indian classical dance form through social participation to combat cognitive frailty among older adults

Aging brings with it many health issues that can make life challenging. As much of the attention is given to non-communicable diseases, there are others which are slowly becoming a matter of great concern. One such issue is cognitive frailty, which is a high risk factor for dementia, falls, fractures and hospitalization. Though not yet declared a public health concern, it deserves early detection and prevention strategies. As it is reversible if treated on time, there is a need to look into its prevention and cure. Physical activity has proven to be very effective in the treatment of cognitive frailty. This scoping review thus aims to study the impact of physical activity through social participation on cognitive frailty. The authors recommend that focussing on one's muscular fitness through participation in sports and elements of Indian classical dance form like Kathak in groups/ communities can be a very effective way of combating cognitive frailty among older adults.

The effectiveness of digital technology-based Otago Exercise Program on balance ability, muscle strength and fall efficacy in the elderly: a systematic review and meta-analysis

OBJECTIVE

To explore the impact of the digital implementation of the Otago Exercise Program (OEP) on balance ability (static and dynamic), muscle strength, and fall efficacy in elderly people; and analyze different potential influencing factors in subgroups to find the most suitable training plan.

METHODS

EBSCO, PubMed, Web of Science, and China Knowledge Network databases (core) were searched up to August 1, 2023. Experimental studies of implementing OEP based on digital technology to improve outcomes related to falls in the elderly were included. Bias risks were assessed using the Cochrane collaboration tool. Meta-analysis was performed to assess the pooled effect of balance ability (static and dynamic), muscle strength, and fall efficacy using a random effects model. Subgroup analyses were conducted to examine the potential modifying effects of different factors (e.g., training period, frequency, duration, age).

RESULTS

Twelve articles were included from the literature, including 10 randomized controlled trials, one single-group quasi-experimental study, and one case report. Digital technologies used in the studies were categorized into three types: (1) online interventions (Zoom, WeChat), (2) recorded videos (via computers, TVs, DVDs), and (3) wearable technologies (motion sensors, augmented reality systems). The implementation of OEP based on digital technology showed significantly improved on static balance (SMD = 0.86, 95% CI 0.35-1.37), dynamic balance (SMD = 1.07, 95% CI 0.90-1.24), muscular strength (SMD = 0.43, 95% CI 0.17-0.69), and fall efficacy (SMD=-0.70, 95% CI -0.98, -0.41); Subgroup analysis by period '≥12 weeks', frequency '≥3 times/week', and duration '≤45 minutes per session', respectively, showed significant improvements on static balance (SMD = 0.73, 95% CI 0.21-1.25; SMD = 0.86, 95% CI 0.35-1.37; SMD = 1.10, 95% CI 0.31-1.89), dynamic balance (SMD = 1.08, 95% CI 0.88-1.28; SMD = 1.01, 95% CI 0.93-1.27; SMD = 1.07, 95% CI 0.89-1.25), muscle strength (SMD = 0.43, 95% CI 0.10-0.75; SMD = 0.54, 95% CI 0.30-0.77; SMD = 0.53, 95% CI 0.19-0.87), and fall efficacy (SMD=-0.75, 95% CI -1.39, -0.11; SMD=-0.70, 95% CI -0.98, -0.41; SMD=-0.74, 95% CI -1.10, -0.39).

CONCLUSIONS

OEP implemented through digital technology effectively enhances static and dynamic balance, muscle strength, and self-efficacy in older adults. A training regimen of 12 weeks or more, with sessions occurring three or more times per week for 30 to 45 min, appears to be an effective approach for improving these outcomes based on the available evidence from the included studies. Future research should prioritize specific digital technologies and target populations, employing high-quality research designs to further explore these interventions, and consider new technologies such as wearables, to assess changes in fall prevalence.

Feasibility and Acceptance of a Remotely Supervised Home-Based Group Mobility Exercise for Older Adults Using a Mobile Robotic Telepresence: A Pilot Study

BACKGROUND/OBJECTIVES

 Mobile robotic telepresence could be used to remotely supervise physical activity programs. Our study aims to explore the feasibility, acceptance, and usability of a physical activity program offered synchronously via a mobile robotic telepresence platform.

METHODS

 For this interventional study, five Cutii robots were made available in two residences for older adults in Quebec. Participants received the exercise program, two sessions per week for 4-6 weeks, delivered remotely via the robot. The following feasibility indicators were collected during the study, as recommended by Thabane et al.: process, resources, management, and intervention. Acceptance and usability of the technology were measured using the extended version of the Unified Theory of Acceptance and Use of Technology-based questionnaire and the System Usability Scale, respectively.

RESULTS

 Eighty percent of participants completed the protocol, and 58% of participants attended 80% of the sessions. Various technical problems (internet connection and technology issues) limited the usability and acceptance of the technology.

CONCLUSION

 The results revealed that the program was feasible according to the process, management, and intervention indicators but unsatisfactory in terms of resources. For some participants, minor modifications were needed to improve technology support and facilitate connection to the mobile robotic telepresence. Further studies will need to focus on the evaluation of the effectiveness of this type of intervention.

IMPLICATIONS

These results emphasize the importance of continuing research evaluating the opportunities provided by new technologies to enhance older adults' engagement in physical activity and inform clinicians and policymakers to improve future services in this domain.

Study protocol: process and outcome evaluation of the Walk with Ease program for fall prevention

BACKGROUND

Falls are the leading cause of injury related morbidity and mortality in older adults. Primary and secondary prevention strategies that address modifiable risk factors are critically important to reduce the number of falls and fall related injuries. A number of evidence-based fall prevention programs are available, but few offer potential for broad dissemination and public health impact due to implementation barriers, such as a need for trained program leaders and clinicians.

METHODS

The study will use a randomized controlled trial design to evaluate incorporating physical therapy exercises (primary prevention strategy) within an existing intervention called Walk with Ease. While Walk with Ease has an established evidence-base related to the management of arthritis pain and symptoms, the present study will determine the potential to also reduce falls and fall risk in community-dwelling older adults. The integrated process and outcome evaluation will determine the relative effectiveness of individually-prescribed exercises (compared to standardized exercises) as well as the potential of 'habit training' resources (relative to generic behavior prompts) to improve compliance with exercises in this population.

DISCUSSION

The study, conducted through a local clinical-community partnership will advance both the science and practice of community-based fall prevention programming, while also informing implementation strategies needed to promote broader dissemination.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT05693025, Registered January 20, 2023, Updated March 1, 2023.

Effects of Otago exercise program on physical function in older adults: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Maintaining physical function is critical for older adults to achieve healthy aging. The Otago exercise program (OEP) has been widely used to prevent falls for older adults. However, the effects of OEP on physical function remain controversial and the possible effects modifiers have not been assessed.

OBJECTIVE

To evaluate the effects of OEP on physical function in older adults and to explore potential moderators underlying the effects of OEP.

METHODS

We searched five electronic databases and relevant systematic reviews to identify studies. We included randomized controlled trials (RCTs) evaluating the effects of OEP as a single intervention on physical function among older adults aged 65 and over. Meta-analysis was performed using the random-effects model. Standardized mean differences (SMD) for physical function changes, pertinent to balance, strength, and mobility, were outcome measures. Subgroup analyses on exercise protocol and participants' characteristics were performed.

RESULTS

Thirteen RCTs consisting of 2402 participants were included in this systematic review and meta-analysis. Results indicated a significant effect of OEP on balance (SMD = 0.59, 95 % CI: 0.22∼0.96), lower body strength (SMD = 0.93, 95 % CI: 0.31∼1.55), and mobility (SMD = -0.59, 95 % CI: -0.95∼-0.22) against control groups. No significant OEP effects were found on upper body strength (MD = 1.48, 95 % CI: -0.58∼3.55). Subgroup analysis revealed that the video-supported delivery mode was more effective for improving balance (P = 0.04) and mobility (P = 0.02) than the face-to-face mode. Session durations over 30 min was more effective on lower body strength (P < 0.001) and mobility (P < 0.001) than those 1-30 min. Program period of 13-26 weeks was more effective on mobility (P = 0.02) than those of 4-12 weeks. However, the effects of OEP on physical function were not associated with age groups, and baseline falling risks.

CONCLUSION

The OEP could improve physical function including balance, lower body strength, and mobility in older adults. Implementing the OEP in video-supported, more than 30 min per session and 4-12 weeks may be the most appropriate and effective exercise protocol for improving physical function among older adults. More RCTs with rigorous design and larger scale are needed to further assess the effectiveness of diverse OEP protocols and quantify the dose-effect relationship.

Comparison of effects of Otago exercise program vs gaze stability exercise on balance and fear of fall in older adults: A randomized trial

BACKGROUND

Fall occurrences and the associated risk of injury are debilitating and major health concerns in the older population. Several interventions have been investigated and implemented to address the needs of balance impairments and to reduce the increased risk of falls. This study aimed to compare the effectiveness of the Otago exercise program (OEP) and gaze stability exercises (GSE) on balance and the risk of falls in older adults residing at an old age home facility.

METHODS

Thirty elderly participants were equally and randomly divided into 2 groups: Group OEP received the OEP, and group GSE received GSE for 8 weeks (thrice a week). In addition, both groups also performed core muscle-strengthening exercises. The outcome measures were the Berg balance scale (BBS) and the Fall efficacy scale-International (FES-I).

RESULTS

The interventions resulted in significant improvements (P < .001) in both outcome measures in both groups. The mean pretest BBS scores of groups OEP and GSE increased from 40.4 and 39.2 to the mean post-test scores of 48 and 45.2, respectively. Similarly, the mean pretest FES-I scores of groups OEP and GSE also improved from 39.47 and 40.4 to the mean post-test scores of 32.73 and 36.07. The between-group comparison showed greater improvement (P < .05) in OEP group in both variables.

CONCLUSIONS

OEP and GSE were found to be beneficial rehabilitation programs in improving balance and fear of falls in healthy older adults. However, the OEP was found to be a more effective intervention and may allow better balance and fall prevention improvements.

TRIAL REGISTRATION

The study has been registered in clinicaltrials.gov (ID: NCT05781776; on 23/03/2023).

Effect of Intrapersonal and Interpersonal Behavior Change Strategies on Physical Activity Among Older Adults: A Randomized Clinical Trial

Importance

Despite guidelines that recommend physical activity (PA), little is known about which types of behavior change strategies (BCSs) effectively promote sustained increases in PA in older adults who are insufficiently active.

Objective

To determine whether intrapersonal BCSs (eg, goal setting) or interpersonal BCSs (eg, peer-to-peer sharing or learning) combined with the Otago Exercise Program (17 strength and balance exercises and a walking program that are learned and individually tailored, with instruction to perform 3 times per week at home or location of choice) and a wearable PA monitor help older adults sustain increases in their PA.

Design, Setting, and Participants

This 2 × 2 factorial randomized clinical trial (Community-Based Intervention Effects on Older Adults' Physical Activity) of community-dwelling older adults 70 years or older with PA levels below minimum national PA guidelines was conducted in urban community centers. Dates of enrollment were from November 17, 2017, to June 15, 2021, with final follow-up assessments completed on September 2, 2022.

Interventions

Participants were randomized to intrapersonal (eg, goal setting) BCSs, interpersonal (eg, problem-solving with peer-to-peer sharing and learning) BCSs, intrapersonal and interpersonal BCSs, or an attention control group. All interventions included a PA monitor and 8 weekly small-group meetings with discussion, practice, and instructions to implement the exercise program and relevant BCSs independently between meetings and after the intervention.

Main Outcomes and Measures

The primary outcome was daily minutes of objectively measured total PA (light, moderate, or vigorous intensities) averaged over 7 to 10 days, measured at baseline and after the intervention at 1 week, 6 months, and 12 months.

Results

Among 309 participants (mean [SD] age, 77.4 [5.0] years; 240 women [77.7%]), 305 (98.7%) completed the intervention, and 302 (97.7%) had complete data. Participants receiving PA interventions with interpersonal BCS components exhibited greater increases in total PA than did those who did not at 1 week (204 vs 177 PA minutes per day; adjusted difference, 27.1 [95% CI, 17.2-37.0]; P < .001), 6 months (195 vs 175 PA minutes per day; adjusted difference, 20.8 [95% CI, 10.0-31.6]; P < .001), and 12 months (195 vs 168 PA minutes per day; adjusted difference, 27.5 [95% CI, 16.2-38.8]; P < .001) after the intervention. Compared with participants who did not receive interventions with intrapersonal BCS components, participants who received intrapersonal BCSs exhibited no significant changes in total PA at 1 week (192 vs 190 PA minutes per day; adjusted difference, 1.8 [95% CI, -8.6 to 12.2]; P = .73), 6 months (183 vs 187 PA minutes per day; adjusted difference, -3.9 [95% CI, -15.0 to 7.1]; P = .49), or 12 months (177 vs 186 PA minutes per day; adjusted difference, -8.8 [95% CI, -20.5 to 2.9]; P = .14) after the intervention. Interactions between intrapersonal and interpersonal BCSs were not significant.

Conclusions and Relevance

In this randomized clinical trial, older adults with low levels of PA who received interpersonal BCSs, the exercise program, and a PA monitor exhibited significant increases in their PA for up to 12 months after the intervention. Intrapersonal BCSs elicited no significant PA changes and did not interact with interpersonal BCSs. Our findings suggest that because effects of a PA intervention on sustained increases in older adults' PA were augmented with interpersonal but not intrapersonal BCSs, approaches to disseminating and implementing the intervention should be considered.

Trial Registration

ClinicalTrials.gov Identifier: NCT03326141.

Optimizing and Implementing a Community-Based Group Fall Prevention Program: A Mixed Methods Study

Falls and fall-related injuries among older adults are associated with decreased health. Therefore, fall prevention programs (FPPs) are increasingly important. However, the translation of such complex programs into clinical practice lacks insight into factors that influence implementation. Therefore, the aim of this study was to identify how to optimize and further implement a widely used group-based FPP in the Netherlands among participants, therapists and stakeholders using a mixed methods study. FPP participants and therapists filled out a questionnaire about their experiences with the FPP. Moreover, three focus groups were conducted with FPP participants, one with therapists and one with other stakeholders. Data were analysed according to the thematic analysis approach of Braun and Clarke. Overall, 93% of the 104 FPP participants were satisfied with the FPP and 86% (n = 12) of the therapists would recommend the FPP to older adults with balance or mobility difficulties. Moreover, six themes were identified regarding further implementation: (1) recruiting and motivating older adults to participate; (2) structure and content of the program; (3) awareness, confidence and physical effects; (4) training with peers; (5) funding and costs; and (6) long-term continuation. This study resulted in practical recommendations for optimizing and further implementing FPPs in practice.

Effectiveness of telehealth in preventive care: a study protocol for a randomised controlled trial of tele-exercise programme involving older people with possible sarcopenia or at risk of fall

BACKGROUND

Continuous loss of muscle mass and strength are the consequences of the ageing process, which increase the risk of falls among older people. Falls can lead to severe consequences such as bone fractures and hampered physical and psychological well-being. Regular exercise is the key to reversing muscle atrophy and relieving sarcopenia. However, the frailty of older people and the recent COVID-19 pandemic may affect their confidence to leave home to attend classes in the community. A feasible and effective alternative should be explored.

METHODS

The primary objective is to evaluate the effectiveness of tele-exercise (TE) in relation to physical functioning and exercise adherence among community-dwelling older people at risk of falls in comparison with a community-based group (CB). The secondary objective includes evaluating older people's experience with tele-exercise, emphasizing their psychological welfare, social well-being, and acceptance of the telehealth approach. The design, conduct, and report follow the SPIRIT guidelines (Standard Protocol Items: recommended items to address in a Clinical Trial Protocol and Related Documents). Older people will be recruited from 10 local community centres in Hong Kong and randomly allocated into two groups. All participants will attend the exercise training 3 days per week for 3 months but the mode of delivery will differ, either online as the tele-exercise group (TE) or face-to-face as the community-based group (CB). The outcome measures include muscle strength, physical function, exercise adherence and dropout rate, psychological and social well-being will be assessed at the baseline, and the 3rd, 6th and 12th month. Some participants will be invited to attend focus group interviews to evaluate their overall experience of the tele-exercise training.

DISCUSSION

Tele-exercise reduces the barriers to exercise, such as time constraints, inaccessibility to facilities, and the fear of frail older people leaving their homes. Promoting an online home-based exercise programme for older people can encourage them to engage in regular physical activity and increase their exercise adherence even when remaining at home. The use of telehealth can potentially result in savings in cost and time. The final findings will provide insights on delivering exercise via telehealth to older people and propose an exercise delivery and maintenance model for future practice.

TRIAL REGISTRATION

Chinese Clinical Trial Registry ( https://www.chictr.org.cn/hvshowprojectEN.html?id=219002&v=1.1 ), registration number: ChiCTR2200063370. Registered on 5 September 2022.

Home care worker-supported exercise program to address falls: a feasibility study

BACKGROUND

Falls are a major concern for community-dwelling older adults. The Otago Exercise Program (OEP) is an evidence-based home program that reduces risk of falls. Exercise participation and program adherence can be challenging. Home care workers (HCWs) are well positioned to provide support for older adults.

METHODS

This feasibility study included: HCW training; HCW in-home support of a physiotherapist-tailored OEP; online physiotherapy consultations; older participant questionnaires and functional outcome measures; and HCW and older participant interviews.

RESULTS

Twelve older adults, eight HCWs and one physiotherapist participated. A small falls risk reduction, and improvement in falls efficacy, quality of life and functional improvement were noted. Thematic analysis showed formal and informal support was valued by older adults and HCWs. A role-ordered matrix synthesis highlighted variable ongoing independent program participation.

CONCLUSIONS

By Your Side, a physiotherapist-led and home care worker-supported modified OEP provides a feasible and acceptable option for falls prevention in home care services. Collaborative teamwork, and both formal and informal support, are key aspects to optimising engagement and benefits.

Otago Exercise Program as an Adjunct to Routine Physiotherapy in a Patient With Tibial Plateau Injury: A Case Report

The tibia is a long bone in the lower limb. Tibial fractures account for approximately 20% of adults and 8% of older people. A tibial plateau fracture may result from low-energy forces, most commonly in older people with low bone density. The tibial plateau fractures vary widely, from stable non-displaced fractures with little soft tissue damage to severely comminated unstable fractures with severe soft tissue damage. Fractures of the tibia plateau had a significant impact on patients' lives, lowering their quality of life and limiting their participation in sports. Other effects of the injury itself, such as arthritis later developing, muscle, bone wasting, and joint stiffness, can have an impact on patients' lives. For these patients, physical therapy can target areas to improve some of such conditions. A 50-year-old female was diagnosed with lateral tibial plateau injury in the left knee and post tibial plateau injury in the right knee joint on an X-ray after a road accident, and a bilateral above-knee cast was applied for four weeks, following a period of non-weight-bearing. Along with this, a physiotherapy treatment plan was advised, which included a variety of exercises, electrotherapy, and an Otago exercise program, which resulted in pain reduction and improvements in range of motion (ROM), strength, balance, and gait ability. A structured physiotherapy program with an Otago exercise program gradually improved the functional goals, balance, and gait patterns progressively.

Feasibility of a Modified Otago Exercise Program for Older Adults With Cognitive Vulnerability

Cognitive vulnerability, that is, clinically significant symptoms of dementia, depression, or delirium, puts older adults at high risk for physical inactivity and falls. Programs addressing activity and falls are needed. The purpose was to determine feasibility of an in-home, modified, Otago Exercise Program (OEP) for those with cognitive vulnerability, based on acceptability (retention and adherence), safety (pain intensity and falls), and potential positive effects (change in short physical performance battery (SPPB)). This secondary analysis of a randomized controlled trial included 80 participants who received the OEP; 64 completed it, 48% had depression, 22% had dementia, and 30% had a combination dementia/depression/delirium. Adherence to home exercise was low to moderate; pain was stable over 16 weeks; 31% of participants reported falls unrelated to OEP. SPPB increased from 6.95 to 7.74 (p < .01); age by time and diagnosis by time interactions were not significant. The modified OEP shows promising feasibility for older adults with cognitive vulnerability.

Physical functioning and health-related quality of life after COVID-19: a long-term perspective case series

The purpose of our study was to monitor the long-term changes in physical functioning and health-related quality of life in individuals who received outpatient rehabilitation after COVID-19. Individuals referred to outpatient rehabilitation for post-COVID-19 physical therapy were assessed before the treatment, at the end of the treatment, and 2 and 6 months after the end of the treatment. The physical functioning was assessed by Barthel Index, Timed Up and Go test, Short Physical Performance Battery test (SPPB), Patient-Specific Functioning Scale (PSFS), and EuroQOL 5D-3L. Friedman's test was utilized to assess changes in the assessments. The proportions of individuals showing variation in performance equal to or greater than the absolute minimal detectable change (MDC) value of the SPPB and PSFS were calculated. Forty-four cases were monitored for 7.3-15.6 months. At baseline, they showed substantial independence in activities of daily living, moderate mobility limitations, and below-average health-related quality of life. Their status significantly improved over time (Friedman's test P = 0.002 to <0.001); post hoc analysis confirmed the improvement of mobility and health-related quality of life at 6-month follow-up relative to the baseline. After accounting for MDC values, 55% meaningfully improved on SPPB and 45% on PSFS, although some worsened (11 and 5%, respectively) and the remaining showed no meaningful change. Despite good independence in activities of daily living and perceived health, individuals surviving the COVID-19 may not have fully recovered their premorbid functioning status seven to 15 months after the infection.

Effect of the Active Aging-in-Place-Rehabilitation Nursing Program: A Randomized Controlled Trial

(1) Background: It is of great importance to promote functional capacity and positive lifestyles, since they contribute to preventing the progression of frailty among the older adults. The aim of this study was to evaluate the effect of active aging-in-place−rehabilitation nursing program (AAP-RNP) on the functional capacity and lifestyles of frail older adults. (2) Methods: This was a single-blinded, two-group, randomized, controlled trial of 30 frail older people enrolled at a Health-care unit in Portugal between 2021 and 2022. The duration of the program was 12 weeks, and the sessions took place at the participants’ homes. We used as instruments the Tilburg Frailty Indicator; Fried frailty phenotype; Senior Fitness Test battery; Barthel Index; Lawton Index; handgrip strength measurement; Tinetti Index; Individual lifestyle profile; and Borg’s perception of effort. (3) Results: Post-program, there was an improvement in multidimensional and physical frailty, functional capacity, balance, and perceived exertion (p < 0.05) in the experimental group. Among the older adults’ lifestyles, we observed significant improvements in physical activity habits, relational behavior, and stress management. (4) Conclusions: Rehabilitation nurses have a relevant role, and the AAP-RNP seems to be effective in improving functional capacity and lifestyles in frail older adults.

Effects of Otago Exercise Program on Physical and Psychosocial Functions Among Community-Dwelling and Institutionalized Older Adults: A Scoping Review

To review the effects of Otago exercise program (performed individually or in group) on several physical and psychosocial outcomes for community-dwelling and institutionalized older adults. Fourteen articles met the inclusion criteria. Three electronic databases and reference lists of identified studies were searched. Eligibility criteria included clinical trials of the Otago exercise program conducted among older adults. Two studies were conducted in institutions, 2 in groups. None of the studies reviewed reported the post-intervention result of the Otago exercise program on depression or any other psychological construct. Otago exercise program was effective in reducing falls, improving balance, strength, mobility, and health-related quality of life within the community and in institutions. Available evidence suggests group performance may be better than individual programs. The Otago exercise program is an important and effective exercise strategy which can be administered in groups or individualized to both community-dwelling and institution-resident older adults. Future reviews, especially, systematic reviews with meta-analysis should be performed.

Prescribing tailored home exercise program to older adults in the community using a tailored self-modeled video: A pre-post study

Background

Community rehabilitation for older people after hospital discharge is necessary to regain functional ability and independence. However, poor adherence to exercise programs continues to hinder achieving positive health outcomes in older people. This study aimed to evaluate the effectiveness of prescribing a tailored video self-modeled DVD-HEP for 6 weeks, on functional mobility, physical activity, exercise self-efficacy, and health-related quality of life, in a sample of frail older adults.

Materials and methods

A pre- and post-test intervention study design was conducted, with each participant acting as their own control. A convergent, parallel, mixed-methods approach involving quantitative, and qualitative data collection was used. Participants received an individualized assessment at baseline and subsequently were provided with a 30-min tailored 6-week self-modeled DVD-HEP that showed the physiotherapist instructing the participant. The physiotherapist phoned participants fortnightly to encourage engagement in the program and explore responses to it. Outcomes evaluated included functional mobility, balance, gait speed, and exercise self-efficacy.

Results

Participants (n = 15) showed clinically meaningful improvements at follow-up compared to baseline in functional mobility (TUG_MCID = 3.4-3.5 s, 3-MWT_MCID = 0.1-0.2 m/s) and gait speed (3-MWT_MCID = 0.1-0.2 m/s). There were also significant improvements in balance and self-efficacy for exercise and a 2.5- and a 1.3-fold increase in moderate and light physical activity participation at follow-up compared to baseline. The deductive themes were: (i) Enjoyment, self-efficacy, and wellbeing; (ii) Achieving life goals; (iii) Background music as a motivator to adherence; and (iv) Enhanced motor performance and learning: Task goal mastery, multimodal feedback, autonomy to self-regulate learning. The new inductive theme was (v) Preference for in-person support for exercise.

Conclusion

Future studies are warranted to compare a tailored self-modeled video HEP to face-to-face programs and other digital health modalities to evaluate older adults' adherence levels and functional improvement.

Engagement of older adults in STRIDE's multifactorial fall injury prevention intervention

BACKGROUND

Evidence-based multifactorial fall prevention interventions in clinical practice have been less effective than expected. One plausible reason is that older adults' engagement in fall prevention care is suboptimal.

METHODS

This was a post-hoc analysis of 2403 older adults' engagement in a multifactorial fall prevention intervention in the Strategies to Reduce Injuries and Develop Confidence in Elders (STRIDE) pragmatic trial. Based on the direct clinical care level of the Patient and Family Continuum of Engagement (CE) framework, three indicators of progressively interactive engagement were assessed: (1) Consultation (receiving information), (2) Involvement (prioritizing risks), and (3) Partnership (identifying prevention actions). Drop off at each step was determined as well as predictors of engagement.

RESULTS

The participants' engagement waned with increasingly interactive CE domains. Although all participants received information about their positive fall risk factors (consultation) and most (51%-96%) prioritized them (involvement), fewer participants (33%-55%) identified fall prevention actions (partnership) for most of their risk factors, except for strength gait or balance problems (95%). More participants (70%) identified home exercises than other actions. Finally, fall prevention actions were identified more commonly among participants who received two visits compared to one (OR = 2.33 [95% CI, 2.06-2.64]), were ≥80 years old (OR = 1.83 [95% CI, 1.51-2.23]), and had fewer fall risk factors (OR = 0.90 [95% CI, 0.83-0.99]).

CONCLUSIONS

The drop-off in participants' engagement based on the level of their interaction with clinicians suggests that future multifactorial fall prevention interventions need to be more focused on interactive patient-clinician partnerships that help older adults increase and maintain fall prevention actions. Our analyses suggest that more frequent contact with clinicians and more monitoring of the implementation and outcomes of Fall Prevention Care Plans could potentially improve engagement and help older adults maintain fall prevention actions.

The impact of Otago exercise programme on the prevention of falls in older adult: A systematic review

Objective

To improve the quality of life of older adult in their later years, by increasing the physical activity participation of older adult, the occurrence of falls accident scores in older adult can be prevented. This paper comprehensively summarizes the origin, development, participation forms, and fitness effects of the Otago exercise program (OEP).

Methods

Using PubMed, web of science, CNKI, dimensional spectrum, and other databases, search for research papers from 2005 to April 2021 by using keywords such as Otago project exercise; aged, Fall; Cognitive function, Balance ability, Lower limb strength, Fall efficiency, and so on. PEDro Scale was used to check the quality of the literatures.

Results

A total of 34 papers were included after searching for kinds of literature related to the subject of this paper and after careful review by researchers.

Conclusions

Otago exercise programme is beneficial to improve the cognitive function of older adult, enhance their lower limb muscle strength and dynamic and static balance ability, and then improve the gait stability and posture control ability of older adult, which has significant positive benefits for the prevention of falls in older adult. OEP is helpful to improve the falling efficiency of older adult, help older adult overcome the fear of falling, and form a positive emotion of "exercise improves exercise," to reduce the harm caused by sedentary behavior and the incidence of depression and improve their subjective wellbeing. Although OEP has significant positive effects on improving the health and physical fitness of older adult, preventing falls, and restoring clinical function, the corresponding neural mechanism for preventing falls is not very clear. At the same time, how OEP can be combined with emerging technologies to maximize its benefits needs to be further discussed in the future.

Effect of home-based exercise programs with e-devices on falls among community-dwelling older adults: a meta-analysis

Aim: To explore the effectiveness of home-based exercise programs with e-devices (HEPEs) on falls among community-dwelling older adults. Methods: Twelve randomized controlled trials were included in the meta-analysis considering four fall-related outcomes. Results: HEPEs significantly reduced the rate of falls (risk ratio: 0.82; 95% CI: 0.72-0.95; p = 0.006) and improved lower extremity strength (mean difference: -0.94; 95% CI: -1.71 to -0.47; p < 0.001). There was a significant improvement favoring HEPEs on balance if the participants were aged >75 years (mean difference: -0.55; 95% CI: -1.05 to -0.05; p = 0.03), or the intervention duration was at least 16 weeks (mean difference: -0.81; 95% CI: -1.58 to -0.05; p = 0.04). Conclusion: HEPEs demonstrated an overall positive effect on falls among community-dwelling older adults.

Effects of Modified-Otago Exercise Program on Four Components of Actual Balance and Perceived Balance in Healthy Older Adults

Falls are a serious problem for older adults, leading to adverse injuries and decreased quality of life. Balance impairment is a key factor in falls. The Otago Exercise Program (OEP) is a promising intervention for preventing falls, thereby improving balance and gait. Previous studies reported improved effects on balance using the OEP conducted in a group setting, and recommended additional walking. Walking is a feasible exercise that benefits both fall-related physical and physiological functions. This study aims to investigate the effects of a modified-Otago Exercise Program (modified-OEP) on four components of actual balance (static, dynamic, proactive, and reactive balance) and perceived balance in healthy older adults, by conducting the modified-OEP in a groupsetting, and including additional walking in one session to gain better efficacy. Participants aged 60–85 years old were randomly assigned to the modified-OEP group or the control group (CT). The modified-OEP consisted of 60 min sessions made up of 30 min of OEP and 30 min of walking, three times a week for 12 weeks, while no intervention was assigned to the control group. The modified-OEP group showed significant improvement in the four components of actual balance and in perceived balance. Furthermore, the modified-OEP group outperformed the control group in all parameters except for dynamic balance, after 12 weeks. The present study highlights the beneficial effects of a modified-OEP on all balance components. Additionally, this study is the first to demonstrate the measurement of all actual balance components as well as perceived balance.

Physical and Functional Clinical Profile of Older Adults in Specialized Geriatric Rehabilitation Care Services in Saguenay-Québec: A Retrospective Study at La Baie Hospital

Musculoskeletal disorders, cardiovascular and neurological diseases were the most commonly debilitating conditions and risk factors associated with pain, mobility limitations, increased risk of falls and disability. Studies barely address the profile of older adults in care within a specialized geriatric rehabilitation service (SGRS) to provide subsidies for new actions within the public healthcare to reduce falls and improve management in health investments. This study aimed to establish a clinical physical and functional profile of the patients with neuromusculoskeletal and cognitive disorders and fallers in interventions within SGRS. From a retrospective study design, 127 medical records were compiled and analyzed to determine the physical and functional profile of older adults and differences according to sex, age groups and the benefits for local physical therapy intervention. The users were between 76 and 85 years of age, with diverse clinical diagnoses and debilitating conditions and impairments. A higher proportion presented gait and balance impairments and had two or more falls in 12 months. A significant effect for advanced age was observed. Overall, real benefits were reported with intervention for functional improvement, although the absence of a control group. These results have direct implications for a better understanding of a local SGRS and provide subsidies for developing new approaches for the assessment and treatment of older adults with high a risk of falls in order to reduce costs for the public health system.

Effect of home-based exercise on falls in community-dwelling older adults: an umbrella review

Aims

The aim of this review study was to examine the effectiveness of home-based and community-based exercise programmes in the rate of falls and improving physical functioning in community-dwelling older adults.

Methods

All types of home-based and community-based exercise interventions were searched. From 1186 studies identified, 14 studies were selected for the umbrella review. Most studies had high methodological quality. The types of interventions were multi-functional programmes (n = 11 studies) and Otago Exercise Programme (OEP) (n = 3 studies).

Results

The results showed that home-based and community-based exercise interventions can reduce falls by 22-32%. Studies that included meta-analysis showed that the clinical significance of home-based interventions in fall prevention and improving physical function was moderate to high.

Conclusions

In conclusion, home-based and community-based exercise interventions are a safe, effective, and feasible method of fall prevention that could be implemented with minimum supervision by allied health professionals to maximise autonomy, self-efficacy, and adherence in community-dwelling older adults.

Community-based group physical activity and/or nutrition interventions to promote mobility in older adults: an umbrella review

BACKGROUND

Physical activity and a healthy diet are important in helping to maintain mobility with aging. This umbrella review aims to identify group-based physical activity and/or nutrition interventions for community-dwelling older adults that improve mobility-related outcomes.

METHODS

Five electronic databases (MEDLINE, Embase, CINAHL, Cochrane CENTRAL, Sociological Abstracts) were searched from inception to December 2021. Eligibility criteria included systematic reviews exploring the effectiveness of physical activity or structured exercise, alone or combined with nutrition interventions on mobility-related outcomes (aerobic capacity, physical function, balance, falls/safety, muscle strength, health-related quality of life/wellbeing). Interventions must have been delivered in a group setting to community-dwelling older adults aged 55+. Two reviewers independently performed eligibility screening, critical appraisal (using AMSTAR 2) and data extraction. The GRADE approach was used to reflect the certainty of evidence based on the size of the effect within each mobility-related outcome category. Older adult/provider research partners informed data synthesis and results presentation.

RESULTS

In total, 62 systematic reviews (1 high, 21 moderate, 40 low/critically low quality) were identified; 53 included physical activity only, and nine included both physical activity and nutritional supplements. No reviews included nutrition interventions alone. Combined aerobic/resistance, general physical activity, and mind-body exercise all improved physical function and balance (moderate-high certainty). Aerobic/resistance training improved aerobic capacity (high certainty). Resistance training and general physical activity improved muscle strength (moderate certainty). Aerobic/resistance training and general physical activity are likely to reduce falls among older adults (moderate certainty). There was no evidence of benefit for nutritional supplementation with physical activity.

CONCLUSIONS

Group-based physical activity interventions that combine aerobic and resistance, general PA and mind-body exercise can improve measures of mobility in community-dwelling older adults. We found no reviews focused on nutrition only, highlighting a gap in the literature.

Addressing Physical, Functional, and Physiological Outcomes in Older Adults using an Integrated mHealth Intervention "Active for Life": A Pilot Randomized Controlled Trial

Objective

We evaluated components of an integrated, mobile health-based intervention "Activate for Life" (AFL) on health outcomes in lower-income older adults (≥ 60 years).

Methods

AFL incorporates balance (Otago; OG), physical strength (Gentle Yoga and yogic Breathing; GYYB), and mental engagement (Behavioral Activation; BA) components. Thirty participants were randomly allocated to one of three study arms (n=10): OG (Arm 1), OG+GYYB (Arm 2), or OG+GYYB+BA (Arm 3; a.k.a. "full AFL"). Participants were evaluated for physical, functional, and physiological endpoints at baseline and post-intervention (12-weeks and/or 3-month follow up).

Results

Improvements in pain interference and 1,5- anhydroglucitol biomarker levels over time were noted for all arms. No significant changes were observed for other physical, functional, or physiological measures.

Discussion

This study illustrates potential benefits of the AFL intervention on the health of lower-income older adults. Lessons learned from this pilot trial will inform design improvements for a large-scale randomized controlled trial.

Feasibility of implementing an exercise intervention in older adults with hematologic malignancy

Older adults with Hematologic Malignancy (HM) are vulnerable to functional decline secondary to disease and treatment. Interventions for physical deconditioning, in concert with routine hematology care are limited. The feasibility of accrual, retention, and demand for an exercise intervention among a high-risk HM population was piloted.

METHODS

Older adults with HM, on active treatment, with functional impairment were recruited prospectively to participate in a 6-month Otago Exercise Programme (OEP). Measures of motivation, self-efficacy, patient identified barriers to exercise, barriers to clinical trial enrollment, study satisfaction, and serious adverse events were captured.

RESULTS

63 patients were approached, 18 declined trial enrollment, 45 consented, 30 patients enrolled in the exercise program. The main barrier for trial enrollment was transportation/travel concerns (n = 15). Of the 45 consented participants, 8 (12.7%) dropped out due to clinical deterioration, 5 (7.9%) withdrew, and 2 (3.2%) were ineligible prior to exercise-intervention intiation. The median age was 75.5 years (range 62-83) with plasma cell dyscrasia (63%), non-Hodgkin lymphoma (20%) and leukemia (17%). Retention of the physical therapist (PT) led-OEP was 76.6% of patients (n = 23/30), and end-of-study retention was 66.7% (n = 20/30). Of the evaluable patients, 23/29 completed the PE-led OEP yielding a completion rate of 79%. Participants were extremely motivated (72.4%) and strongly intended (89.7%) to engage in regular physical activity. Exercising when tired increased from a median score of 50 at Visit 1 to 70 at Visit 2, but dropped significantly to 45 at Visit 3 (p < 0.001). Participants reported significantly lower self-efficacy to exercise over the next 6 months from Visit 1 to Visit 3 (p = 0.001).

CONCLUSIONS

Older patients with HM had higher completion of in-person, PT-led exercise compared to at-home, independent exercise. Older adults were motivated and found the program acceptable, yet the ability to sustain a structured exercise program was challenging due to changes in health status. ClinicalTrials.gov Identifier: NCT02791737.

The effect of group-based Otago exercise program on fear of falling and physical function among older adults living in nursing homes: A pilot trial

This pilot trial explored the feasibility of group-based Otago exercise program (OEP) and its impact on fear of falling (FOF) and physical function among Chinese older adults living in nursing homes. The intervention group received group-based OEP for 12 weeks, while the control group received routine care. The modified Survey of Activities and Fear of Falling in the Elderly (mSAFFE), timed Up and Go test (TUG), four-stage Balance test (FSBT), and 30 seconds sit-to-stand test (30s-SST) were used. After twelve weeks, we found that the intervention group had better outcomes than the control group in mSAFFE, TUG, FSBT and 30s-SST (p<0.05). Also, we compared the pretest-posttest results within the two groups, respectively. We found that, within the intervention group, the outcomes of mSAFFE, TUG, FSBT, and 30s-SST become significantly better after twelve weeks, but within the control group, the outcomes of TUG, FSBT, and 30s-SST become significantly worse. Our findings demonstrated that a group-based OEP was feasible and acceptability among Chinese older adults living in nursing homes and the group-based OEP could improve FOF and physical function among those older adults.

The effects of the Otago Exercise Programme on actual and perceived balance in older adults: A meta-analysis

Objective

Falls are serious issues in older populations. Balance problems are a major cause of falls and may lead to fear of falling and decreased balance confidence. The Otago Exercise Programme (OEP) is an effective fall prevention program that benefits balance function and fear of falling. The primary aim of the meta-analysis was to investigate the effectiveness of the OEP intervention on actual balance performance (i.e., static, dynamic, proactive or reactive balance) and perceived balance ability (i.e., balance confidence or fear of falling) for older adults; the secondary aim was to examine which OEP protocol most improves balance in older adults.

Methods

A systematic electronic review search was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines to identify randomized controlled trials (RCTs) investigating the effects of the OEP on actual balance performance and perceived balance ability in healthy older adults, and examining which OEP training protocol and intervention format most improves balance.

Results

A total of 12 RCTs were included in the analyses. The OEP exerted significant effects on static balance (Hedges’s g = 0.388; 95% confidence interval [CI] = 0.131 to 0.645), dynamic balance (g = -0.228; 95% CI = -0.352 to -0.1.4), proactive balance (g = 0.239; 95% CI = 0.061 to 0.416) and perceived balance (g = -0.184; 95% CI = -0.320 to -0.048) in older adults. Subgroup analysis indicated that the group format for the OEP was more effective for improving static (p = 0.008), dynamic (p = 0.004) and perceived balance (p = 0.004) than was the individual format. Sessions of >30 minutes were more effective in improving static (p = 0.007) and perceived balance (p = 0.014) than were sessions of ≤30 minutes. However, the effects of the OEP on balance were unrelated to the types of control group, training frequency and training period.

Discussion

The OEP is helpful for improving actual balance including static, dynamic, and proactive balance; enhancing confidence in balance control; and reducing fear of falling in older adults. In particular, administrating the OEP in a group setting in >30-minute sessions may be the most appropriate and effective exercise protocol for improving balance.

A scoping review of physical activity interventions for older adults

BACKGROUND

To inform implementation and future research, this scoping review investigates the volume of evidence for physical activity interventions among adults aged 60+. Our research questions are: (1) what is the evidence regarding interventions designed to increase total physical activity in adults aged 60+ years, in accordance with three of the four strategic objectives of GAPPA (active societies, active environments, active people); (2) what is the current evidence regarding the effectiveness of physical activity programmes and services designed for older adults?; and (3) What are the evidence gaps requiring further research?

METHODS

We searched PEDro, MEDLINE, CINAHL and Cochrane from 1 January 2010 to 1 November 2020 for systematic reviews and meta-analyses of physical activity interventions in adults aged 60+. We identified interventions designed to: (1) increase physical activity; and (2) deliver physical activity programmes and services in home, community or outpatient settings. We extracted and coded data from eligible reviews according to our proposed framework informed by TIDieR, Prevention of Falls Network Europe (PROFANE), and WHO's International Classification of Functioning, Disability and Health (ICF). We classified the overall findings as positive, negative or inconclusive.

RESULTS

We identified 39 reviews of interventions to increase physical activity and 342 reviews of programmes/services for older adults. Interventions were predominantly structured exercise programmes, including balance strength/resistance training, and physical recreation, such as yoga and tai chi. There were few reviews of health promotion/coaching and health professional education/referral, and none of sport, workplace, sociocultural or environmental interventions. Fewer reported outcomes of total physical activity, social participation and quality of life/well-being. We noted insufficient coverage in diverse and disadvantaged samples and low-middle income countries.

CONCLUSIONS

There is a modest but growing volume of evidence regarding interventions designed to increase total physical activity in older adults, although more interventional studies with long term follow-up are needed, particularly for GAPPA 1. Active Societies and GAPPA 2. Active Environments. By comparison, there is abundant evidence for GAPPA 3. specific programmes and services, but coverage of sport and workplace interventions, and diverse samples and settings is lacking. Comprehensive reviews of individual studies are now needed as well as research targeting neglected outcomes, populations and settings.

The Relation between Functional Performance, Falls and Previous Falls Among Participants in the Otago Programme: A Secondary Data Analysis

Fall prevention is a key priority in healthcare policies. Multicomponent exercises reduce the risk of falls. The purpose of this study is to describe the relationship between functional performance and falls after following the Otago multicomponent exercise programme and previous falls. A prospective multi-centre intervention study was performed on 498 patients aged over 65 in primary care, with or without a history of previous falls. Sociodemographic, anthropometric and functionality data were collected. The primary outcome was the occurrence of falls; functional performance was measured using the Tinetti, Short Physical Performance Battery and Timed Up and Go tests. Among the patients, 29.7% referred to previous falls. There was a statistically significant (p < 0.001) increase in falls at 6 months (10.1%) and at 12 months (7.6%) among participants with previous falls in the baseline assessment compared to those without. In addition, the existence of previous falls could be considered a risk factor at 6 and 12 months (OR =2.37, p = 0.002, and OR = 1.76, p = 0.046, respectively). With regard to balance and gait, differences between the groups were observed at 6 months in the Tinetti score (p < 0.001) and in the baseline assessment Timed Up and Go score (p < 0.044). Multicomponent exercises improve the fall rate, balance and gait in older people, although this improvement is less in people with previous falls. Earlier intervention and tailoring of exercises in patients with previous falls could help improve outcomes.

Can cognitive-motor training improve physical functioning and psychosocial wellbeing in nursing home residents? A randomized controlled feasibility study as part of the PROCARE project

BACKGROUND

A multi-component training program holds promises for the elderly, but still has to be tested on its feasibility and effect in nursing homes.

AIMS

The aim of this study was (1) to design a multi-component training program which improves physical functioning and psychosocial wellbeing and (2) to evaluate the feasibility of this intervention in nursing home residents.

METHODS

This study is a two-arm, stratified-randomized controlled feasibility trail. Twenty-four nursing home residents (aged 83.7 ± 6.4, 21 women) were divided into an intervention and a waiting-list control group. The intervention group completed a multi-component training (including dual-task, dynamic balance, endurance and strength exercises) for 16 weeks (twice per week for 45-60 min). Primary outcomes were lower extremity functionality (SPPB), gait performance (GAITRite), health-related quality of life (SF-12) as well as life satisfaction (SWLS).

RESULTS

Life satisfaction (SWLS) and physical functioning (SPPB) increased in the intervention group after training whereas the control group showed a decrease. Gait parameters could only be analyzed for n = 5 participants of the intervention group and n = 2 of the control group and showed no time differences for the intervention group. The mean number of participants was 12.5 ± 1.9 per session (attendance ranged between 66% and 90%).

CONCLUSION

A multi-component training seems (1) to lead to clinically relevant improvements in physical functioning as well as in psychosocial wellbeing and (2) to be feasible and well accepted in nursing home residents. Nevertheless, the complexity and progression of the program as well as the testing protocol have to be adapted. Further research should test the effectiveness of this adapted program in a larger sample size.

Physical therapy interventions for older people with vertigo, dizziness and balance disorders addressing mobility and participation: a systematic review

BACKGROUND

Vertigo, dizziness and balance disorders (VDB) are among the most relevant contributors to the burden of disability among older adults living in the community and associated with immobility, limitations of activities of daily living and decreased participation. The aim of this study was to identify the quality of evidence of physical therapy interventions that address mobility and participation in older patients with VDB and to characterize the used primary and secondary outcomes.

METHODS

A systematic search via MEDLINE (PubMed), Cochrane Library, CINAHL, PEDro, forward citation tracing and hand search was conducted initially in 11/2017 and updated in 7/2019. We included individual and cluster-randomized controlled trials and trials with quasi-experimental design, published between 2007 and 2017/2019 and including individuals ≥65 years with VDB. Physical therapy and related interventions were reviewed with no restrictions to outcome measurement. Screening of titles, abstracts and full texts, data extraction and critical appraisal was conducted by two independent researchers. The included studies were heterogeneous in terms of interventions and outcome measures. Therefore, a narrative synthesis was conducted.

RESULTS

A total of 20 randomized and 2 non-randomized controlled trials with 1876 patients met the inclusion criteria. The included studies were heterogeneous in terms of complexity of interventions, outcome measures and methodological quality. Vestibular rehabilitation (VR) was examined in twelve studies, computer-assisted VR (CAVR) in five, Tai Chi as VR (TCVR) in three, canal repositioning manoeuvres (CRM) in one and manual therapy (MT) in one study. Mixed effects were found regarding body structure/function and activities/participation. Quality of life and/or falls were assessed, with no differences between groups. VR is with moderate quality of evidence superior to usual care to improve balance, mobility and symptoms.

CONCLUSION

To treat older individuals with VDB, VR in any variation and in addition to CRMs seems to be effective. High-quality randomized trials need to be conducted to inform clinical decision making.

TRIAL REGISTRATION

PROSPERO 2017 CRD42017080291 .

Balance and functional training and health in adults: an overview of systematic reviews

This overview of systematic reviews examined the effect of balance and functional strength training on health outcomes in adults aged 18 years or older, to inform the Canadian 24-hour Movement Guidelines. Four electronic databases were searched for systematic reviews published between January 2009 and May 2019. Eligibility criteria were determined a priori for population (community-dwelling adults), intervention (balance and functional training), comparator (no intervention or different types/doses), and outcomes (critical: falls and fall-related injuries; adverse events; important: physical functioning and disability; health-related quality of life; physical activity; and sedentary behaviour). Two reviewers independently screened studies for eligibility and performed AMSTAR 2 assessment. One review was selected per outcome. Of 3288 records and 355 full-text articles, 5 systematic reviews were included, encompassing data from 15 890 participants in 23 countries. In adults 65 years and older, balance and functional training and Tai Chi reduced the rate of falls and the number of people who fell, and improved aspects of physical functioning and physical activity. The effect on health-related quality of life and falls requiring hospitalization was uncertain. While inconsistently monitored, only 1 serious adverse event was reported. No evidence was available in adults under age 65 years. Included systematic reviews and primary evidence reported by review authors ranged in quality. Overall, participation in balance and functional training reduced falls and improved health outcomes in adults 65 years of age and older. PROSPERO registration no.: CRD42019134865.

Novelty This overview informs updated guidelines for balance training in adults. Balance and functional training reduced falls and improved health outcomes.

The Effects of Physical Exercise on Balance and Prevention of Falls in Older People: A Systematic Review and Meta-Analysis

The aims of this systematic review and meta-analysis were to evaluate the effects of physical exercise on static and dynamic balance in the elderly population, and to analyze the number of falls and fallers. A systematic literature search was conducted using PubMed-Medline, Cochrane Central, and Google Scholar to select randomized clinical trials that analyzed the role of exercise on balance and fall rate in patients aged 65 or older. Sixteen articles were included in this review. Applying the Cochrane risk-of-bias tool, three studies were determined to be at low risk of bias, nine at unclear risk of bias, and four at high risk of bias. The meta-analysis showed improvements in dynamic balance (p = 0.008), static balance (p = 0.01), participants' fear of falling (p = 0.10), balance confidence (p = 0.04), quality of life (p = 0.08), and physical performance (p = 0.30) in patients who underwent physical exercise compared to controls. The analysis of the total numbers of falls showed a decreased likelihood of falls in patients who participated in exercise programs (p = 0.0008). Finally, the number of patients who fell at least once was significantly reduced in the intervention group (p = 0.02). Physical exercise is an effective treatment to improve balance and reduce fall rates in the elderly.

Effects of dynamic exercise utilizing PNF patterns on the balance of healthy adults

[Purpose] The purpose of this study is to examine the effects of dynamic exercise utilizing the proprioceptive neuromuscular facilitation patterns accompanied by the abdomen drawing-in on balance of healthy adults. [Participants and Methods] The total number of participants was 30, and 15 were randomly placed in the training group (TG) and 15 in the control group (CG). The participants in the TG have conducted the 3 sets to 5 sets of dynamic exercise utilizing the proprioceptive neuromuscular facilitation patterns per day, 3 times a week for 6 weeks. The balance was measured by the Terax, a balance-measuring device with force plates. [Results] Comparing the TG's balance pre-test and post-test, there was a statistical significance in stability score (SS), weight distribution index (WDI), CD force plates and AC force plates (A: left rearfoot, B: left forefoot, C: right rearfoot, D: right forefoot). [Conclusion] Dynamic trunk stabilization exercise utilizing the proprioceptive neuromuscular facilitation patterns seem to help increase the balance of healthy adults.

Effects of A "Modified" Otago Exercise Program on the Functional Abilities and Social Participation of Older Adults Living in the Community-The AGA@4life Model

Strength and balance exercises form part of multifactorial programs to reduce the risk of falling and promote active ageing. The aim of this study was to evaluate the effect of a strength and balance exercise program, adapted from the traditional Otago Exercise Program (OTAGO) into a technological system. A non-randomized experimental study enrolled 34 participants (83.24 ± 6.89 years) from a daycare center in Portugal, who were distributed into an intervention group (IG; 18 participants) and a control group (CG; 16 participants). The IG underwent a "modified" OTAGO incorporated in a technological system using pressure and inertial sensors, feedback, and Exergames for 8 weeks, 3 times a week. The CG continued their regular activities. Outcome measures were evaluated at baseline and after 8 weeks of intervention. After the program, differences were observed between the groups in handgrip strength (p = 0.03), step test (p = 0.03), 4stage balance test "modified" (p < 0.001) and activities and participation profile related to mobility (PAPM) (p < 0.001). The IG showed positive results in the self-efficacy for exercise (p = 0.03), PAPM (p = 0.00) and all functional tests, except for timed up and go (p = 0.35). No significant changes were observed in the CG. The results support this intervention program as a good exercise solution to improve functional abilities, social participation, and self-efficacy, reducing the risk of falling.

Bridging the gap between research-based knowledge and clinical practice: a qualitative examination of patients and physiotherapists' views on the Otago exercise Programme

BACKGROUND

Falls and fall-related injuries exacerbate the health problems of older adults, and they are a public health concern. Despite an abundance of research, the implementation of evidence-based fall prevention programs has been slow and limited, additionally and these programs have not reduced the incidence of falling. Therefore, the primary objective of the present study was to examine patients and physiotherapists' views on the factors that influence the implementation of the community- and evidence-based Otago Exercise Programme for fall prevention.

METHODS

We conducted eight in-depth interviews with physiotherapists and patients, and a focus group interview with 12 physiotherapists and authority figures who represented local hospitals and municipalities. The resultant qualitative data were subjected to thematic analysis.

RESULTS

The analysis yielded two main themes: the researcher's role and position in the implementation process and the tension between research-based knowledge and clinical practice. The participants believed that research-based knowledge can address the challenges of clinical practice. Further, the patients reported that the fall prevention program made them feel safe and enhanced their ability to cope with daily life. The physiotherapists also observed that research findings do not readily translate into clinical practice. Further, they contended that research-based knowledge is not universal and that it cannot be generalized across different contexts; instead, it must be adapted and translated into a user-friendly language. The findings suggest that the application of research-based knowledge does equate to filling up empty jars and that research-based knowledge does not flow from the expert to the non-expert as water through a tube. Indeed, physiotherapists and patients are not tabula rasa. Additionally, the participants believed that researchers and stakeholders must think critically about who has the power and voice to create a common understanding.

CONCLUSIONS

Our findings delineate the means by which the gap between research and practice regarding the Otago fall prevention program can bridged. The program can guide clinical work and provide important information that can be used to improve the quality of other fall prevention programs. However, the research-based knowledge that it confers must be adapted for use in clinical contexts.

Developing an Intervention for Fall-Related Injuries in Dementia (DIFRID): an integrated, mixed-methods approach

BACKGROUND

Falls in people with dementia can result in a number of physical and psychosocial consequences. However, there is limited evidence to inform how best to deliver services to people with dementia following a fall. The aim of the DIFRID study was to determine the feasibility of developing and implementing a new intervention to improve outcomes for people with dementia with fall-related injuries; this encompasses both short-term recovery and reducing the likelihood of future falls. This paper details the development of the DIFRID intervention.

METHODS

The intervention was designed using an integrated, mixed-methods approach. This involved a realist synthesis of the literature and qualitative data gathered through interviews and focus groups with health and social care professionals (n = 81). An effectiveness review and further interviews and observation were also conducted and are reported elsewhere. A modified Delphi panel approach with 24 experts was then used to establish a consensus on how the findings should translate into a new intervention. After feedback from key stakeholders (n = 15) on the proposed model, the intervention was manualised and training developed.

RESULTS

We identified key components of a new intervention covering three broad areas: • Ensuring that the circumstances of rehabilitation are optimised for people with dementia • Compensating for the reduced ability of people with dementia to self-manage • Equipping the workforce with the necessary skills and information to care for this patient group Consensus was achieved on 54 of 69 statements over two rounds of the Delphi surveys. The statements were used to model the intervention and finalise the accompanying manual and protocol for a feasibility study. Stakeholder feedback was generally positive and the majority of suggested intervention components were approved. The proposed outcome was a 12-week complex multidisciplinary intervention primarily based at the patient's home.

CONCLUSIONS

A new intervention has been developed to improve outcomes for people with dementia following a fall requiring healthcare attention. The feasibility of this intervention is currently being tested.

TRIAL REGISTRATION

ISRCTN41760734 (16/11/2015).