OP0158-HPR THE FALL PREVENTION PROGRAMME ‘SICHER DURCH DEN ALLTAG’ IS EFFECTIVE AND COST-EFFECTIVE

Background:

Falls in older people are frequent and have often severe health consequences. Reinforced by population ageing, they represent a substantial challenge for health care systems. Falls are often due to a combination of intrinsic and extrinsic risk factors. For these reasons, the Swiss League Against Rheumatism (SLAR) developed the multidimensional, home-based fall prevention programme ‘Sicher durch den Alltag’ (‘Safely Through Everyday Life’). The programme has been implemented nationwide since 2013 and is financed by selected health insurance companies. Trained physiotherapists (PTs) or occupational therapists (OTs) visit the senior at home for a 60-90 minutes session. They perform a detailed assessment of the senior’s individual risk of falling and subsequently eliminate identified environmental risk factors and provide tailored exercises. After 4 weeks, the PT/OT calls the senior to discuss further needs. The cost of the intervention is at 500 Swiss Francs (approximately 460 Euro) per senior.

Objectives:

Assess the effectiveness and cost-effectiveness of this fall prevention programme.

Methods:

A prospective, longitudinal observational study was performed. Baseline study data was assessed at the home visit, including the self-reported number of falls during a) the year and b) the month before the visit. The participants of the programme were monitored for one year after the home visit by bi-monthly telephone calls. Participants were asked to report the falls that they continuously documented in a diary. Questionnaires administered orally included the Falls Efficacy Scale-International (FES-I), a Quality of Life Questionnaire (EQ-5D-5L), and the amount of moderately intensive physical activity (PA).To compare the falls during the years before and after the home visit, the mean number of falls before the visit was calculated based on reported falls during a) the year and b) the month (multiplied by 12) before the visit. A 2:1 weighted mean from a) and b) was calculated, considering that retrospective reporting over one year or over one month may underestimate or overestimate, respectively, the number of falls. Statistical analysis fitted a GEE-Poisson-Modell (Generalized Estimating Equations) to the data for number of falls and a Linear Mixed Model (LMM) for fear of falling, quality of life and PA. Falls related health care spending in the years before and after the intervention were compared based on health insurance claims data.

Results:

Overall, 639 person-years of observation time were available for analysis. Participants were mainly female (59%) and had a mean age of 81.8+/- 5.2 years. On average, rate of falling decreased from 1.35 to 1.02 per person year (-23.9%), fear of falling decreased by -1.27 (95%CI -1.50, -1.05), quality of life improved by -0.88 (95%CI -1.09, -0.68), PA increased by 9.87 minutes per day (95%CI 5.65, 14.09). Health insurance claims data showed a 48.0% reduction (95%CI 30.5%, 61.0%) of medically treated falls. The average cost per prevented medically treated fall was estimated at 1317 Swiss Francs (approximately 1200 Euro) and the probability of the intervention being cost-saving at 47%.

Conclusion:

This low-threshold fall prevention programme was found to be very effective and cost-effective. Home visits by trained PTs or OTs contribute substantially to reduce falls in the elderly. The high cost-effectiveness is explained by a substantial reduction of severe falls.

References:

[1]Swiss Council for Accident Prevention BFU (2019); https://www.bfu.ch/de/die-bfu/medien/statistik-der-nichtberufsunfaelle-1. Downloaded 15 Dec. 2020.

[2]Kempen G et al. The Short FES-I: a shortened version of the falls efficacy scale-international to assess fear of falling. Age and Ageing, 37(1)

[3]Herdman M et al. Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L). Qual Life Res. 2011;20(10):1727.

[4]Craig CL et al: International physical activity questionnaire: 12-country reliability and validity. Medicine and science in sports and exercise 2003, 35(8):1381-1395

Disclosure of Interests:

None declared

Sensorimotor and body perception assessments of nonspecific chronic low back pain: a cross-sectional study

BACKGROUND

Low back pain (LBP) is one of the most common musculoskeletal disorders, causing significant personal and social burden. Current research is focused on the processes of the central nervous system (particularly the sensorimotor system) and body perception, with a view to developing new and more efficient ways to treat chronic low back pain (CLBP). Several clinical tests have been suggested that might have the ability to detect alterations in the sensorimotor system. These include back-photo assessment (BPA), two-point discrimination (TPD), and the movement control tests (MCT). The aim of this study was to determine whether the simple clinical tests of BPA, TPD or MCT are able to discriminate between nonspecific CLBP subjects with altered body perception and healthy controls.

METHODS

A cross-sectional study was conducted. At one point in time, 30 subjects with CLBP and 30 healthy controls were investigated through using BPA, TPD and MCT on the lower back. Correlations among the main covariates and odds ratios for group differences were calculated.

RESULTS

MCT showed an odds ratio for the presence of CLBP of 1.92, with a statistically significant p-value (0.049) and 95%CI. The TPD and BPA tests were unable to determine significant differences between the groups.

CONCLUSIONS

Of the three tests investigated, MCT was found to be the only suitable assessment to discriminate between nonspecific CLBP subjects and healthy controls. The MCT can be recommended as a simple clinical tool to detect alterations in the sensorimotor system of nonspecific CLBP subjects. This could facilitate the development of tailored management strategies for this challenging LBP subgroup. However, further research is necessary to elucidate the potential of all the tests to detect alterations in the sensorimotor system of CLBP subjects.

TRIAL REGISTRATION

No trial registration was needed as the study contains no intervention. The study was approved by the Swiss Ethics Commission of Northwest and Central Switzerland (EKNZ) reference number 2015-243.

An investigation into the association of the physical fitness of equestrians and their riding performance: a cross-sectional study

Poor riding performance may be due to medical issues with the horse or a variety of other factors, such as inadequate equipment or deficiencies in training. The physical fitness of the equestrian is one of the most unexplained factors of current research. The aim of this study is to investigate the association between the physical fitness of the equestrian and riding performance. 115 equestrians were assessed for physical fitness and riding performance. Seven components of physical fitness (balance, endurance, flexibility, reaction, speed, strength, symmetry) were measured by a physiotherapist using equestrian-specific tests. Based on a video-recorded riding test, individual riding performance was rated by two equestrian judges. The riding test included the horse and rider performing a walk, sitting trot, rising trot and canter in both directions. A linear model for riding performance, including the domains of physical fitness and potential confounders (body-mass-index, riding experience, hours of riding per week, and test-motivation), was fitted to the data. Inter-rater reliability of the judges was investigated by calculating the intraclass correlation coefficient (ICC). Endurance, reaction and strength were positively associated with riding performance, whereas flexibility had a negative association. The final model could explain 16.7% of the variance in riding performance. The effects of endurance and strength were significant (P<0.05), but not that of reaction. No association with riding performance was found for the components of balance, speed and symmetry. The inter-rater reliability of judges was confirmed to be ‘good’ to ‘excellent’ (ICC=0.9, 95% confidence interval: 0.86-0.93). Findings suggest that physical fitness is positively associated with riding performance. Fitness-training for equestrians should be included in current training concepts. Future research should investigate whether similar associations exist for junior and elite athletes.

Efficacy of six months neuromuscular exercise on lumbar movement variability - A randomized controlled trial

INTRODUCTION

Lumbar movement variability during heavy, repetitive work may be a protective mechanism to diminish the progression of lumbar disorders and maintain neuromuscular functional integrity. The effect of neuromuscular exercise (NME) on the variability of lumbar movement is still to be determined.

METHODS

A randomised controlled trial was conducted on a population of nursing personnel with subacute LBP. Following randomization, the NME group participants completed an NME program of six months duration. The participants in the control group only attended the assessment sessions. The outcomes were assessed at: baseline; after six months intervention; 12 months. The primary outcome was lumbar movement variability based on angular displacement and velocity.

RESULTS

A positive treatment effect on lumbar movement variability was seen after six months of NME intervention. Angular displacement improved, and angular velocity remained constant. At the 12-month follow up, however, the effect faded in the NME group. Lumbar movement variability worsened in the control group over all time periods.

CONCLUSION

NME may improve lumbar movement variability in the short term and may indicate improved neuromuscular functional integrity. The design of an optimal NME program to achieve long-term improvement in lumbar movement variability is a subject worthy of further research.

Pain intensity attenuates movement control of the lumbar spine in low back pain

INTRODUCTION

Pain intensity attenuates muscular activity, proprioception, and tactile acuity, with consequent changes of joint kinematics. People suffering from low back pain (LBP) frequently show movement control impairments of the lumbar spine in sagittal plane. This cross-sectional, observational study investigated if the intensity of LBP attenuates lumbar movement control. The hypothesis was that lumbar movement control becomes more limited with increased pain intensity.

METHODS

The effect of LBP intensity, measured with a numeric rating scale (NRS), on lumbar movement control was tested using three movement control tests. The lumbar range of motion (ROM), the ratio of lumbar and hip ROM as indicators of direction specific movement control, and the recurrence and determinism of repetitive lumbar movement patterns were assessed in ninety-four persons suffering from LBP of different intensity and measured with an inertial measurement unit system. Generalized linear models were fitted for each outcome.

RESULTS

Lumbar ROM (+ 0.03°, p = 0.24) and ratio of lumbar and hip ROM (0.01, p = 0.84) were unaffected by LBP intensity. Each one point increase on the NRS resulted in a decrease of recurrence and determinism of lumbar movement patterns (-3.11 to -0.06, p ⩽ 0.05).

DISCUSSION

Our results indicate changes in movement control in people suffering from LBP. Whether decreased recurrence and determinism of lumbar movement patterns are intensifiers of LBP intensity or a consequence thereof should be addressed in a future prospective study.

Differences in activities of daily living (ADL) abilities of children across world regions: a validity study of the assessment of motor and process skills

BACKGROUND

One important goal of paediatric occupational therapy services is to improve activities of daily living (ADL) abilities of children. In order to plan and evaluate the effectiveness of targeted interventions, valid assessments are critically needed. The Assessment of Motor and Process Skills (AMPS) is an internationally standardized assessment of ADL performance that has not been validated for use with children in Middle Europe.

AIM

To evaluate for (i) significant differences in mean ADL motor and mean ADL process ability measures among children from Middle Europe compared with children from North America, UK/Republic of Ireland, Nordic countries, Western Europe, Australia/New Zealand and Asia; and (ii) meaningful differences between the international age-normative means of the AMPS and those for children from Middle Europe.

METHOD

We analysed data of children across world regions extracted from the international AMPS database using many-facet Rasch and two-way anova analyses and by estimating contrasts to evaluate for significant group differences.

RESULTS

anova analyses of data for 11 189 children ages 2-15 revealed significant effects for mean ADL motor and ADL process ability by region [F ≥ 15.32, d.f. = (6, 11 091), MSE ≥ 0.20, P < 0.001, ή(2) ≥ 0.008], and age [F ≥ 253.47, d.f. = (13, 11 091), MSE ≥ 0.20, P < 0.001, ή(2) ≥ 0.229], and a significant interaction effect for mean ADL process ability [F = 1.48, d.f. = (78, 11 091), P = 0.004, ή(2) = 0.010]. Out of 168 estimated contrasts between Middle Europe and the other world regions for mean ADL motor and ADL process ability, seven were statistically significant (4.17%), but none exceeded ±1SE from the international means.

CONCLUSION

The AMPS remains free of relevant differences in mean ADL ability measures between Middle Europe and other world regions, indicating that the international age-normative mean values are likely to be applicable to children from Middle Europe. The AMPS can be used internationally to evaluate ADL performance in children and to determine if the child is eligible for occupational therapy services.

The effect of mountain bike suspensions on vibrations and off-road uphill performance

AIM

This study evaluates the effect of front suspension (FS) and dual suspension (DS) mountain-bike on performance and vibrations during off-road uphill riding.

METHODS

Thirteen male cyclists (27+/-5 years, 70+/-6 kg, VO(2max)59+/-6 mL.kg(-1).min(-1), mean+/-SD) performed, in a random sequence, at their lactate threshold, an off-road uphill course (1.69 km, 212 m elevation gain) with both type of bicycles. Variable measured: a) VO(2) consumption (K4b2 analyzer, Cosmed), b) power output (SRM) c) gain in altitude and d) 3-D accelerations under the saddle and at the wheel (Physilog, EPFL, Switzerland). Power spectral analy- sis (Fourier) was performed from the vertical acceleration data.

RESULTS

Respectively for the FS and DS mountain bike: speed amounted to 7.5+/-0.7 km.h(-1) and 7.4+/-0.8 km.h(-1), (NS), energy expenditure 1.39+/-0.16 kW and 1.38+/-0.18, (NS), gross efficiency 0.161+/-0.013 and 0.159+/-0.013, (NS), peak frequency of vibration under the saddle 4.78+/-2.85 Hz and 2.27+/-0.2 Hz (P<0.01) and median-frequency of vertical displacements of the saddle 9.41+/-1.47 Hz and 5.78+/-2.27 Hz (P<0.01).

CONCLUSION

Vibrations at the saddle level of the DS bike are of low frequencies whereas those of the FS bike are mostly of high frequencies. In the DS bike, the torque produced by the cyclist at the pedal level may generate low frequency vibrations. We conclude that the DS bike absorbs more high frequency vibrations, is more comfortable and performs as well as the FS bicycle.