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Aiguade R.1, Moure L.1, Guitard L.1, Aguado X.2, Fuente A.3
1University of Lleida, Physical Therapy, Lleida, Spain, 2University of Castilla La Mancha, School of Physical Activity and Sports, Toledo, Spain, 3University of Girona - University of Barcelona, EUSES School of Physiotherapy, Bellvitge Campus, Barcelona, Spain
Background: The incidence of falls in institutionalized patients is greater for those suffering from Backward Disequilibrium (BD). Foot and proprioceptive physiotherapy treatment are key aspects to successfully treating the motor components of BD. Differentiating the work of the fore and rearfoot has been advised in the past. Unstable mini-boards are novel, small platforms of hard plastic, and various shapes. They allow for rear and forefoot differentiated work and are safer to use than the usual, larger platforms.
Purpose: The study's primary objective was to determine whether this protocol could improve balance in institutionalized older adults with BD syndrome. Secondary objectives were: to identify changes in balance and to compare them to the standard physiotherapy treatment.
The study was developed to obtain a PhD in Public Health, for the School of Medicine at the Barcelona Autonomous University.
The study was developed to obtain a PhD in Public Health, for the School of Medicine at the Barcelona Autonomous University.
Methods: A case series study was conducted with 80 (p 0.05) institutionalized participants, ages ≥65, diagnosed with BD, with a Tinetti test (TT) score of ≤19 (high fall risk), not presenting vestibular or cerebellar disorders. After baseline measuring with Timed Up and Go (TUG) and TT tests, participants performed a proprioceptive treatment protocol using unstable mini-boards. For each foot, it consisted in 5 sets of 2-minute exercises, and a 2-minute rest time in between series. It was performed 3 times per week, over a 12-week period. The outcomes were TUG and TT test scores -considering static (TTSB) and dynamic balance (TTDB) scores - at weeks 6, 8 and 12. Data analysis was conducted by an independent statistician using SPSS-IBM 21.0, Friedman and Wilcoxon test.
Results: Compliance rate at the end of the study was 100% (p 0.0001). Measured at weeks 8 and 12, TUG scores showed a significant reduction (p 0.0001) compared to baseline, but were not significant at week 6. Intra-subject TUG improvements were significant (p 0.05). TTSB scores showed a progressive and significant improvement(p 0.0001) for all comparison measurements, from baseline to week 12. Intra-subject TTSB improvements were significant (p 0.01). TTDB scores showed significant improvement
(p 0.0001) at weeks 6, 8 and 12, but not from baseline to week 6 (p=0.059). Intra-subject TTDB improvements were significant (p 0.01) for weeks 6, 8 and 12. TT scores showed a progressive and significant improvement (p 0.0001) for all comparison measurements. Intra-subject TT improvements were also significant (p 0.01).
Conclusion(s): The use of mini-boards was well tolerated. There were no dropouts or adverse events, thus the use of unstable mini-boards can be considered safe. The study protocol causes continuous improvement of TUG and TTSB scores, but at least 8 weeks of treatment are need for significant results. Because improvement of TUG and TTSB scores strongly correlate to effective fall prevention, the use of unstable mini-boards could make for a cost-efficient, convenient and effective way to treat BD syndrome.
Implications: The use of unstable mini-boards should be considered as an effective proprioceptive treatment for institutionalized older adults. Balance can be expected to significantly improve after 8 weeks of treatment.
Funding acknowledgements: The study was partially funded by the University of Lleida, an institution that states no conflicts of interest.
Topic: Older people
Ethics approval: The study was authorized by the Ethics Committee for Clinical Research , at Hospital Universitari Arnau de Vilanova, in Spain.
All authors, affiliations and abstracts have been published as submitted.
