Baldursdottir B1, Whitney SL2, Ramel A3, Jonsson PV4, Mogensen B4, Petersen H4, Kristinsdottir EK4
1Landspitali University Hospital, Physiotherapy, Reykjavik, Iceland, 2University of Pittsburgh, Physical Therapy, Pittsburg, United States, 3Gerontological Research Institute, Landspitali, Reykjavik, Iceland, 4University of Iceland, Faculty of Medicine, Reykjavik, Iceland
Background: Wrist fracture is the most frequent first fracture among Icelandic women. It has shown to be a strong predictor of future fracture risk and often is a precursor to hip fractures. Asymmetric vestibular function, decreased plantar sensation, reduced postural control and muscle strength in lower limbs have been associated with fall-related wrist fractures.
Purpose: To investigate whether multi-sensory balance training (MST) improves postural control, vestibular function, foot sensation and functional ability among people with fall-related wrist fractures compared to wrist stabilization training (WT).
Methods: This was an assessor-blinded, randomized controlled trial. Ninety-eight participants, who had sustained a fall-related wrist fracture (mean age: 61.9 ± 7.1; range 50-75; females = 85, males = 13), were randomized to MST or WT. Participants in both groups attended six treatment sessions (30 minutes each), supervised by a physiotherapist, during a three months period. Participants in both groups further received a written exercise program that was to be performed daily at home. Outcome measures before and after the training included the head-shake test (HST) and the video-head impulse test (vHIT) to assess vestibular function, Semmes-Weinstein Monofilaments (SWF) and the Biothesiometer (BT) were used to quantify sensation in the feet, the Sensory Organization Test (SOT) was utilized to assess postural control, the 10-Meter Walk-Test (10MWT) was used to record walking speed and the Five-Times Sit-to-Stand Test (FTSTS) to assess lower limb muscle strength. Perceived dizziness and confidence during daily activities were assessed with the Dizziness Handicap Inventory (DHI) and Activities-specific Balance Confidence (ABC) scales.
Results: There was a 16% non-significant (p=0.058) reduction in asymmetric vestibular function (HST) in the MST group but no change in the WT group. There were significant endpoint differences in the SOT composite score (p=0.01) between the two groups, in favour of the MST group, but no changes were seen in other outcome variables. Subgroup analysis with participants below normal baseline SOT composite scores indicated that the MST was more effective in improving 10MWT fast (p=0.04), FTSTS (p=0.04), SWF (p=0.04) and SOT scores (p=0.04) than the WT group.
Conclusion(s): Multi-sensory training improved postural control among people with fall-related wrist fracture, especially in those who had poor balance.
Implications: In the current emergency care settings in Iceland, people aged 50-75 years, who have sustained a fall-related wrist fracture receive treatment for the fracture. However, postural control, vestibular function, sensation in the feet and lower-limb strength are usually not evaluated and exercise programmes to improve or maintain balance control to reduce the risk of future falls is not routinely offered. As the study results suggest that MST is more effective for those with SOT balance scores below age related norms, post- wrist fracture multi-sensory balance training should be available for individuals who are found to have reduced balance control as part of falls and fracture prevention.
Keywords: Wrist fracture, Multi-sensory training, Fall-prevention
Funding acknowledgements: The St. Josef's Hospital Fund, Reykjavik, Iceland. The Icelandic Physiotherapy Association Research Fund. The Landspitali University Hospital Research Fund.
Purpose: To investigate whether multi-sensory balance training (MST) improves postural control, vestibular function, foot sensation and functional ability among people with fall-related wrist fractures compared to wrist stabilization training (WT).
Methods: This was an assessor-blinded, randomized controlled trial. Ninety-eight participants, who had sustained a fall-related wrist fracture (mean age: 61.9 ± 7.1; range 50-75; females = 85, males = 13), were randomized to MST or WT. Participants in both groups attended six treatment sessions (30 minutes each), supervised by a physiotherapist, during a three months period. Participants in both groups further received a written exercise program that was to be performed daily at home. Outcome measures before and after the training included the head-shake test (HST) and the video-head impulse test (vHIT) to assess vestibular function, Semmes-Weinstein Monofilaments (SWF) and the Biothesiometer (BT) were used to quantify sensation in the feet, the Sensory Organization Test (SOT) was utilized to assess postural control, the 10-Meter Walk-Test (10MWT) was used to record walking speed and the Five-Times Sit-to-Stand Test (FTSTS) to assess lower limb muscle strength. Perceived dizziness and confidence during daily activities were assessed with the Dizziness Handicap Inventory (DHI) and Activities-specific Balance Confidence (ABC) scales.
Results: There was a 16% non-significant (p=0.058) reduction in asymmetric vestibular function (HST) in the MST group but no change in the WT group. There were significant endpoint differences in the SOT composite score (p=0.01) between the two groups, in favour of the MST group, but no changes were seen in other outcome variables. Subgroup analysis with participants below normal baseline SOT composite scores indicated that the MST was more effective in improving 10MWT fast (p=0.04), FTSTS (p=0.04), SWF (p=0.04) and SOT scores (p=0.04) than the WT group.
Conclusion(s): Multi-sensory training improved postural control among people with fall-related wrist fracture, especially in those who had poor balance.
Implications: In the current emergency care settings in Iceland, people aged 50-75 years, who have sustained a fall-related wrist fracture receive treatment for the fracture. However, postural control, vestibular function, sensation in the feet and lower-limb strength are usually not evaluated and exercise programmes to improve or maintain balance control to reduce the risk of future falls is not routinely offered. As the study results suggest that MST is more effective for those with SOT balance scores below age related norms, post- wrist fracture multi-sensory balance training should be available for individuals who are found to have reduced balance control as part of falls and fracture prevention.
Keywords: Wrist fracture, Multi-sensory training, Fall-prevention
Funding acknowledgements: The St. Josef's Hospital Fund, Reykjavik, Iceland. The Icelandic Physiotherapy Association Research Fund. The Landspitali University Hospital Research Fund.
Topic: Disability & rehabilitation; Older people
Ethics approval required: Yes
Institution: Landspitali University Hospital
Ethics committee: The Icelandic National Bioethics Committee
Ethics number: VSNb2013110036/03.11
All authors, affiliations and abstracts have been published as submitted.
