PERTURBATION TRAINING COMPARED TO BALANCE AND STRENGTHENING EXERCISE AMONG ELDERLY AT RISK OF FALLING. A RANDOMIZES CONTROLLED TRIAL

A. Shashua¹, S. Yaron², I. Levran¹

¹Clalit Health Services, Physical Therapy, Tel Aviv, Israel, ²Clalit Health Services, Community Medicine, Tel Aviv, Israel

Background: Falls among elderly is very prevalent. Walking is the major activity in which large proportion of falls in older adults occurs. Several studies recommend including challenging balance conditions and perturbations in exercise interventions to reduce the fall risk in older adults.
Balance Tutor (BT) system is a unique technology, which allows reactive response training in both standing and walking using controlled perturbation in simple task or multitask performance.

Purpose: To evaluate the effectiveness of a perturbation training program using BT on falls and risk of falling, among elderly at risk of falling, compared to balance and strengthening exercise.

Methods: A randomized control trial amongolder adults aged 65-85, at moderate and high risk of falling, who were referred to one of three physical therapy clinics of Clalit Health Services. Exclusion criteria were progressive neurological conditions, severe orthopedic conditions, blindness, uncontrolled chronic disease, severe osteoporosis, and active cancer during the past three years prior to baseline. After approving informed consent, participants were randomly assigned to BT or balance exercise group. Participants in both groups received twelve physical therapy treatment sessions of 30 minutes twice a week, and two additional sessions for baseline and final assessment. The BT intervention included controlled perturbation training while standing or walking on the BT device. The dose and intensity of perturbations were adjusted to each individual. The balance exercise intervention included individual balance and strengthening exercise, using different bases of support and adjusted difficulty level.
Primary outcome measure was rate of falls 6 months and 1 year after end of intervention. Secondary outcome measures included Balance Evaluation Systems Test (Mini-BESTest), fear of falling assessed by Activities-Specific Balance Confidence Scale (ABC scale), and level of physical activity assessed by the Physical Activity Scale for the Elderly (PASE).

Results: We recruited 105 participants with mean age of 73±5.615. Fifty-five were allocated for the BT group and fifty for the balance exercise group. No differences were observed between baseline characteristics of both groups.
Rate of falls decreased significantly in both groups post intervention (13.5% and 5.3% for BT and balance exercise, respectively; Pv<0.001), and increased between end of treatment and 6 months follow up in the balance exercise group (17.6%, Pv=0.027). In between group comparison, no differences were found in rate of falls through all follow up measurements.
As for the secondary outcomes, in pre post comparison, participants in both groups improved in Mini-BESTest (M=20.76, Pv<0.001) with no differences between groups in all secondary outcomes.

Conclusions: Both perturbation training and balance exercise training are effective in reducing fall rates and improving balance performance among elderly at risk of falling. However, after termination of treatment, rates of falls tend to increase.

Implications: Intervention programs for elderly at risk of falling, containing balance training of any kind, should be continuous or at least intermittent in order to maintain balance abilities and prevent falls.

Funding acknowledgements: The authors acknowledge Meditouch LTD for supplying the Balance Tutor device for Clalit Health Services.

Keywords:
Fall prevention
Perturbation training
Elderly

Topics:
Health promotion & wellbeing/healthy ageing/physical activity
Innovative technology: robotics
Older people

Did this work require ethics approval? Yes

Institution: Clalit Health Services

Committee: community Helsinki Committee

Ethics number: 0075-19-COM2