Richardson J.1, Dufour S.1, Sinclair S.1
1McMaster University, School of Rehabilitation Science, Hamilton, Canada
Background: Approaching functional decline from a primary prevention perspective through targeting low risk individuals for falls prevention is important. However, it is likewise essential that older people are appropriately assigned to the most clinically and cost-effective primary prevention intervention. Individuals in the preclinical Mobility Limitation (PCML) stage constitute a cohort of individuals at a lower risk for falls. Therefore we hypothesis that a task oriented motor learning program will show greater changes in mobility than the current community-based falls-prevention exercise program and is likely to be more sustainable and tailored for individuals. in the PCML stage.
Purpose: The purpose of this study was to determine whether older adults with PCML show greater improvement in mobility (gait speed,) gait endurance, lower extremity strength, gait efficacy and number of falls) after a 12-week multi component intervention that include task oriented motor learning and mobility self- management program compared to community-based exercise programming.
Methods: A pilot randomized control trial (RCT) will be followed up with focus groups
Participants were recruited through advertisements in the community newspaper. A convenience sample of community-dwelling older adults n=60 (≥55 years), at the stage of PCML were recruited and randomized into either:
1) PCML Self-Management Program, or
2) standard community-based exercise program.
The intervention is a tailored 12-week 2hours/week PCML Self-Management Program facilitated by physiotherapists. The Self-Management Program will aim to enhance participants understanding of:
2) how to self-monitor different aspects of mobility,
3) the importance of maintaining optimal alignment and posture,
4) impairment-based strategies to improve mobility,
5) dynamic TOML strategies to improving mobility, including dual tasks and
6) optimal use of current community resources.
The PCML Self- Management Program includes goal setting and action planning. The control group attended the current community-based 12- week exercise program, Stand up, which consists of two one-hour exercise sessions each week as well as half an hour education session (related to falls prevention) per week. The participants were followed for 12 weeks post-intervention and assessed again at 24 weeks.
Results: T tests using STATA 13 showed there is no difference between the groups on two of the outcomes, the two minute walk test mean difference=0.39, t=0.05, p=0.95 or the gait efficacy scale, mean difference=-2.15, t= -0.54, p=0.59.
Conclusion(s): Both groups showed a similar improvement in the primary outcome of walking speed (an increase of 7metres/2mins) over the 12 week period. However since there was not a statistically significant difference between the groups it seems likely that both interventions are comparable and could be used interchangeably to achieve this change. The Stepping-UP program might be selected over the control intervention as it was more efficient and only involved less time commitment per week for the participants.
Implications: Community dwelling older persons who are starting to show changes in their mobility are also able to reverse these changes and increase their walking speed with a 12 week community based interventions involving exercise and self-management.
Funding acknowledgements: This project was funded through a grant from the Optimal Aging Opportunities Fund
Topic: Research methodology & knowledge translation
Ethics approval: Ethics approval from the McMaster ethics board # 15-093
All authors, affiliations and abstracts have been published as submitted.
