Falls in older people are devastating, widespread, costly and increasing in the aging Australian population. Although falls occur in approximately one third of older adults, certain population groups such as the sarcopenic/frail present with further elevated risk of falls. Many exercise interventions have been trialled but systematic review evidence indicates such programs reduce fall rates by an average of only 20% and encounter issues such as compliance. Reactive balance training (also called perturbation-based balance training) utilises a task-specific approach to balance training, applying repeated exposure to unpredictable perturbations that mimic balance disturbances experienced in daily life. Evidence suggests 50% reductions in falls might be achievable in a time efficient manner with reactive balance training but more evidence is required. In this study, ecologically valid, unpredictable trips and slips will be exposed to older people in a safe environment to train their reactive balance. Three 40 min weekly training sessions will be followed by 3-monthly retraining session over one year (40 min x 6 training sessions = 4 hours of training in total). The neuromuscular, physiological, psychological, behavioural effects of the reactive balance training will be comprehensively examined.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
SINGLE
Enrollment
118
Reactive balance training involves the use of the Trip and Slip walkway that is able to expose participants to unpredictable trips and slips. Trips and slips will occur at random location on the walkway and times within the gait cycle, with the participants receiving 3-monthly retraining sessions along with an educational booklet.
The control intervention will be receiving an educational booklet as part of standard care. The education component will target a variety of fall risk factors and provide strategies to mitigate these risk factors.
Neuroscience Research Australia
Randwick, New South Wales, Australia
Laboratory induced falls
Fall incidence after slips and trips in the laboratory (Okubo et al., 2019). A fall will be defined by the harness supported load when it exceeded 30% of the person's body weight (Yang et al., 2011).
Time frame: 12 month re-assessment
Trips in daily life
Number of trips in daily life will be recorded using a fridge calendar and reported weekly via SMS or email.
Time frame: Throughout a follow-up period (one year from randomisation)
Slips in daily life
Number of slips in daily life will be recorded using a fridge calendar and reported weekly via SMS or email.
Time frame: Throughout a follow-up period (one year from randomisation)
Falls in daily life
Number of falls in daily life will be recorded using a fridge calendar and reported weekly via SMS or email.
Time frame: Throughout a follow-up period (one year from randomisation)
Fall Risk
A summary fall risk score will be calculated from the Physiological Profile Assessment short form which includes tests of vision, balance, proprioception, reaction time and strength (Lord et al., 2003).
Time frame: 12 month re-assessment
Fear of falling
Fear of falling will be assessed using the Falls Efficacy Scale - International (Yardley et al., 2005), a 16 item scale scored out of 64 where higher scores indicate greater fear of falling
Time frame: Week 3 (following the third training session)
Fear of falling
Fear of falling will be assessed using the Falls Efficacy Scale - International (Yardley et al., 2005), a 16 item scale scored out of 64 where higher scores indicate greater fear of falling
Time frame: Month 6 (middle of the follow-up period)
Fear of falling
Fear of falling will be assessed using the Falls Efficacy Scale - International (Yardley et al., 2005), a 16 item scale scored out of 64 where higher scores indicate greater fear of falling
Time frame: 12 month re-assessment
Fall risk awareness and behaviours
Fall risk awareness and behaviours will be assessed using the 24-item Fall Behavioural Scale (Clemson et al., 2008). Mean scores range from 1.0 to 4.0 in which higher scores indicate safer behaviours
Time frame: Week 3 (following the third training session)
Fall risk awareness and behaviours
Fall risk awareness and behaviours will be assessed using the 24-item Fall Behavioural Scale (Clemson et al., 2008). Mean scores range from 1.0 to 4.0 in which higher scores indicate safer behaviours
Time frame: Month 6 (middle of the follow-up period)
Fall Behavioural Scale
Fall risk awareness and behaviours will be assessed using the 24-item Fall Behavioural Scale (Clemson et al., 2008). Mean scores range from 1.0 to 4.0 in which higher scores indicate safer behaviours
Time frame: 12 month re-assessment
Anxiety
Anxiety will be assessed using the General Anxiety Disorder - 7-item scale (Spitzer, 2006), a 21 point scale where higher scores indicate greater anxiety
Time frame: 12 month re-assessment
Physical activity levels
Physical activity levels will be assessed using the Incidental and Planned Exercise Questionnaire (Delbaere et al., 2009). A total physical activity (hours per week) in the past 3 months will be estimated.
Time frame: 12 month re-assessment
Volitional Stepping Reaction time
Volitional stepping will be assessed using the Choice Stepping Reaction Time test standard version (Lord et al., 2001).
Time frame: 12 month re-assessment
Stepping inhibition
Stepping inhibition will be assessed using the Choice Stepping Reaction Time test moving arrow version.
Time frame: 12 month re-assessment
Catch-inhibition accuracy
Catch-inhibition accuracy will be assessed using the React Stick simple and complex modes (Richardson et al., 2017).
Time frame: 12 month re-assessment
Executive function
Executive function will be assessed using the Trail Making Test A and B (Tombaugh et al., 2004). Test scores B - A will be used as a measure of executive function.
Time frame: 12 month re-assessment
Margin of stability
Margin of stability (Hof et al., 2005) during the slip and trip trials will be assessed using the Vicon 3D motion analysis system with the full-body 27-marker model
Time frame: 12 month re-assessment
Extrapolated centre of mass
Extrapolated centre of mass (Hof et al., 2005) during the slip and trip trials will be assessed using the Vicon 3D motion analysis system with the full-body 27-marker model
Time frame: 12 month re-assessment
Step length
Step length during the slip and trip trials will be assessed using the Vicon 3D motion analysis system with the full-body 27-marker model
Time frame: 12 month re-assessment
Range of trunk sway
Range of trunk sway during the slip and trip trials will be assessed using the Vicon 3D motion analysis system with the full-body 27-marker model
Time frame: 12 month re-assessment
Muscle activation onset latency (semitendinosus)
Time (milliseconds) from a trip/slip onset to muscle activation onset will be recorded using surface electromyography on the semitendinosus. Muscle activation onset will be defined when the activation level exceeds 3 standard deviation above the baseline level.
Time frame: 12 month re-assessment
Muscle activation onset latency (rectus femoris)
Time (milliseconds) from a trip/slip onset to muscle activation onset will be recorded using surface electromyography on the rectus femoris. Muscle activation onset will be defined when the activation level exceeds 3 standard deviation above the baseline level.
Time frame: 12 month re-assessment
Muscle activation amplitude (semitendinosus)
Muscle activation amplitude will be recorded using surface electromyography on the semitendinosus. This will be assessed as percentage of the activation level during the trip and slip trials relative to the maximal voluntary contraction.
Time frame: 12 month re-assessment
Muscle activation amplitude (rectus femoris)
Muscle activation amplitude will be recorded using surface electromyography on the rectus femoris. This will be assessed as percentage of the activation level during the trip and slip trials relative to the maximal voluntary contraction.
Time frame: 12 month re-assessment
Enjoyment of reactive balance training
Enjoyment of reactive balance training will be assessed using the 8-item Physical Activity Enjoyment Scale (PACES-8, Mullen et al., 2011). Scores range from 8 to 56 with higher scores indicate greater enjoyment.
Time frame: Throughout training sessions taking place at week 1, 2 and 3, and month 3, 6 and 9
Adverse events during reactive balance training
Adverse events such as muscle soreness, discomfort, pain or injury will be collected by staff during reactive balance training sessions.
Time frame: Throughout training sessions taking place at week 1, 2 and 3, and month 3, 6 and 9
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