Citation

Lurie JD, Zagaria AB, Ellis L, Pidgeon D, Gill-Body KM, Burke C, Armbrust K, Cass S, Spratt KF, McDonough CM. Phys. Ther. 2020; ePub(ePub): ePub.

Affiliation

University of Pittsburgh, Pittsburgh, Pennsylvania.

Copyright

(Copyright © 2020, American Physical Therapy Association)

DOI

10.1093/ptj/pzaa023

PMID

31998949

Abstract

BACKGROUND: Falls are the leading cause of injuries among older adults and trips and slips are major contributors to falls.

OBJECTIVE: Compare the effectiveness of adding a component of surface-perturbation training to usual gait/balance training for reducing falls and fall-related injury in high-risk older adults referred to physical therapy.

DESIGN: This was a multi-center, pragmatic, randomized, comparative effectiveness trial. SETTING: Treatment took place within 8 outpatient physical therapy clinics. PATIENTS: This study included 506 patients aged 65+ at high fall risk referred for gait/balance training. INTERVENTION: This trial evaluated surface-perturbation treadmill training integrated into usual multimodal exercise-based balance training at the therapist's discretion versus usual multimodal exercise-based balance training alone. MEASUREMENTS: Falls and injurious falls were assessed with a prospective daily fall diary, which was reviewed via telephone interview every 3 months for 1 year.

RESULTS: 211/253 (83%) of patients randomized to perturbation-training and 210/253 (83%) randomized to usual treatment provided data at 3-month follow-up. At 3 months, the perturbation-training group had significantly reduced chance of fall-related injury (5.7% vs. 13.3%; relative risk 0.43, p < 0.01) but no significant reduction in the risk of any fall (28% vs. 37% ST; relative risk 0.78 p<0.07) compared to usual treatment. Time to first injurious fall showed reduced hazard in the first 3 months, but no significant reduction when viewed over the entire first year (p=0.67). LIMITATIONS: The limitations of this trial included lack of blinding and variable application of interventions across patients based on pragmatic study design.

CONCLUSION: The addition of some surface perturbation training to usual physical therapy significantly reduced injurious falls up to 3 months post-treatment. Further study is warranted to determine the optimal frequency, dose, progression and duration of surface perturbation aimed at training postural responses for this population.

© 2020 American Physical Therapy Association.

Language: en

Keywords

Accidental Falls; Balance; Gait: Gait Training; Rehabilitation