Is calf muscle strength a predictor of risk of falls in elderly?

Not yet recruiting

Conditions: Geriatric Individuals between 60 to 80 years

Registration Number: CTRI/2018/07/014878

Lead Sponsor: sancheti institute college of physiotherapy

Brief Summary: **CAN PLANTAR FLEXOR STRENGTH PREDICT FALLS IN THE ELDERLY?**

**Introduction**

India is the most populous country having over 104 million elderly persons (aged 60 and above) constituting about 8.6% of the total population in India. The old age dependency ratio increased to 14.9% and 13.6% in males and females respectively in 2011(1). One of the main reasons why this huge number becomes dependent is â€˜fallsâ€™. Falls are one of the major problems in the elderly and hence are considered as one of the â€œGeriatric giantsâ€

Every year accidental falls occur in nearly one-third of those aged more than 60 years, with 10% of these falls resulting in serious injury(2). Loss of balance and falls in the elderly constitute a major problem associated with human suffering as well as high costs for society(3).

But, falls that do not lead to injury often begin a downward spiral of fear that leads to inactivity and decreased strength, agility and balance that often results in loss of independence in normal activities of self-care(4). With the growing aging population, the number of falls will likely increase in coming years. Therefore, there it is necessary to develop and implement low cost, time-efficient, exercise intervention programs targeting particular muscle groups in order to increase strength, functional mobility and balance in older adults and, subsequently, to decrease the risk of falls(5).

Hence, finding all the variables influencing the risk of falls in the elderly is essential.

Ageing is associated with reduced muscle strength(6). The age-related modifications on motor system can be viewed as examples of an inevitable, genetically programmed process that causes both decline and physiological adaptation in neuromuscular function. These modifications, involving the loss of cells, lead to the reduction in complement of motor neurons and muscle fibres, inducing, in turn, the reduction of muscle mass and strength, especially in the lower limbs(7).

Amongst the lower limb muscles, the ratio of muscle strength to muscle thickness in the elderly group was significantly lower than that in the young group in plantar flexors (p<0.001), but not in knee extensors(8). The strength of ankle plantar flexors (PF) is related to mobility functions of older adults(9). The ankle PF provides stability for the weight-bearing limb and allows for advancement of the swinging limb in both walking and stair climbing tasks(10, 11). However, when all 4 muscle groups were considered together, only the PF muscle performance (repeated heel-rise ability) showed a significant association with all 3 mobility tasks. The importance of PF muscle performance in lower extremity ambulation activities has been emphasised(9, 10, 11). The PF is also a significant predictor of postural control(9) and balance(12) in community dwelling older persons.

The mobility requirements for ankle DF during gait and balance are primarily weight-bearing related(13). There is decrease in ankle joint range of motion with increasing age and this affects balance also(14). Ankle dorsiflexion measured with weight bearing methods resulted in a significant correlations for balance in the older age group(13)

Balance is strongly associated with falls in the elderly. The TUG is a simple and inexpensive tool that was developed to screen functional mobility(15). Within research, the use of the TUG has increased over the last few years, and it is recommended by several geriatric societies when screening for risk of falling.(16), (17)

Thus considering all these factors, this study aims to form a predictive model with these variables (Plantar flexor strength, Dorsiflexion ROM), wherein contribution of each variable to the risk of fall will be identified and thus can be used in the intervention to delay their risk of falls.

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|**AIM:**

To find out the contribution of Plantar flexor strength to the risk of falls in the elderly

**OBJECTIVE:**

**1.** To assess TUG performance and classify the subjects into fallers or non-fallers group depending on their TUG score.

**2.** To assess Plantar flexor strength, dorsiflexion ROM, Fall risk assessment tool(FRAT), Physical activity scale in elderly (PASE) in the subjects.

**3.** To find the contribution of plantar flexor strength, dorsiflexion ROM, Fall risk assessment tool(FRAT), Physical activity scale in elderly (PASE) to the risk of fall in the elderly.

**Methodology:**

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|**STUDY DESIGN:** Cross-sectional- Analytical study

**STUDY POPULATION:** Community dwelling elderly

**SAMPLING TECHNIQUE:** Quota sampling

**SAMPLE SIZE:** 70

**INCLUSION CRITERIA:**

**1.** Males and Females in the age group of 60 to 80years.

**2.** Walking atleast 10 meters.

**EXCLUSION CRITERIA:**

**1.** Any cardiovascular, musculoskeletal involvement severe enough to affect ambulation.

**2.** Central nervous system pathology.

**3.** Visual impairment (blindness, cataract causing severe visual challenge wherein basic ADLs are difficult),

**4.** Auditory impairment (should be able to hear instructions correctly, with or without hearing Aid),

**5.** Cognitive impairment (MMS < 24)

**OUTCOME MEASURES:**

1.Plantar flexor strength: Micro-FET HHD

2.      Dorsiflexion ROM: Weight bearing lunge test

3.      Case record: Fall risk assessment tool(FRAT)

4.      Dynamic balance: TUGT

5.      Anthropometric measures: BMI

6.      Physical activity level: PASE

Record of co-morbidities

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|**PROCEDURE:**

â€¢         After the approval from the ethical committee, the subjects will be explained about study and a written informed consent will be taken.

â€¢         The subjects will be assessed for (1) Plantar flexor muscle strength (predictor variable) (2) Dorsiflexion range and PASE (predictor variable), BMI, FRAT. The subjects will be instructed to perform TUG (outcome variable).

â€¢         The subjects will be divided into two groups: Fallers and non-Fallers depending on their TUG score.

â€¢         A logistic regression will be conducted to predict the likelihood of belonging to the fallers v/s non-fallers group, using the predictor variables of plantar flexor strength, dorsiflexion ROM, PASE and BMI.

Detailed Description: Not available

Recruitment & Eligibility

Status: Not Yet Recruiting

Sex: All

Target Recruitment: 70

Inclusion Criteria

1.Males and Females in the age group of 60 to 80years.
2.Walking atleast 10 meters.

Exclusion Criteria

Any cardiovascular, musculoskeletal involvement severe enough to affect ambulation.
Central nervous system pathology.
Visual impairment (blindness, cataract causing severe visual challenge wherein basic ADLs are difficult), 4.
Auditory impairment (should be able to hear instructions correctly, with or without hearing Aid), 5.
Cognitive impairment (MMS < 24).

Study & Design

Study Type: Observational

Study Design: Not specified

Primary Outcome Measures

Name	Time	Method
1. Plantar flexor strength: Micro-FET HHD	one time assessment
2. Dorsiflexion ROM: Weight bearing lunge test	one time assessment
3. Case record: Fall risk assessment tool(FRAT)	one time assessment
4. Dynamic balance: TUGT	one time assessment
5. Anthropometric measures: BMI	one time assessment
6. Physical activity level: PASE	one time assessment

Secondary Outcome Measures

Name	Time	Method

Trial Locations

Locations (1): Old age home, Community dwelling eldery of pune city
🇮🇳
Pune, MAHARASHTRA, India
Old age home, Community dwelling eldery of pune city
🇮🇳Pune, MAHARASHTRA, India
Payal Shetkar
Principal investigator
02028999713
shetkarpayal@gmail.com