Does Fall Arrest Strategy Training (FAST) Added to a Fall Prevention Program Improve Physical Capacity to Prevent Serious Fall-related Injury in Older Women?
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 40
- 主要终点
- UE Strength - Isometric
研究概览
简要总结
Falls are the leading cause of injury hospitalization for seniors across Saskatchewan and addressing the underlying causes is a provincial health priority. Older women are more vulnerable to the most common fall-related injuries (upper body) during forward falling while walking. Exercise programs designed to improve balance and strength can reduce fall risk but it is not known if specific exercises targeted to upper body strength and agility can improve chances for safe landing when a fall is inevitable. The investigators have developed such a program, Fall Arrest Strategy Training (FAST) and successfully piloted the feasibility of the exercises to be included in a standard fall prevention program. FAST is meant to increase arm strength, reaction time, trunk control, and teach better landing techniques. The potential efficacy of such an intervention to improve landing capacity has not been studied in older women. Thirty-two women age 60 years or older will be randomly assigned to either FAST or a Standard Exercise group. Half will do standard exercises targeting balance, mobility and lower extremity strength; the other half will do the same exercises with the addition of FAST. Both groups will exercise twice per week for 12 weeks. Participants will be tested before and after for arm strength, reaction time, balance, mobility and the ability to control body descent (absorb energy) using a technique we developed in our lab. While in a safety harness, participants will simulate a forward fall onto a platform that measures energy during impact. While completely preventing falls is not possible, this study will help the investigators learn if simple exercises like FAST combined with balance training can decrease fall risk AND reduce the risk of serious injury when a fall is unavoidable. It will help address the growing personal and societal cost of fall-related injury. This study will also inform future research targeted to include a large-scale trial evaluating the impact and implementation of FAST training in older adults across the spectrum of care and development of a computer simulation model to determine which factors are most important for reducing the risk of fall-related injury.
详细描述
Falls are the current leading cause of fracture and head injury in older adults in Saskatchewan and will continue to be a growing health concern given the aging population. Determining effective and feasible interventions to prevent the downward spiral of failing health, admission to long term care and even death following a serious fall-related injury is important to Saskatchewan seniors, the health care team, policy makers and the public at large.
Exercise is known to decrease fall risk in community-dwelling older adults and should theoretically also reduce risk for injury during a fall; however, there are no clinical trials evaluating exercises designed specifically to enhance safe landing when a fall is imminent. Ideally, the health care team would like to support older adults in preventing all falls but in reality, this is not possible. Developing an intervention targeting both fall AND injury prevention (in the event a fall is inevitable) should enhance the effectiveness of exercise for reducing fall-related injury. This study will investigate the efficacy of novel Fall-Arrest Strategy Training (FAST) to improve the physical capacity to arrest a fall and reduce injury risk in older community-dwelling women.
The risk of injury from falls depends on both the severity of impact and neuromuscular capacity such as bone and muscle strength of the affected body part. Sixty percent of all falls in older adults occur in a forward direction, more often in women than men. Forward falls are typically combined with hand contact as a protective response to prevent head, hip or torso injury. The effectiveness of these important protective strategies unfortunately decreases with aging. Evidence suggests forward fall arrest strategies can be modified to improve safe landing and reduce impact forces. The critically important question is whether older adults, in particular older women at high risk for fracture, can enhance their ability to efficiently utilize fall arrest strategies intended to diminish both the risk of head impact and the risk of wrist fracture.
Fall Arrest Strategy Training (FAST) is a new, innovative exercise intervention the investigators have developed uniquely focusing on enhancing upper extremity (UE) strength, response time, trunk control and specific strategies to safely lower the body. The severity of impact with a forward fall is determined primarily by pre-impact neuromuscular factors - muscle strength, movement time, and kinematic placement of the upper extremity (UE) which may also depend on available joint range of motion (ROM). FAST uses functional exercises specifically targeted to address these factors and are easily incorporated into general fall prevention programs. Staying on Your Feet is an established and effective fall prevention program offered to community-dwelling older adults in the Saskatoon Health Region. The feasibility of implementing FAST into Staying on Your Feet was verified in a previous pilot study. The important extension of this work is to determine if functional improvements result in improved fall-specific neuromuscular capacity and ability to absorb energy. The focus of this project is to further advance our understanding of the effect of FAST on functional fall risk outcomes and fall-arrest capacity in older women.
The goal of FAST is to increase fall-arrest capacity, defined as neuromuscular ability that could be utilized to prevent and minimize injury during a fall. While fall-related injury risk is difficult to measure directly, increases in fall-arrest capacity will likely lead to a reduction in that risk. Therefore, the effectiveness of injury risk reduction interventions such as FAST can be measured by their ability to increase fall-arrest capacity. One important factor recently emerging in the falls literature is energy absorption; older women absorb less energy in their UE during a controlled forward descent compared to younger women. The investigators have developed an experimental apparatus which can measure UE energy absorption in both controlled and unexpected forward body descents. Muscle strength, particularly surrounding the shoulder girdle and elbow, is another important forward fall-arrest capacity factor.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Prevention
- 盲法
- Single (Outcomes Assessor)
盲法说明
Assessors were blinded to intervention
入排标准
- 年龄范围
- 60 Years 至 —（Adult, Older Adult）
- 性别
- Female
- 接受健康志愿者
- 是
入选标准
- •Women aged 60 years or older living in the community.
排除标准
- •Any recent upper body (hand, wrist, shoulder, trunk, neck) injury or painful joint problem that limited day to day activities or resulted in pain on a daily basis,
- •A prior distal radius fracture in the past 2 years,
- •Any fracture in the past year, or multiple fractures of the wrist or forearm,
- •Any history of UE neurological problems (i.e. Stroke, Multiple Sclerosis, Parkinson's Disease, Reflex Neuropathy),
- •Any cardio-vascular problems that would contradict UE strength testing or training,
- •Any signs of severe cognitive impairment or
- •Unable to safely ambulate independently (with or without a walking aid) in the community.
- •A medical and demographic screening questionnaire as well as the Mini-Cog (Borson et al, 2000) were used to determine eligibility.
研究组 & 干预措施
Standard
Twice per week exercise program, 45 minutes duration for 12 weeks conducted in a community site (assisted living residence). Participants also attended a 3o minute fall prevention education session once per week. The Standard intervention consisted of a fall prevention exercise program designed for community-dwelling older adults. Exercises focussed on balance, leg strength, walking and mobility exercises designed to decrease fall risk.
干预措施: Exercise (Other)
FAST
Twice per week exercise program, 45 minutes duration for 12 weeks conducted in the community. Participants attended a 30-minute fall prevention education session once per week. FAST followed the same principles as Standard, with the addition of the following goals: 1) Increase UE strength (shoulder girdle/arm) utilizing both concentric and eccentric contractions, 2) Improve trunk and neck postural control during slow and fast body motions, 3) Optimize forward descent strategies via practice of quick response reaching, landing and controlled descent with hands on the wall or on the floor as able. Training progression for strength and body control included increasing the distance standing from the wall, progressing to one arm descents, increasing reps and speed and moving to greater gravity and body weight resistance such as hands and knees position on the floor as able. Quick movement practice targeted unexpected reaching activities, balloon and ball toss
干预措施: Exercise (Other)
结局指标
主要结局
UE Strength - Isometric
时间窗: 12 weeks
Measured with a hand-held dynamometer; mean of three trials for shoulder abduction, shoulder flexion and elbow extension
UE Strength - Grip
时间窗: 12 weeks
Measured with a dynamometer; participant in sitting, standardized elbow flexion position and handle position, gripping maximum exertion; mean of three trials for shoulder abduction, shoulder flexion and elbow extension
UE Mobility
时间窗: 12 weeks
Shoulder Extension and Wrist Extension Active Range of Motion with passive overpressure measure with a manual goniometer in a sitting position
Energy Absorption during simulated forward descent
时间窗: 12 weeks
Forward Descent and Landing Apparatus used to measure a controlled and unexpected release onto outstretched hands (simulated forward fall). An eight camera motion capture system collected 3D upper extremity kinematics. Energy absorption was calculated calculated using the total ground reaction force and the movement of the shoulders as a measure of the vertical displacement of the body, normalized to height and body weight. Participants performed a controlled descent with body at an angle 30 degrees from vertical, and then in an unexpected release while tethered to the ceiling, shoulders in 90 degrees of flexion and hands just hovering above force plate. Mean of 3 trials.
UE Strength - Isokinetic Concentric and Eccentric
时间窗: 12 weeks
Using a protocol developed in the investigators' lab, with the Humac Norm isokinetic dynamometer. An upper extremity pushing motion of primarily elbow extension measuring maximal force for concentric and eccentric motion. Mean of three trials used
Balance - One Leg Standing
时间窗: 12 weeks
Timed ability to stand on one leg with no support, up to 60 seconds. Two trials on each leg
Balance - Tandem Standing
时间窗: 12 weeks
This is a standard test first described by Hile et al (2012) where the participant tries standing in a tandem position, one foot in front of the other first with and then without support for up to 30 seconds without support. Scored on a scale of 5, with maximum score of 5 meaning standing without support for full 30 seconds
Elbow ROM during simulated forward descent
时间窗: 12 weeks
Forward Descent and Landing Apparatus used to measure a controlled and unexpected release onto outstretched hands (simulated forward fall). An eight camera motion capture system collected 3D upper extremity kinematics. Maximal elbow ROM was measured as participants performed a controlled descent with body at an angle 30 degrees from vertical, and then in an unexpected release while tethered to the ceiling, shoulders in 90 degrees of flexion and hands just hovering above force plate. Mean of 3 trials.
UE Strength - Isometric Push-off Test
时间窗: 12 weeks
Measured with a hand-held dynamometer for grip strength with the handle inverted and stabilized on a table top. Participant pushes downward in a standing position; mean of 3 trials used
Self Report Fall Risk - FROP-Com
时间窗: 12 weeks
Fall Risk for Older People living in the Community (National Aging Research Institute, 2012 http://www.mednwh.unimelb.edu.au/nari_tools/nari_tools_falls.html) measures fall risk in 13 categories, for a total possible score of 60 (higher risk)
Self Report Balance Confidence
时间窗: 12 weeks
Activities Balance Confidence Scale (ABC; Powell \& Myers 1995) rating of confidence for 16 day to day functional tasks on a scale 0 - 100; mean of 16 items used as total score
Sit to Stand Test
时间窗: 12 weeks
Number of full sit to stand movements completed within 30 seconds with arms crossed. One practice followed by actual test
UE Response Time
时间窗: 12 weeks
Time from the start of an auditory cue to lift hands from a position standing with arms at side of body to the first touch on a force from auditory cue to touching a forceplate at shoulder level. Mean of three trials for right, left and both hands together used.
Ground Reaction Force
时间窗: 12 weeks
Forward Descent and Landing Apparatus used to measure a controlled and unexpected release onto outstretched hands (simulated forward fall). Bilateral force platforms recorded ground reaction forces as participants performed a controlled descent with body at an angle 30 degrees from vertical, and then in an unexpected release while tethered to the ceiling, shoulders in 90 degrees of flexion and hands just hovering above force plate. Mean of 3 trials.
Timed Up and Go Test (TUG)
时间窗: 12 weeks
Timed test to stand up from a chair, walk 3 meters, turn to chair and sit down. One practice trial, followed by one timed test (Podsiadlo \& Richardson 1991)
Peak elbow moment and elbow stiffness during simulated forward descent
时间窗: 12 weeks
Forward Descent and Landing Apparatus used to measure a controlled and unexpected release onto outstretched hands (simulated forward fall). An eight camera motion capture system collected 3D upper extremity kinematics. Elbow moments and stiffness values were calculated, normalized to height and body weight. Participants performed a controlled descent with body at an angle 30 degrees from vertical, and then in an unexpected release while tethered to the ceiling, shoulders in 90 degrees of flexion and hands just hovering above force plate. Mean of 3 trials.
次要结局
- Falls(64 weeks)
- Muscle Activity(12 weeks)
研究者
Cathy Arnold
Professor
University of Saskatchewan