Please select the eligibility criteria that correspond to the clinical trial below.
Title: The Efficacy of Low-magnitude, High-frequency Vibration Treatment on Reducing Fracture Risks and Fracture Incidences in the Community Elderly - a Prospective Randomized Trial
Brief Summary: Fragility fracture is common due to global aging problem, incurring huge healthcare expenditure. The occurrence of fragility fracture is usually caused by a fall incidence of an elderly with low bone quality and poor balancing ability. Therefore, any approach to improve or retard both sarcopenia and osteoporosis will be helpful to prevent osteoporotic fracture incidence. With the intensive research on low magnitude high frequency vibration (LMHFV), many scientific evidences support the application of this biophysical modality on elderly to maintain or improve the musculoskeletal tissues in elderly.

Many previous studies showed the osteogenic properties of vibration treatment and its positive effects on muscular performance and blood circulation. The investigators' previous reports also indicated that LMHFV could enhance the bone quality in spine and tibia in elderly after one-year intervention, as well as the balancing ability with high compliance. In animal studies, the application of LMHFV on fracture healing also demonstrated the significant acceleration of healing by inducing callus formation and maturation, from which upregulation of collagen I, II and BMP-2 gene expression was detected at molecular level. To date, the long-term efficacy of LMHFV on reducing fracture risks and fracture rate is, however, not available, which needs a systematic large-scale study to answer this important research question.

Therefore, the hypothesis of this study is that LMHFV can maintain or enhance the performance of various tissues of the musculoskeletal system in community elderly, thus reducing the fracture risks and fracture rate. A large-scale prospective randomized clinical trial will be conducted in multiple communities to investigate the long-term effect of LMHFV on fracture rate and reduction of fracture risks in community elderly, in which multi-factorial effects, in terms of muscle and bone, on musculoskeletal system will also be evaluated. A total of 704 elderly from 28 community centres will be recruited within 1.5-year time for a 18-month LMHFV treatment, who will be assessed on the fracture risks at fixed time points while their fracture rates on the third year of this study will be regarded as primary outcome for analysis. The findings of this study will provide very useful scientific data to support the application of LMHFV for elderly. The ultimate goal is to reduce the fracture rate and the quality of life of community-living elderly.


Options:
A: Inclusion Criteria:

* Aged 65 years or older
* Living in the community
* Without previous Jaques-Dalcroze eurhythmics experience (except during childhood)
* Identified as being at high risk of fall (i.e., one or more self-reported falls after the age of 65 years or balance impairment as assessed by a simplified Tinetti test higher than 2 over 7 or the presence of one or two indicators of physical frailty based on Fried's criteria)

Exclusion Criteria:

* Neurological or orthopaedic disease (e.g., stroke with residual motor deficit, Parkinson's disease, osteoarthritis) with a significant impact on gait and balance performances
* Progressive or unstable medical conditions that could limit participation (e.g., terminal illness)
* Fully dependent on an assistive device such as canes and walkers
B: Inclusion Criteria:

* Age ≥ 65 years
* Seen in the Emergency Department for a fall or injury related to a fall
* Able to follow 3 step commands
* Singapore citizen or Permanent Resident
* Living at home upon discharge
* Provision of informed consent
* If admitted to the hospital, the illness or disability is one from which they are expected to recover basic ADLs or weight bearing of the lower extremity within the next month

Exclusion Criteria:

* Those patients with severe physical and/or mental impairments which preclude participation in a program of physical therapy (as determined by a primary physician) will NOT be eligible for participation.
* Unable to participate in the exercise program due to conflicting schedules (e.g. full-time employment, on dialysis)
* Serious life limiting illness
* Patients seen at ED due to road traffic accidents
* Unable to walk even with assistance
* Not community dwelling prior to ED visit
* Total blindness
* Needs emergency inpatient surgery and, if admitted to the hospital, the illness or disability is one from which they are not expected to recover basic ADLs or weight bearing in the lower extremity within the next one month.
C: Inclusion Criteria:

* women aged 75 years and older,
* living at home but with impaired physical functional capacity (as assessed by simple functional tests: 6-meter walking test and tandem walk test).

Exclusion Criteria:

* serious health problems preventing practice of a physical activity (medical contra-indications),
* already engaged in fall prevention or general group exercise classes.
D: Inclusion Criteria:

* 65 years old or above
* independent in accessing the centres

Exclusion Criteria:

* having habitual exercise or participate in supervised exercise
* having drug treatment that affects normal metabolism of musculoskeletal system
* having hypo- or hyperparathyroidism, renal, liver or other chronic diseases
* having low-energy fracture history
* previous or current smokers or drinkers

Answer: D