Effectiveness of Impairment Specific Exercises for Balance and Fall Risk in Community-Living Older Adults at Risk: A Randomized Controlled Trial
Condition: Balance, Postural; Exercise Therapy
Study type: Interventional

Summary: 
      Background Balance impairment is a key factor contributing to falls in older adults.
      Conceptually, clinicians may be able to prescribe targeted exercises if specific impairments
      can be identified. Objective Our objective was to use a model of balance subsystems to
      identify balance impairments and demonstrate the effectiveness of targeted (matched)
      exercises to improve balance and reduce fall risk in community-dwelling older adults. The
      investigators used the Balance Evaluation System Test (BESTest) as the model because it
      categorizes balance into 6 subsystems. Design Randomized, partially blinded,
      pretest-post-test clinical trial consisting of 2 Phases: 1. A comparison between
      impairment-matched exercises and a control, and 2. A comparison between impairment-matched
      and mismatched exercises. Setting Senior independent living community. Participants Adult
      volunteers (n = 40; aged 74-94) recruited as sample of convenience who met the criteria.
      Participants (n = 20) identified with impairment in the biomechanical (BC) constraints
      subsystem and participants (n = 20) with impairment in anticipatory postural adjustment (APA)
      subsystem were enrolled and randomized into 2 subgroups (matched and control/delayed
      mismatched; n = 10 each subgroup). Intervention Phase 1: Participants in the matched subgroup
      received a 6-week exercise program matched to their impaired subsystem while the mismatched
      subgroup served as control. Phase 2: Following the delay, participants in the mismatched
      group received a 6-week exercise program mismatched to their impairment. Measurements Primary
      outcome variables were scores on the targeted subsystem (BC, APA), BESTest total, Berg
      Balance Scale, and fear of falling measure. Quality of life was a secondary outcome. Outcome
      data were collected by the tester blind to pretest scores and group allocation. Results The
      matched exercise subgroups demonstrated both statistical and clinical improvement in all
      outcome variables compared to the control; and showed greater improvement in balance
      impairments compared to the mismatched subgroup, but not in fall risk reduction. Limitations
      The therapist who administered the pretest knew the subgroup assignment and implemented the
      exercises. Conclusions Results provide preliminary evidence that using a balance assessment
      model to identify impairments in the BC and APA subsystems and prescribing targeted exercises
      reduces these balance impairments for older adults and may warrant future studies.
    


Intervention name(s): Matched: Targeted (specific) balance exercise interventions; Mismatched: Untargeted (non-specific) balance exercise interventions
Intervention type(s): Other; Other
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Older Adults, Falls