Study on the Steps to Avoid Falls in the Elderly
Condition: Fall; Fall Prevention; Pre- Frail
Study type: Interventional

Summary: 
      This study focuses on administering home-based exercises which include balance, strength,
      endurance, and mobility training to pre-frail subjects via one of the 3 intervention arms.
      These evidence-based home exercises are performed two times a week for 12 weeks (3 months). A
      follow-up assessment will be conducted at the end of 9 months after 6 months maintenance
      phase.
    

Detailed description: 
      Falls are the most common morbid and expensive health condition involving older adults. The
      range of exercises included in the SAFE programme is designed to be adaptable to a wide range
      of physical functions targeting pre-frail older adults. The exact exercises will vary on the
      patients' functional status. However, all exercise sessions must include balance exercises
      that challenge the patient's balance during static activities, during movement and also may
      include challenges as the patient has divided attention (walking and talking, walking while
      carrying objects). Balance is first emphasised followed by strengthening exercises of the
      lower extremities. The improvement in walking, physical activity and endurance, is dependent
      on the patients' improvement in balance and strength. The overall design of the intervention
      is to develop and maintain functional mobility by targeting deficiencies in balance,
      strength, mobility, and endurance.

      Despite efforts to provide exercises to improve patients' balance and strength to prevent
      falls, many do not comply with the programme upon discharge. To address this challenge, the
      investigators propose to conduct a pilot study that will employ novel approaches, using an
      evidence-based, person-centred falls prevention intervention (SAFE programme), which is
      sustainable and cost-effective for the general public in Singapore. These three interventions
      in the study include video conferencing, newly created exercise games (Gamification) and a
      self-guided home exercise programme.

      A key aspect of the SAFE exercise programme is its simple yet structured series of exercises,
      with gradual progression, to improve balance, mobility and lower limb strength. It is
      important that subjects continually challenge themselves during the exercise sessions to
      promote ongoing improvement in physical function. An exercise stratification grid has been
      developed to help guide the subjects on the types of exercises and level of intensity, that
      will be appropriate for them. Performance level (as defined in the stratification grid)
      should be re-assessed weekly so as to track the progress of the subject i.e. once a subject
      has achieved the level of the specified exercise in a category, the participants will
      progress to the next level for the same category. In addition, the subjects will be
      encouraged to participate in walking both, as much and as far as possible, to improve their
      functional capacity. Therefore, the SAFE exercises are very appropriate to be used in the
      home setting.

      140 pre-frail subjects discharged from SKH, SGH and OCH will be recruited for the study. Only
      those who meet the requirements criteria using the Ward PT Checklist will be randomised into
      the 3 intervention groups. All groups are required to exercise at least twice a week and
      complete the intervention over a 3-month period. Baseline, 3- and 9-months follow-up data
      will be collected by independent assessors. Outcome measures in 9 categories will be measured
      and compared across the 3 groups. These measures will be correlated to the subject's
      compliance to the intervention and effectiveness will be compared between the 3 groups.
    

Intervention name(s): Home Base Exercises
Intervention type(s): Other
Intervention description(s): The study developed 3 approaches that innovate beyond the existing delivery modes of the SAFE programme, by developing means for providing an intervention that is functionally equivalent to the SAFE programme but can be implemented in a patient's home. These home approaches include: (a) video conferencing; (b) gamification; and (3) self-guided home exercise programme. The investigators' task is to focus on developing these 3 modes and evaluating each in a pilot context for participants upon discharge from the hospital.
Allocation: Randomized
Intervention model: Sequential Assignment
Intervention model description: Sequential multiple assignment randomized trial.
Masking: Double (Investigator, Outcomes Assessor)
Primary purpose: Prevention