Reactive Balance Training Targeting Both Slip- and Trip-Induced Falls

Study Overview
=================
Brief Summary
-----------------
The goal of this study was to evaluate the effects of reactive balance training (RBT) targeting slipping and tripping on laboratory-induced slips and trips. In an effort to build upon prior work, the present study included: 1) a control group receiving an alternative balance training intervention; 2) separate training and assessment sessions; 3) alternative RBT methods that may be more amenable to work outside the lab compared to prior methods, and 4) older adult participants receiving individualized training to reduce drop-out. The investigators hypothesized that slips after RBT would result in improved reactive balance kinematics, and a lower incidence of falls, compared to either initial slips before any intervention or after a control intervention. The investigators also hypothesized that trips after RBT would result in improved reactive balance kinematics, and a lower incidence of falls, compared to either initial trips before any intervention or after a control intervention. Results were intended to contribute to knowledge regarding the efficacy of alternative methods for RBT, and provide additional evidence regarding its efficacy.

Official Title
-----------------
Reactive Balance Training Targeting Both Slip- and Trip-Induced Falls Among Older Adults: a Pilot Randomized Controlled Trial

Conditions
-----------------
Accidental Fall

Intervention / Treatment
-----------------
* Behavioral: Reactive balance training
* Behavioral: Otago Balance Training


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: 1) pass a medical history and screening administered by a physician that excluded participants with osteoporosis of the lumbar spine or proximal femur as assessed by Dual Energy X-ray Absorptiometry (Lunar iDXA, GE Healthcare, Chicago, IL), or any unstable or progressive medical conditions that could contribute to imbalance or falls Exclusion Criteria: smoked were in physical therapy had a self-reported fragility fracture within the last 10 years had an acute lower extremity injury within the last 3 months had lower extremity surgery within the last six months had an ankle arthroplasty had a knee or hip arthroplasty within the last 12 months

Ages Eligible for Study
-----------------
Minimum Age: 60 Years
Maximum Age: 80 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
Accepts Healthy Volunteers

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Prevention
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: A two-group, pretest-posttest parallel design was employed. Participants were first assigned to either the reactive balance training or control intervention using minimization. During the first week, participants completed a pre-intervention assessment involving exposure to a single laboratory-induced slip or trip based upon random assignment. During the second and third weeks, participants completed a total of four sessions of their assigned intervention (two sessions per week for two weeks). During the fourth week, participants completed a post-intervention assessment involving exposure to the other perturbation (slip or trip) that they did not experience during the pre-intervention assessment. This design was selected to evaluate gait and reactive balance prior to any training intervention, and to avoid any unintended training effects induced by exposing participants to the same perturbation more than once.
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Reactive balance training<br>Four training sessions, conducted twice a week for two weeks in groups of 1-2 participants. Each session was 0.5-1 hours, with an active training time of 30 minutes for each participant. Reactive balance training involved both slip and trip training. Slip training involved repeatedly stepping onto a low-friction interface (nylon fabric placed over a 0.9 × 0.9 meter polycarbonate sheet) while practicing controlling/decelerating the slipping foot and properly positioning the non-slipping foot under the pelvis. Trip training involved repeatedly practicing recovery from simulated trips on a modified treadmill. While standing on a modified treadmill, the treadmill belt was quickly accelerated posteriorly to elicit a forward loss of balance that mimicked a trip while walking. Participants attempted to step to avert a fall, and to establish a stable gait on the treadmill, after which the treadmill speed was slowed to zero to complete the trial. | Behavioral: Reactive balance training<br>* Participants were exposed to simulated trips and slips under safe, controlled conditions in order to practice their reactive response to these common balance perturbations.<br>|
| Active Comparator: Control balance training<br>Four training sessions, conducted twice a week for two weeks in groups of 1-2 participants. Each session was 0.5-1 hours, with an active training time of 30 minutes for each participant. The control intervention involved general balance exercises adapted from the Otago Exercise program. Briefly, all four sessions involved balance exercises and strength exercises using ankle weights, and were progressively increased as performance improved by increasing ankle weights or the difficulty of the balance exercises (e.g., not holding onto a wall or support). | Behavioral: Otago Balance Training<br>* Balance exercises and strength exercises using ankle weights, and were progressively increased as performance improved by increasing ankle weights or the difficulty of the balance exercises (e.g., not holding onto a wall or support).<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Peak Slip Speed | highest instantaneous speed of slipping foot during actual slip | during week 1, before the intervention that spanned weeks 2 and 3 | 
| Peak Slip Speed | highest instantaneous speed of slipping foot during actual slip | during week 4, after the intervention that spanned weeks 2 and 3 | 
| Trunk Angle at Touchdown After Tripping | anterior-posterior trunk angle relative to vertical at instant of touchdown of initial recovery step over tripping obstacle | during week 1, before the intervention that spanned weeks 2 and 3 | 
| Trunk Angle at Touchdown After Tripping | anterior-posterior trunk angle relative to vertical at instant of touchdown of initial recovery step over tripping obstacle | during week 4, after the intervention that spanned weeks 2 and 3 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Slip Distance | distance moved by slipping foot during actual slip | during week 1, before the intervention that spanned weeks 2 and 3 | 
| Slip Distance | distance moved by slipping foot during actual slip | during week 4, after the intervention that spanned weeks 2 and 3 | 
| Fall Incidence After a Laboratory-induced Slip | the outcome of each slip was categorized as either a: fall, recovery, or harness-assisted | during week 1, before the intervention that spanned weeks 2 and 3 | 
| Fall Incidence After a Laboratory-induced Slip | the outcome of each slip was categorized as either a: fall, recovery, or harness-assisted | during week 4, after the intervention that spanned weeks 2 and 3 | 
| Recovery Step Length After Tripping | anterior-posterior step distance of first step over tripping obstacle | during week 1, before the intervention that spanned weeks 2 and 3 | 
| Recovery Step Length After Tripping | anterior-posterior step distance of first step over tripping obstacle | during week 4, after the intervention that spanned weeks 2 and 3 | 
| Fall Incidence After a Laboratory-induced Trip | the outcome of each trip was categorized as a: fall, recovery, or harness-assisted | during week 1, before the intervention that spanned weeks 2 and 3 | 
| Fall Incidence After a Laboratory-induced Trip | the outcome of each trip was categorized as a: fall, recovery, or harness-assisted | during week 4, after the intervention that spanned weeks 2 and 3 | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
balance training, step training, perturbation-based balance training, dynamic balance, aging