A Community-Based Falls Prevention Program for Adults At-Risk for Falls

Study Overview
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Brief Summary
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The goal of this interventional study is to implement a Falls Prevention Program to impact the risk and injuries related to falls. The main question is to learn and examine the effects of a falls prevention program on the functional mobility of adults at risk for falls. Participants will: Complete functional mobility assessments Complete Falls prevention obstacle course training Complete Falls Strategies Training Complete walking and balance training

Detailed Description
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The purpose of the study is to implement a Fall Prevention Program to impact the risk and injuries related to falls. This study is innovative in that (1) it will be implemented as a community service program for the first time in the United States (2) it will attempt to standardize an obstacle course as a reliable and valid outcome measure for balance and falls (3) it will incorporate community outreach learning opportunity for students in a doctor of physical therapy curriculum at the University of St. Augustine for Health Sciences and (4) it will assess effectiveness using a variety of standardized and valid outcome measures to address balance and coordination deficits, fear of falling, incidence of falling, gait speed, feasibility and patient perception and satisfaction. Specific Aim 1: To examine the effects of a falls prevention program on the functional mobility of adults at risk for falls. Hypothesis: Physical exercise and dynamic balance training has been shown to be effective in decreasing risk for falls. The Falls Prevention Program will have a positive effect on balance, gait speed, fear of falls, incidence of falls and incorporation of falls techniques. Specific Aim 2: To create a falls prevention program within a Doctor of Physical Therapy curriculum. Hypothesis: Community outreach which are learning opportunities that benefit the community at large are part of the Doctor of Physical Therapy curriculum. It is expected that the Falls Prevention Program will be successfully integrated into the Geriatric Rehabilitation for Physical Therapy course with appropriate participation from the students. Specific Aim 3: Evaluate the reliability and validity of an obstacle course as a measure of fall risk. Hypothesis: The Falls Prevention Program includes a 17-item obstacle course that significantly challenges the participant's functional mobility and standing dynamic balance. It is expected that the obstacle course will serve as a reliable and valid test for the assessment for balance and mobility. Specific Aim 4: Evaluate the acceptability of a Falls Prevention Program. Hypothesis: There are no current falls prevention programs available to the community as a free community service program. It is believed that the program will be accepted by the community as well as the faculty and students leading the program. Specific Aim 5: Determine whether disease moderates the relationship between the effects of a Falls Prevention Program and functional mobility of adults at risk for falls. Hypothesis: Fall Prevention Programs to improve balance and functional mobility have been effective for participants at risk for falls. This program will aim to assess the impact a Falls Prevention Program has on different populations. Specific Aim 6: Determine the effects of the Falls Prevention Program on Anticipatory Postural Assessment and Compensatory Postural Assessment. Hypothesis: Older adults will improve their Anticipatory Postural Assessment and Compensatory Postural Assessment (less magnitude and faster responses of muscle activity along with less body displacement) in response to balance perturbations a a result of the intervention.

Official Title
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A Community-Based Falls Prevention Program for Adults At-Risk for Falls

Conditions
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Neurologic Disorder, Accidental Fall, Old Age; Debility, Healthy Aging

Intervention / Treatment
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* Other: Falls Prevention Program


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Male or female Age range: 18-100 At risk for falls (as determined by any of the following: Positive history of falls within 5 years Timed up and Go <45 seconds Medical clearance for participation in Falls Prevention Program Able to attend biweekly sessions for 5 weeks Exclusion Criteria: Unable to independently kneel and sit and on the floor and return to chair Taking prescription anti-coagulants without physician clearance to participate No medical clearance for participation in Falls Prevention Program Unable to attend bi-weekly on-site sessions for 5 weeks Other reasons that may limit participation in intervention

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 100 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Falls Prevention training<br>The intervention consists of 10 sessions. One session a week consists of obstacle course training. The other session consists of falls strategies and walking and balance exercises. Each session lasts approximately 1.5 hours | Other: Falls Prevention Program<br>* The intervention consists of 10 sessions. One session a week consists of obstacle course training. The other session focuses on falls strategies training and walking and balance exercises. Each session lasts approximately 1.5 hours.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Changes over time in Activities-Specific Balance Confidence Scale from baseline to one year | The Activities-Specific Balance Confidence Scale is a self-report measure of balance confidence in performing various activities without losing balance or experiencing a sense of unsteadiness. | Baseline, 6-weeks, 6-months and 1-year post intervention. | 
| Changes in Falls Efficacy Scale - International from baseline to 1-year post | A self-administered questionnaire designed to assess fear of falling in mainly community-dwelling older population | Baseline, 6-weeks, 6-months and 1-year post intervention. | 
| Changes in Berg Balance Test from baseline to 1-year post | The Berg Balance Test is used to objectively determine a patient's ability (or inability) to safely balance during a series of predetermined tasks | Baseline, 6-weeks, 6-months and 1-year post intervention. | 
| Changes in Functional Reach Test from baseline to 1-year post | The Functional Reach measures the participant to complete a forward reach while in a standing position | Baseline, 6-weeks, 6-months and 1-year post intervention. | 
| Changes in Single Limb Stance from baseline to 1-year post | The Single Limb Stance test is a measurement to assess the individual's ability to stand unsupported on one limb. | Baseline, 6-weeks, 6-months and 1-year post intervention. | 
| Changes in Tandem Stance from baseline to 1-year post | The Tandem Stance test is a measurement to assess the individual's ability to stand unsupported with one foot directly in front of the other | Baseline, 6-weeks, 6-months and 1-year post intervention. | 
| Changes in 10-Meter Walk Test from baseline to 1-year post | The 10 Meter Walk Test is a performance measure used to assess walking speed in meters per second over a short distance | Baseline, 6-weeks, 6-months and 1-year post intervention. | 
| Changes in 6-Minute Walk Test from baseline to 1-year post | The 6 Minute Walk Test is a sub-maximal exercise test used to assess aerobic capacity and endurance | Baseline, 6-weeks, 6-months and 1-year post intervention. | 
| Changes in Timed Up and Go from baseline to 1-year post | The Timed Up and Go test is a measure that assess fall risk by performing sit to stand and walking | Baseline, 6-weeks, 6-months and 1-year post intervention. | 
| Changes in Anticipatory & Compensatory Postural Assessment from baseline to 1-year post | Electromyography measure of postural stability in standing | Baseline, 6-weeks, 6-months and 1-year post intervention. | 
| Changes in Obstacle Course performance from baseline to 1-year post | The obstacle course measures time to complete 17 obstacles and errors performed on each of the obstacles | Baseline, 6-weeks, 6-months and 1-year post intervention. | 
| Changes in falls occurrences from baseline to 1-year post | The questionnaire assesses incidence of falls, falls with injuries and falls requiring hospitalization | Baseline, 6-weeks, 6-months and 1-year post intervention. | 
| Changes Physical Activity Intensity Monitoring from baseline to 1-year post intervention | Heart rate monitoring during all components of falls prevention program | Baseline, 6-weeks, 6-months and 1-year post intervention. | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Falls, Balance, Neurological, Geriatrics, Risk