Clinical trial NCT06175871: New Clinical Rehabilitation Approach for the Management of Falls Risks
Official title: Development of a New Clinical Rehabilitation Approach for the Management of Elderly People With a Neuromusculoskeletal Disorder and a Risk of Falls: a Partnership Project Between UQAC and the Specialized Geriatric Services of CIUSSS-SLSJ
Study type: INTERVENTIONAL
Overall status: RECRUITING
Phase: NA
Conditions: Musculoskeletal Diseases
Chronic Disease
Fall Patients
Aging Problems
Postural Low Back Pain
Parkinson Disease
Keywords: Aging
Rehabilitation
Postural control
Falls
Biomechanics
Technology innovative
Prevention
Mobility
Lead sponsor: Université du Québec à Chicoutimi
Sponsor class: OTHER
Collaborators: name: Agence de la Sante et des Services Sociaux du Saguenay-Lac-Saint-Jean
First posted: 2023-12-19
Enrollment: 92
Sex: ALL
Minimum age (years): 65
Maximum age (years): 99
Standard ages: OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Intervention model description: Clinical trial design
Primary purpose: TREATMENT

Brief summary: Accidental falls in older adults are one of the world's major pubic health problem, because of their strong association with injuries and mortality rates. In Quebec, falls are responsible for a high rate of hospitalization (more than 1800 emergency department visits every day) and deaths (more than 10,000 in recent years). Preventing falls is therefore a key mission for health professionals. This research program aims to develop a new clinical approach to the rehabilitation management of the older with a neuro-musculoskeletal disorder and a risk of falling. This program is part of a new partnership project between UQAC and specialized geriatric services at the CIUSSS Saguenay-Lac-St-Jean (La Baie site). These geriatric services admit more than 400 new patients per year, representing a large pool of participants for the new program's development. Specifically, this program has 4 phases: 1) Create a clinical profile of patients in rehabilitation care from specialized geriatric services (ex: reasons for consultation, neuro-musculoskeletal disorders, rates and causes of falls, etc.); 2) to diagnose functional deficits of these patients on different dimensions of functional and physical evaluations, using standardized tests and high-tech instruments (ex: platform of force); 3) determine the effectiveness of a new exercise intervention program (OTAGO) for falls prevention; and 4) Measure client and professional team satisfaction as well as long-term impact of this new approach used to prevent falls. The most significant impact of this new program will be to reduce public health expenditure for care of older adults with balance disorder and risk for falls; and therefore, be implanted in other CIUSSS institutions from Quebec.

Detailed description: This research program on aging to create Living Lab Sag aims at maintaining older adult's full individual and collective abilities in the Saguenay-Lac-Saint-Jean (SLSJ) region. The need for innovation and creativity aims at optimizing independence, whether for mobility, the ability to take charge of one's health, to remain at home, to have access to services, and to prevent falls in a frail and aging population. Thus, this program includes expert investigators in the areas of health, engineering and computer science, aging, neuropsychology, geriatrics, and rehabilitation/prevention within a multidisciplinary work approach for durable health for older adults in Saguenay. Living Lab Sag will be implemented based on an enriched research program, approved by the CIUSSS SLSJ (CER# 2019-008) and entitled: Development of a new clinical approach in rehabilitation for the care of older adults with a neuro-musculo-skeletal disorder and a risk of falling: Project in partnership between UQAC and the specialized geriatrics services of the CIUSSS-SLSJ. Canada census reports clearly show the demographic aging of the local population. It is predicted that people 65 years and older will comprise about 24% of the population in 2036, in Canada and Quebec. In parallel with this demographic phenomenon, 50% of Canadians live with at least one chronic disability that is often associated with advanced age, as well as with different neurological, orthopedic and cardiopulmonary degenerative diseases. Some diseases affecting the neuro-musculo-skeletal system will lead to physical disability and to a significant functional limitation in terms of balance, mobility and walking and, consequently, to an increase in the risk of falling. Falls have a significant financial effect on healthcare services. Every year, in Quebec, approximately 1/3 of people aged 65 and over will fall and, sadly, some data suggest that 424,000 people will die, worldwide, because of a fall. The present scenario also shows the importance of developing strategies to reduce the weight of falls on the healthcare system, such as the creation of Living Lab Sag where the older adults will be at the heart of the situation. With team's experience in the area, one strategy among others is the early identification of physical-functional factors leading to a fall, despite the presence of other associated extrinsic factors that are also associated with the fall (i.e., multifactor phenomenon). This identification can be realized through neurophysiological measures from valid and reliable biological signals in rehabilitation, that will help determine the neuromuscular responses associated to the level of physical frailty of the individual and his/her fall risk. However, geriatric services in general don't often have access to high-end screening tools that permit an early detection of balance problems and fall risk. Within an innovative action plan, our research program, in partnership with specialized geriatric services and researchers aims to determine the efficiency of new evaluation and intervention methods for the health of the older adults. Since 2019, this programm integrate new measures using various high-end equipment to capture biological signals enabling to perform research with patients from Hospital and patients from Parkinson Association and community local. The mission of this program is to build a new paradigm for this site while being a reference to evaluate balance/mobility and walking problems, better screen frail older adults who are at risk of falling and direct then to personalized therapy. At this time, this work will develop a longitudinal intervention study using OTAGO (PEO) exercise program. The name "OTAGO" is not an acronym, as "Otago" is a region of New Zealand located southwest of the southern island. PEO is defined by a reeducation program for strength and balance at home (or in a rehabilitation center), that is personalized, and based on conclusive data. The PEO was developed by a geriatrician (Dr. Campbell) and his team of physiotherapists in 1997, after many years of research, to identify the risks of falling and the potential interventions that could reduce these risks. The program exists worldwide but has never been tested in Québec. Although there are different fall prevention programs, conclusive data show the more frequent use of OTAGO because of its efficiency to reduce the risk of death and the incidence rate of falls over a period of one year in an aging population. This program also reduces falls by 25% according to conclusive data, which no other program in Québec and in rural areas has demonstrated until now. Finally, this program can be a cost-effective intervention for the healthcare system by reducing expenses associated to falls in rural areas, and in particular for patients in La Baie Hospital. Already used in Australia and the United States, we have yet to determine its effects in the Saguenay area. The goal is to test and show its efficiency for the fist time in the area by a random clinical trial in La Baie Hospital. This step will make it possible to advance our research program on the effective intervention plan to reduce future public healthcare expenses related to falls. The aim of this study will thus be to evaluate if the PEO, when adapted to La Baie geriatric services, is superior to conventional therapy to improve parameters of walking, balance, muscle activation, postural trunk control, mobility, force, endurance and perception of symptoms related to pain, function, fall risk and, consequently, quality of life (wellbeing), volume of medication and expenses associated to fall. In other step, the purpose is also evaluate the effect of carrying out the OTAGO exercises in an outdoor and nature modality during a feasibility study to see the impact of nature on the functional abilities of older people with neuromusculoskeletal disorders (ex. Parkinson disease).

Eligibility criteria: Inclusion Criteria:

* Admitted to La Baie Hospital rehabilitation services; or
* Admitted to the waiting list for geriatric services at La Baie Hospital; or
* Older adults from the communityé
* Age 65 and over
* Able-bodied adult with minimal autonomy to perform fall-prevention tests and exercises.
* Have at least one neuro-musculo-skeletal disorders and risk of falls

Exclusion Criteria:

* Cancer
* Red flags (infection, tumor, etc.)
* Severe psychiatric disorders
* Palliative care
* Congenital spinal deformity (spondylolysis, intervertebral fusions)
* Severe systemic syndromes or diseases that may prevent tests and exercises from being performed.
* Stroke - very acute phase (1 week) and this until medial hemodynamic stability.

Primary outcomes:
measure: Postural control
timeFrame: change from baseline at 8 to 12 weeks
measure: Walking
timeFrame: change from baseline at 8 to 12 weeks
measure: Trunk postural control on wobble chair
timeFrame: change from baseline at 8 to 12 weeks
measure: Machine learning-driven neuromusculoskeletal (NMS) assessment
timeFrame: change from baseline at 8 to 12 weeks
Secondary outcomes:
measure: Functional mobility test: TUG
timeFrame: change from baseline at 8 to 12 weeks
measure: 30 Second Sit to Stand Test
timeFrame: change from baseline at 8 to 12 weeks
measure: maximal isometric hand grip strength
timeFrame: change from baseline at 8 to 12 weeks
measure: Walking test in 10 meters
timeFrame: change from baseline at 8 to 12 weeks
measure: 5 times Sit-To-Stand (FTSTS)
timeFrame: change from baseline at 8 to 12 weeks
measure: Numbers of falls
timeFrame: change from baseline at 8 to 12 weeks, 6 and 12 months after
Other outcomes:
measure: Falls Efficacy Scale-International (FES-I)
timeFrame: change from baseline at 8 to 12 weeks
measure: Pain measures
timeFrame: change from baseline at 8 to 12 weeks
measure: Fatigue perception
timeFrame: change from baseline at 8 to 12 weeks
measure: Frailty criteria from Fried
timeFrame: change from baseline at 8 to 12 weeks
measure: Hoehn and Yahr Scale
timeFrame: Only at baseline from Sample characterization when Parkinson was included.
measure: Cognitive status
timeFrame: Only at baseline from Sample characterization.
Locations:
city: Saguenay
country: Canada
facility: Rubens da Silva
state: Quebec
Study officials:
affiliation: CIUSSS-SLSJ (La Baie Hospital)
name: Sharlène Côté, MD
role: STUDY_CHAIR
affiliation: Université du Québec à Chicoutimi
name: Julie Bouchard, PhD
role: STUDY_DIRECTOR
affiliation: CIUSSS-SLSJ (La Baie Hospital)
name: Patrice Tremblay, PT
role: STUDY_CHAIR
affiliation: Université du Québec à Chicoutimi
name: Rubens da Silva
role: PRINCIPAL_INVESTIGATOR
affiliation: Université du Québec à Chicoutimi
name: Marie-Ève Langelier, MD
role: STUDY_CHAIR
References:
citation: Fuzhong L, McAuley E, Fisher KJ, Harmer P, Chaumeton N, Wilson NL. Self-efficacy as a mediator between fear of falling and functional ability in the elderly. J Aging Health. 2002 Nov;14(4):452-66. doi: 10.1177/089826402237178.
citation: Poquet N, Lin C. The Brief Pain Inventory (BPI). J Physiother. 2016 Jan;62(1):52. doi: 10.1016/j.jphys.2015.07.001. Epub 2015 Aug 21. No abstract available.
citation: Barry E, Galvin R, Keogh C, Horgan F, Fahey T. Is the Timed Up and Go test a useful predictor of risk of falls in community dwelling older adults: a systematic review and meta-analysis. BMC Geriatr. 2014 Feb 1;14:14. doi: 10.1186/1471-2318-14-14.
citation: Jiang X, Cooper J, Porter MM, Ready AE. Adoption of Canada's Physical Activity Guide and Handbook for Older Adults: impact on functional fitness and energy expenditure. Can J Appl Physiol. 2004 Aug;29(4):395-410. doi: 10.1139/h04-025.
citation: Guideline for the prevention of falls in older persons. American Geriatrics Society, British Geriatrics Society, and American Academy of Orthopaedic Surgeons Panel on Falls Prevention. J Am Geriatr Soc. 2001 May;49(5):664-72. No abstract available.
citation: Woolcott JC, Khan KM, Mitrovic S, Anis AH, Marra CA. The cost of fall related presentations to the ED: a prospective, in-person, patient-tracking analysis of health resource utilization. Osteoporos Int. 2012 May;23(5):1513-9. doi: 10.1007/s00198-011-1764-1. Epub 2011 Sep 3.
citation: Oliveira MR, Vieira ER, Gil AWO, Fernandes KBP, Teixeira DC, Amorim CF, da Silva RA. One-legged stance sway of older adults with and without falls. PLoS One. 2018 Sep 17;13(9):e0203887. doi: 10.1371/journal.pone.0203887. eCollection 2018.
citation: Vieira ER, Tappen R, Gropper SS, Severi MT, Engstrom G, de Oliveira MR, Barbosa AC, da Silva RA. Changes on Walking During Street Crossing Situations and on Dorsiflexion Strength of Older Caribbean Americans After an Exercise Program: A Pilot Study. J Aging Phys Act. 2017 Oct 1;25(4):525-532. doi: 10.1123/japa.2016-0231. Epub 2017 Sep 14.
citation: Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, Seeman T, Tracy R, Kop WJ, Burke G, McBurnie MA; Cardiovascular Health Study Collaborative Research Group. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001 Mar;56(3):M146-56. doi: 10.1093/gerona/56.3.m146.
citation: Campbell AJ, Robertson MC, Gardner MM, Norton RN, Tilyard MW, Buchner DM. Randomised controlled trial of a general practice programme of home based exercise to prevent falls in elderly women. BMJ. 1997 Oct 25;315(7115):1065-9. doi: 10.1136/bmj.315.7115.1065.
citation: Shubert TE, Smith ML, Goto L, Jiang L, Ory MG. Otago Exercise Program in the United States: Comparison of 2 Implementation Models. Phys Ther. 2017 Feb 1;97(2):187-197. doi: 10.2522/ptj.20160236.
citation: Thomas S, Mackintosh S, Halbert J. Does the 'Otago exercise programme' reduce mortality and falls in older adults?: a systematic review and meta-analysis. Age Ageing. 2010 Nov;39(6):681-7. doi: 10.1093/ageing/afq102. Epub 2010 Sep 4.
citation: Derouesne C, Poitreneau J, Hugonot L, Kalafat M, Dubois B, Laurent B. [Mini-Mental State Examination:a useful method for the evaluation of the cognitive status of patients by the clinician. Consensual French version]. Presse Med. 1999 Jun 12;28(21):1141-8. French.
citation: Jones SE, Kon SS, Canavan JL, Patel MS, Clark AL, Nolan CM, Polkey MI, Man WD. The five-repetition sit-to-stand test as a functional outcome measure in COPD. Thorax. 2013 Nov;68(11):1015-20. doi: 10.1136/thoraxjnl-2013-203576. Epub 2013 Jun 19.
citation: da Silva RA, Vieira ER, Carvalho CE, Oliveira MR, Amorim CF, Neto EN. Age-related differences on low back pain and postural control during one-leg stance: a case-control study. Eur Spine J. 2016 Apr;25(4):1251-7. doi: 10.1007/s00586-015-4255-9. Epub 2015 Oct 1.
citation: Oliveira MR, Vieira ER, Gil AWO, Teixeira DC, Amorim CF, da Silva RA. How many balance task trials are needed to accurately assess postural control measures in older women? J Bodyw Mov Ther. 2019 Jul;23(3):594-597. doi: 10.1016/j.jbmt.2019.04.004. Epub 2019 Apr 12.
citation: Vieira ER, Da Silva RA, Severi MT, Barbosa AC, Amick Iii BC, Zevallos JC, Martinez IL, Chaves PHM. Balance and Gait of Frail, Pre-Frail, and Robust Older Hispanics. Geriatrics (Basel). 2018 Jul 18;3(3):42. doi: 10.3390/geriatrics3030042.
citation: da Silva RA, Vieira ER, Leonard G, Beaulieu LD, Ngomo S, Nowotny AH, Amorim CF. Age- and low back pain-related differences in trunk muscle activation during one-legged stance balance task. Gait Posture. 2019 Mar;69:25-30. doi: 10.1016/j.gaitpost.2019.01.016. Epub 2019 Jan 11.
citation: Dallaire M, Gagnon G, Fortin E, Nepton J, Severn AF, Cote S, Smaili SM, Goncalves de Oliveira Araujo HA, de Oliveira MR, Ngomo S, Bouchard J, da Silva RA. The Impact of Parkinson's Disease on Postural Control in Older People and How Sex can Mediate These Results: A Systematic Review. Geriatrics (Basel). 2021 Oct 29;6(4):105. doi: 10.3390/geriatrics6040105.
citation: de Lima MDCC, Dallaire M, Tremblay C, Nicole A, Fortin E, Maluf IC, Nepton J, Severn AF, Tremblay P, Cote S, Bouchard J, da Silva RA. Physical and Functional Clinical Profile of Older Adults in Specialized Geriatric Rehabilitation Care Services in Saguenay-Quebec: A Retrospective Study at La Baie Hospital. Int J Environ Res Public Health. 2022 Aug 13;19(16):9994. doi: 10.3390/ijerph19169994.