Effects of a complex intervention on fall risk in the general practitioner setting: a cluster randomized controlled trial

Abstract

PurposeTo study the feasibility of first, reaching functionally declined, but still independent older persons at risk of falls through their general practitioner (GP) and second, to reduce their physiological and psychological fall risk factors with a complex exercise intervention. We investigated the effects of a 16-week exercise intervention on physiological (function, strength, and balance) and psychological (fear of falling) outcomes in community-dwelling older persons in comparison with usual care. In addition, we obtained data on adherence of the participants to the exercise program.MethodsTests on physical and psychological fall risk were conducted at study inclusion, and after the 16-week intervention period in the GP office setting. The 16-week intervention included progressive and challenging balance, gait, and strength exercise as well as changes to behavioral aspects. To account for the hierarchical structure in the chosen study design, with patients nested in GPs and measurements nested in patients, a three-level linear mixed effects model was determined for analysis.ResultsIn total, 33 GPs recruited 378 participants (75.4% females). The mean age of the participants was 78.1 years (standard deviation 5.9 years). Patients in the intervention group showed an improvement in the Timed-Up-and-Go-test (TUG) that was 1.5 seconds greater than that showed by the control group, equivalent to a small to moderate effect. For balance, a relative improvement of 0.8 seconds was accomplished, and anxiety about falls was reduced by 3.7 points in the Falls Efficacy Scale–International (FES-I), in the intervention group relative to control group. In total, 76.6% (N = 170) of the intervention group participated in more than 75% the supervised group sessions.ConclusionThe strategy to address older persons at high risk of falling in the GP setting with a complex exercise intervention was successful. In functionally declined, community-dwelling, older persons a complex intervention for reducing fall risks was effective compared with usual care.

Physical Activity Intervention Effects on Physical Function Among Community-Dwelling Older Adults: A Systematic Review and Meta-Analysis

“…Descriptions of study characteristics are available in the Supplementary Table. Studies were published from 1999–2015 and varied in country of origin with 13 studies from Europe (Boshuizen, Stemmerik, Westhoff, & Hopman-Rock, 2005; Capodaglio, Capodaglio Edda, Facioli, & Saibene, 2007; de Vreede, Samson, van Meeteren, Duursma, & Verhaar, 2005; E Freiberger, Haberle, Spirduso, & Zijlstra, 2012; Freiberger et al, 2013; Gine-Garriga et al, 2010; Granacher, Lacroix, Muehlbauer, Roettger, & Gollhofer, 2013; Jorgensen, Laessoe, Hendriksen, Nielsen, & Aagaard, 2013; Puggaard, 2003; Sousa, Mendes, Abrantes, Sampaio, & Oliveira, 2014; Stiggelbout, Popkema, Hopman-Rock, de Greef, & van Mechelen, 2004; Uusi-Rasi et al, 2015; Zech et al, 2012); eight from the United States (Brandon, Boyette, Gaasch, & Lloyd, 2000; Brandon, Boyette, Lloyd, & Gaasch, 2004; M. Brown et al, 2000; Cress et al, 1999; Mangione, Craik, Palombaro, Tomlinson, & Hofmann, 2010; Miszko et al, 2003; Villareal et al, 2011; Villareal, Banks, Sinacore, Siener, & Klein, 2006); three from South America (Bunout et al, 2006; de Andrade et al, 2013; Lustosa et al, 2011); two from Asia (So et al, 2013; Yamada et al, 2011); and two from Australia (Baker et al, 2007; Foley, Hillier, & Barnard, 2011).…”

Cognitive–behavioural therapy-based intervention to reduce fear of falling in older people: therapy development and randomised controlled trial – the Strategies for Increasing Independence, Confidence and Energy (STRIDE) study

“…Although there are no definitions of minimal clinically significant changes in FES-I or any other fear of falling measure, 25 our FES-I effect size is among the highest reported, with recent randomised studies on interventions in fear of falling using the FES-I reporting significant decreases in scores ranging from 0.53 to 3.7. [118][119][120] Dropouts from the study were at variable time points and tended to be triggered by activities arising from the study (e.g. example the CBTi in the intervention group).…”

Barriers to outdoor physical activity and unmet physical activity need in older adults

“…Good sidewalks and proper street maintenance benefit most people, and for older people who use walking aids these may serve as facilitators for physical activity (Rosenberg et al 2012). Insecurity due to fear of falling can be reduced by participation in supervised exercise (Freiberger et al 2013). Changes do not necessarily have to happen in the built environment, but they can also be achieved in the social environment, for example by offering assistance in going out and walking outdoors with a friend, relative or a lay volunteer (Rantanen et al 2014).…”