Motor Control and Ergonomic Intervention Home-Based Program: A Pilot Trial Performed in the Framework of the Motor Control Home Ergonomics Elderlies' Prevention of Falls (McHeELP) Project

Abstract

Falls are a serious problem that can reduce living autonomy and health-related quality of life of older adults. A decrease in the muscular strength of the lower limbs and the deterioration of balance or motor performance deficits may lead to falls. "Motor Control Home Ergonomics Elderlies' Prevention of Falls" (McHeELP) is a novel motor control exercise program combined with ergonomic arrangements of the home environment. This pilot trial is conducted in order to examine the feasibility and acceptability of the McHeELP program, the selection of the most appropriate outcome measures, and the exact sample size calculation that should be used for the randomized controlled trial (RCT) with Clinical Trial Identifier: ISRCTN15936467. Patients and methodsTwenty older adults (aged ≥65 years) who had experienced at least one fall-incident in the past 12 months have participated in the trial; they were randomized in a 1:1 ratio to the McHeELP group (McHeELP-G) and the Control group (CG). The McHeELP-G received a personalized therapeutic motor control and learning exercise program performed three times per week for 12 weeks. Regarding McHeELP -home modification, a booklet that contained basic advice and tips on the modification for their inside and outside home environment was provided to the participants. Objective and self-reported outcome measures, collected at baseline and post-intervention (end of the third month), included functional, fear of falling, and quality of life measurements. ResultsThe McHeELP intervention was very feasible and acceptable to the participants, and the adherence was excellent (100%). The majority of outcome measures seemed appropriate and significant differences were also revealed between the two groups. Specifically, post-intervention statistically significant improvement was found in the 4 meters walking test, Timed Up and Go test, Sit to Stand test, Tandem Stance test, Functional Reach test, Foot tapping test, EuroQoL-5D-5L -visual analog scale (VAS), Lower Extremity Functional Scale, Falls Self-Efficacy International Scale, and Home Falls and Accidents Screening Tool (HOMEFAST) questionnaire of McHeELP-G (all p-values ≤0.002). No statistically significant difference was observed in the mobility, self-care, usual activities, pain/discomfort subscales of Euro QoL-5D-5L (all pvalues >0.05), except the anxiety/depression subscale of McHeELP-G (p=0.008). Moreover, no statistically significant improvement was found regarding McHeELP participants' knee flexion/extension restriction and ankle dorsiflexion/plantar-flexion restrictions. Regarding CG, no statistically significant difference was found (p>0.05), except the Tandem Stance test (p=0.003) and HOMEFAST (p<0.001). Referring to the future McHeELP RCT, it was estimated that a sample size of 25 evaluable patients per group is required. ConclusionsThis pilot trial's findings suggest that it is feasible to deliver an RCT of the McHeLP program to this population. Exercise programs that are easy to administer need to be developed and implemented to...

The Effects of a Home-Based Combined Motor Control and Ergonomic Program on Functional Ability and Fear of Falling: A Randomized Controlled Trial

“…This study provides evidence that older people with a history of falls can safely and effectively participate in an individualized home-based program. The excellent feasibility and acceptability of McHeELP were confirmed in our pilot study [13]. This program may significantly contribute to physiotherapists and health practitioners by developing a novel evidence-based approach to fall prevention in older people.…”

“…Exclusion criteria included: (i) cognitive impairment, (ii) lower-limb muscle weakness due to a central or peripheral neurological etiology, (iii) participants were told not to exercise by a physician, (iv) currently participating in an exercise program. Additional criteria for exclusion were, participants suffering from a vision or vestibular problem or had knee and ankle joint's restrictions that could affect the proper performance of either the exercises or the study's selected physical performance measures (PPMs) [ 13 ]. Participants gave their written informed consent upon acceptance, and their demographic and clinical characteristics were recorded in a face-to-face interview [ 14 ].…”

“…The measurements were carried out by two examiners (senior physiotherapists); one for Attica and one for the Achaia groups, which were blinded concerning the group assignment, and they did not involve in any other part of the study. During the study period (6 months), cases of a new fall-incident were also recorded [ 13 ].…”

“…The sample size estimation, which was calculated in our pilot study [ 13 ], showed that a total of 50 patients (25 patients per group) was required in order to have a 90% probability of demonstrating a between treatment difference of >15% (McHeELP-G: 32%±16 versus CG: 17%±16) in % change from baseline to end of 3rd month (the end of intervention) of Tandem variable with a significance of <5% (two-tailed test).…”

Effects of a modified Otago exercise program delivered through outpatient physical therapy to community-dwelling older adult fallers in Greece during the COVID-19 pandemic: a controlled, randomized, multicenter trial

“…Although falls seem to be a major health problem in Greece, few comprehensive interventions for their prevention have been implemented to date [ 19 – 22 ]. Additionally, the beginning of this study coincided with the beginning of the pandemic in Greece (and also around the world) and was applied in a particularly impacted area of Greece (Central Macedonia), where the older adult population was cut off from all social and sports activities.…”