Potential Implementation of Reactive Balance Training within Continuing Care Retirement Communities

Abstract

Purpose The purpose of the study was to evaluate the feasibility of implementing reactive balance training (RBT) in continuing care retirement communities, as a part of typical practice in these facilities. Methods RBT, a task-specific exercise program, consisted of repeatedly exposing participants to trip-like perturbations on a modified treadmill to improve reactive balance and subsequently reduce fall risk. Semistructured interviews were conducted with retirement community residents (RBT participants) and administrators, to assess the organizational context, perceptions of evidence for falls prevention, and facilitation strategies that could improve the likelihood of implementing RBT as a falls prevention program. Results Contextual factors such as leadership support, culture of change, evaluation capabilities, and receptivity to RBT among administrators and health leaders at the participating retirement communities could facilitate future implementation. The cost associated with RBT (e.g., equipment and personnel), resident recruitment, and accessibility of RBT for many residents were identified as primary barriers related to the intervention. Participants perceived observable health benefits after completing RBT, and had increased awareness toward tripping and greater confidence with respect to mobility. Across interviewees, potential barriers for implementation regarding facilitation revolved around the compatibility and customizability for different participant capabilities that would need to be considered before adopting RBT. Conclusion RBT could fill a need in retirement communities, and the findings provide areas of context, characteristics of the intervention, and facilitation approaches that could improve uptake.

Perturbation-based balance training targeting both slip- and trip-induced falls among older adults: a randomized controlled trial

“…slip or trip) influences the efficacy of PBT. However, reducing participant anxiety during training to maximize participation and adherence, such as through training individualization, is a key consideration for clinical implementation [51] and community adoption [52].…”

A proposed methodology for trip recovery training without a specialized treadmill

“…We anticipate NT to have a measure of acceptability among older adult participants. This expectation is based upon qualitative similarities between NT and treadmill-based trip recovery training programs and the acceptability that has been provided to the latter ( 26 ). We also anticipate NT to elicit improvements in trip recovery after laboratory-induced trips when compared to a control involving general balance and strength exercises not specific to tripping.…”

“…Treadmill-assisted trip recovery training has been conducted using commercially-available specialized treadmills marketed for PBT ( 19 , 23 – 25 ) as well as a lower cost option using a modified off-the-shelf treadmill ( 17 , 20 ). The cost and/or space requirements associated with an electromechanical tripping obstacle within a walkway or a specialized treadmill can present a barrier to wider application trip recovery training ( 26 ). A trip recovery training regimen that does not require either may facilitate its use outside the research setting.…”

“…A trial is planned in the near future to evaluate its effectiveness on laboratory-induced trips in comparison to treadmill-based trip training and a control among community-dwelling older adults. If effective, NT could provide a lower cost method for trip recovery training and facilitate greater implementation outside of the research environment ( 12 , 26 ).…”

Effect of Instability Training on Compensatory Muscle Activation during Perturbation Challenge in Young Adults

“…The limitations to these methods are that they are one-time, abrupt challenges that may provide a reasonable test situation but may not be reasonable for training. While there is substantial research regarding the effect of perturbation balance training using the bottom-up training method [ 33 , 34 , 35 , 36 , 37 , 38 ], there are limited studies examining upper body perturbation training programs on improvements in force steadiness that provide both a continuous proprioceptive challenge requiring continual compensatory muscle activation.…”