Improving balance and mobility in older Veterans

描述(由申请人提供)： 背景：目前，跌倒是65岁以上成年人损伤性死亡和非致命性伤害的主要原因。年龄较大的退伍军人由于负担较重，摔倒的风险可能更大 医疗并存的风险。退伍军人管理局已将预防跌倒的研究列为优先事项。太极目前被认为是最有效的预防跌倒运动干预措施之一，得到了疾控中心的认可，广泛影响着医疗保健政策。然而，很少有研究将太极与另一种积极干预进行比较。太极总体上可能会改善平衡，并提供一般下半身的力量，但太极可能不足以改善步态和动态灵活性，而且对克服障碍几乎没有作用，障碍是导致摔倒的最大因素之一。大多数跌倒发生在行走过程中，滑倒和绊倒是最常见的原因，专注于提高步态和行走能力的有针对性的干预措施在改善平衡和减少跌倒方面可能更有效。目的：这项先导性研究的目的是评估两种老年退伍军人的跌倒减少计划，太极和多模式平衡干预(MMBI)，重点是动态踏步、越障、行走和加强腿部力量。我们建议MMBI将提供太极的许多相同的好处(加强和改善平衡)，但解决了许多太极项目中的不足，包括环境谈判和步行。这项计划也可以很容易地在社区实践中实施。方法：我们计划招募56名老年(年龄65岁)社区居住的退伍军人，他们在过去一年中有跌倒史，他们有反复跌倒的高风险。在基线测试后，个人将被随机分为MMB组或模仿太极运动更好平衡计划的太极干预组。所有参与者都将参加他们指定的干预措施中的集体锻炼课程，每周1小时，持续24周。在完成24周的锻炼后，运动组的变化将被比较：1)平衡(4平方台阶测试)，2)机动性和跌倒风险(功能步态评估、临床步态评估和GAITrite上的步态可变性)，4)问卷(跌倒效果和ABC)，5)下肢等长力量测试(Biodex)，6)腹部、臀部和大腿的全身DXA和CT扫描，以确定下肢和核心肌肉的组成。我们还计划在干预结束后对所有参与者进行为期6个月的跟踪调查，以检查两组之间停止计划后跌倒发生率的差异。影响：这项研究直接使退伍军人受益，因为它可能导致新的有效干预措施，可以减少老年退伍军人跌倒的风险、与伤害相关的住院和死亡。MMBI也可以很容易地输出到社区，并且可以用最少的资源在其他VAS广泛实施，作为护理标准的一部分，类似于MOVE！。该奖项的结果将被用于一项更大的随机临床试验，该试验将检验这两种干预措施的有效性，以降低跌倒风险较高的老年退伍军人的跌倒几率和跌倒风险。

DESCRIPTION (provided by applicant): Background: Falls are currently the leading cause of injurious death and non-fatal injuries for adults over the age of 65. Older veterans may be at greater risk for falls due to their high burden of medical co-morbidity. The VA has made research into fall prevention a high priority. Tai Chi is currently considered to be one of the most effective fall prevention exercise interventions, with an endorsement from the CDC that widely influences health care policy. However, there are few studies comparing Tai Chi with another active intervention. Tai Chi may generally improve balance and provide general lower body strengthening however Tai Chi may not sufficiently improve gait and dynamic mobility and does little to target obstacle negotiation, one of the largest contributors to a fall. The majority of falls occur during walking, with slips and trips beng the most common causes and targeted interventions focused on improving stepping and walking ability may be even more effective at improving balance and reducing falls. Objective: The purpose of this pilot study is to evaluate two fall reduction programs in older veterans, Tai Chi and a multimodal balance intervention (MMBI) focused on dynamic stepping, obstacle negotiation, walking, and lower extremity strengthening. We propose that MMBI will provide many of the same benefits of tai chi (strengthening and improved balance) but addresses the deficits in many tai chi programs including environmental negotiation and walking. This program could also be easily implemented in community practice. Methods: We plan to enroll 56 older (age > 65 years) community dwelling veterans with a history of a fall in the last year who are at high risk for a recurrent fall. After baseline testing individuals will be randomized to either MMB or a Tai Chi intervention modeled after the Tai Chi Moving for Better Balance Program. All participants will participate in a group exercise class in their assigned intervention for 1 hour, times per week for 24 weeks. After the completion of 24 weeks of exercise group changes will be compared for 1) balance (4-square step test), 2) mobility and fall risk (functional gait assessment, clinical gait assessment and gait variability on a GAITrite), 4) questionnaires (falls efficacy and ABC) 5) lower extremity isometric strength testing (biodex), 6) a whole body DXA and CT scan of the abdomen, hips and thighs for determination of lower extremity and core muscle composition. We also plan for follow all participants for 6 months after completion of the intervention to examine differences in fall rates after the cessation of the program between the groups. Impact: This research directly benefits veterans as it may lead to new and effective interventions that could reduce fall risk, injury-related hospitalization and death in older veterans. MMBI is also readily exportable to the community and with minimal resources could be widely implemented at other VAs as part of standard of care, similar to MOVE!. Results from this award will be used to power a larger randomized clinical trial that will examine the effectiveness of the two interventions to reduce rate of falls and risk of falling in older veteran at high risk for falls.