CE-22-006 The effects of intrinsic foot muscle strengthening interventions on balance, proprioception, and fall risk in adults over age 65

CE-22-006 内在足部肌肉强化干预措施对 65 岁以上成年人平衡、本体感觉和跌倒风险的影响

• 批准号: 10686256
• 负责人: Erin Futrell
• 金额: $ 34.06万
• 依托单位: SPRINGFIELD COLLEGE
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-30 至 2025-09-29
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10686256
• 关键词: CE; 22; 006; effects; intrinsic

The effects of intrinsic foot muscle strengthening interventions on balance, proprioception, and falls in adults over age 65 Background: Falls are the leading cause of injury in adults 65 years and older. While causes of falls are multifactorial, foot function plays a vital role. The intrinsic foot muscles (IFM), those that originate and insert within the foot, provide stability and sensory input important for balance. Weakness or disuse of the IFM in older adults can contribute to faulty foot and toe alignment, which have been cited as independent predictors of falls. Wearing minimally cushioned footwear or performing strengthening exercises that target the IFM may improve these muscles' strength, endurance, proprioceptive qualities, and foot/toe structure, which may improve functional mobility and balance in older adults, and thus, prevent falls. Purpose: The purpose of the proposed research is to analyze the effects of two IFM strengthening interventions (minimal footwear use or strengthening exercises) on IFM strength, proprioception, foot/toe structure, balance and functional mobility, and falls incidence in older adults. Design: Randomized control trial Methods: Adults ages > 65 years who can ambulate household distances with or without an assistive device will be invited to participate. Individuals with poor foot sensation, lower extremity amputation, injury or surgery to the lower extremities or lumbar spine in the previous 6 months, impaired cognitive ability to follow verbal and written instructions, or vestibular disorders will be excluded. Following informed consent and initial screening, participants will be randomly allocated to one of four intervention groups (n=120, n=30/group): 1) intrinsic foot muscle strengthening exercises 2) minimal footwear prescribed walking 3) intrinsic foot muscle strengthening exercises and minimal footwear prescribed walking 4) non-minimal footwear prescribed walking (control) Participants will be encouraged to perform interventions 5 days/week for 16 weeks. After an initial in-person instruction session, participants will have 1 follow-up meeting to review instructions, after which they will receive bimonthly phone calls as a reminder to adhere to the intervention and to record any falls and related details. Participants will be asked to record intervention performance, daily step count (measured by pedometer), and falls in provided diaries. Balance and functional mobility will be measured using the Mini-BesTest, proprioception will be measured using the Lower Extremity Position Test, foot and toe structure will be measured using navicular drop and valgus angle of the 1st metatarsophalangeal joint. Cross sectional area (cm2) of the abductor hallucis, flexor hallucis brevis, flexor digitorum brevis, and quadratus plantae muscles will be measured using ultrasound imaging. Measures regarding balance and functional mobility, proprioception, foot/toe structure, and muscle cross sectional area will occur at baseline, 8, 10, 12, and 16 weeks. Following the 16-week intervention period, participants will be encouraged to continue their intervention twice per week. Ongoing falls diaries and bimonthly phone calls from researchers will occur for 12 months after baseline to record long-term fall rate (falls per person per year). Data Analysis: a 4 group x 5 time point repeated measures analysis of variance (ANOVA) will be used to assess changes in balance, and functional mobility, proprioception, foot/toe structure, and muscle cross sectional area. Falls data will be measured as the rate of falls per person in a 12-month period beginning with the date of the baseline measure. Significance: Intrinsic foot muscle strengthening interventions have seldom been studied in older adults and their effects and mechanism are not established. This will be the first study to assess the effects of these interventions on proprioception in older adults, the first to use ultrasound imaging measurement following intrinsic foot muscle strengthening in older adults, and the first study to analyze the long-term effects on falls after the performance of these interventions. The interventions assessed in this research proposal are simple, safe, and affordable and may have a major impact on functional mobility and reduction of falls for older adults.

固有的脚部肌肉加强干预措施对平衡，本体感受和落入的影响 65岁以上的成年人 背景：跌倒是65岁及以上成人受伤的主要原因。而跌倒的原因是 多因素，脚部功能起着至关重要的作用。固有的脚部肌肉（IFM），那些起源和插入的肌肉 在脚内，提供稳定性和感官输入对于平衡很重要。年龄较大的IFM的弱点或废弃 成年人可能会导致脚和脚趾对准有故障，这被认为是跌倒的独立预测指标。 穿着最小的缓冲鞋类或执行针对IFM的增强练习可能会改善 这些肌肉的力量，耐力，本体感受的品质和脚/脚趾结构，可能会改善 老年人的功能活动和平衡，因此可以防止下降。 目的：拟议研究的目的是分析两种IFM加强干预措施的影响 （最小的鞋类使用或增强练习）IFM强度，本体感受，脚趾结构，平衡 和功能性活动性，并在老年人中跌落。 设计：随机控制试验 方法：年龄> 65岁的成年人可以在有或没有辅助设备的情况下行动家庭距离 将邀请参加。脚部感觉差，下肢截肢，受伤或手术的个体 在过去的6个月中，下肢或腰椎，认知能力受损的能力 书面说明或前庭疾病将被排除。遵循知情同意和初始筛选， 参与者将被随机分配给四个干预组之一（n = 120，n = 30/组）： 1）固有的脚部肌肉加强运动 2）最小鞋类规定的步行 3）固有的脚部肌肉增强运动和最少的鞋类行走 4）非最小鞋类规定的步行（控制） 将鼓励参与者在16周内进行5天/周的干预措施。最初的面对面之后 指导会议，参与者将举行1次后续会议来审查说明，之后他们将收到 每两个月打电话提醒您遵守干预措施并记录任何跌倒和相关的细节。 将要求参与者记录干预性能，每日步数（通过计步器衡量）和 跌倒提供的日记。平衡和功能迁移率将使用小型最佳的本体感受来衡量 将使用下肢位置测试测量，脚和脚趾结构将使用导 第一个metatophangeal关节的滴和外向角。绑架者幻觉的横截面区域（CM2）， 将使用超声测量屈肌幻觉Brevis，Brevis和Quadratus plantae肌肉 成像。有关平衡和功能流动性，本体感受，脚趾结构和肌肉的措施 横截面面积将在基线，8、10、12和16周发生。在16周的干预期之后， 鼓励参与者每周两次继续干预。正在进行的瀑布日记和双月 研究人员的电话将在基线后12个月发生，以记录长期跌倒率（每人跌倒 每年）。 数据分析：4组X 5时间点重复测量方差分析（ANOVA）将用于评估 平衡的变化以及功能迁移，本体感受，脚/脚趾结构和肌肉横截面区域。 跌倒数据将被衡量为每人在12个月内的每人跌倒率。 基线度量。 意义：在老年人和 他们的效果和机制尚未确定。这将是第一个评估这些影响的研究 老年人对本体感受的干预措施，首先使用超声成像测量 老年人的脚部肌肉加强，以及第一次分析对跌倒的长期影响的研究 这些干预措施的表现。在本研究建议中评估的干预措施是简单，安全的，并且 负担得起，可能会对老年人的功能流动性和减少跌倒产生重大影响。