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.

内在足部肌肉强化干预措施对平衡、本体感觉和跌倒的影响 65岁以上的成年人 背景：跌倒是 65 岁及以上成年人受伤的主要原因。虽然跌倒的原因有 多因素影响下，足部功能起着至关重要的作用。足部内在肌肉 (IFM)，即起源和插入的肌肉 在脚内，提供对平衡很重要的稳定性和感觉输入。老年人 IFM 较弱或不使用 成年人可能会导致足部和脚趾排列错误，这被认为是跌倒的独立预测因素。 穿最小缓冲鞋或进行针对 IFM 的强化练习可能会有所改善 这些肌肉的力量、耐力、本体感觉质量和脚/脚趾结构，可能会改善 老年人的功能活动能力和平衡能力，从而防止跌倒。 目的：拟议研究的目的是分析两种 IFM 强化干预措施的效果 （最少穿鞋或强化练习）关于 IFM 力量、本体感觉、脚/脚趾结构、平衡 和老年人的功能活动能力以及跌倒发生率。 设计：随机对照试验 方法：年龄 > 65 岁、可以在有或没有辅助装置的情况下在家庭距离内行走的成年人 将受邀参加。足部感觉差、下肢截肢、受伤或手术的个体 过去 6 个月内，下肢或腰椎出现损伤，遵循语言和语言的认知能力受损 书面说明或前庭障碍将被排除。在知情同意和初步筛选后， 参与者将被随机分配到四个干预组之一（n=120，n=30/组）： 1）内在足部肌肉强化练习 2) 行走时规定的最低限度鞋子 3) 内在足部肌肉强化练习和规定步行所需的最少鞋子 4) 非最低限度鞋类规定步行（对照） 我们鼓励参与者每周 5 天进行干预，持续 16 周。初次面对面交流后 指导会议，参与者将有 1 次后续会议来审查指导，之后他们将收到 每两个月打电话一次，提醒坚持干预并记录任何跌倒和相关细节。 参与者将被要求记录干预表现、每日步数（通过计步器测量）以及 落在提供的日记中。将使用 Mini-BesTest、本体感觉来测量平衡和功能活动能力 将使用下肢位置测试进行测量，足部和脚趾结构将使用舟骨进行测量 第一跖趾关节下垂角和外翻角。拇展肌横截面积（cm2）， 将使用超声波测量拇短屈肌、指短屈肌和跖方肌 成像。关于平衡和功能活动性、本体感觉、足/脚趾结构和肌肉的测量 横截面积将在基线、第 8、10、12 和 16 周时出现。经过 16 周的干预期后， 将鼓励参与者每周继续进行两次干预。正在进行的秋季日记和双月刊 研究人员将在基线后 12 个月内打电话来记录长期跌倒率（每人跌倒次数） 每年）。 数据分析：将使用 4 组 x 5 个时间点重复测量方差分析 (ANOVA) 进行评估 平衡、功能活动能力、本体感觉、足/脚趾结构和肌肉横截面积的变化。 跌倒数据将按照从跌倒日期开始的 12 个月内每人的跌倒率来衡量 基线测量。 意义：很少对老年人和老年人进行内在足部肌肉强化干预措施的研究。 它们的作用和机制尚未确定。这将是第一项评估这些影响的研究 对老年人本体感觉的干预，首先使用超声成像测量内在内在 老年人的足部肌肉强化，以及第一项分析老年人足部肌肉强化后跌倒的长期影响的研究 这些干预措施的表现。本研究提案中评估的干预措施简单、安全且 负担得起，并且可能对老年人的功能活动能力和减少跌倒产生重大影响。