A Remotely Delivered Tai Ji Quan Intervention to Reduce Incidence of Falls in High Risk Community-Dwelling Older Adults

远程太极拳干预可降低高危社区老年人跌倒发生率

• 批准号: 10628517
• 负责人: FUZHONG LI
• 金额: $ 66.6万
• 依托单位: OREGON RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-04-01 至 2028-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10628517
• 关键词: Address; Adoption; Adult; American; Behavior; Binding; COVID-19 pandemic; Cessation of life; Clinical; Clinical Practice Guideline; Communication; Communities; Community Health Services; Community Healthcare; Country; Data; Dissemination and Implementation; Economic Burden; Effectiveness; Elderly; Equilibrium; Evaluation; Exercise; Fall prevention; Geography; Goals; Healthcare Systems; Home; Incidence; Injury; Intervention; Life; Mediator; Morbidity - disease rate; Participant; Performance; Persons; Physical Function; Physical Performance; Prevention strategy; Public Health; Randomized; Randomized, Controlled Trials; Research; Resources; Risk; Schedule; Social Environment; Tai Ji; Target Populations; Task Performances; Technology; Testing; Time; Training; Transportation; Treatment Efficacy; Videoconferencing; Walking; Work; aged; aging population; clinical care; clinically relevant; cognitive function; cognitive performance; community living; community setting; comparative effectiveness; cost; cost effective; effective intervention; effectiveness evaluation; evidence base; executive function; exercise intervention; exercise program; fall risk; falls; flexibility; follow-up; high risk; human old age (65+); implementation barriers; implementation research; implementation strategy; improved; innovation; instructor; intervention program; mode of exercise; mortality; multi-component intervention; multimodality; novel; novel strategies; post intervention; preventive intervention; primary outcome; programs; remote delivery; response; secondary outcome; social; social media; success; videoconference; virtual

PROJECT SUMMARY Among persons aged 65 and older, falls are the leading cause of morbidity and mortality and impose significant social and economic burdens on community health services and healthcare systems. Although evidence shows that group-based, in-person exercise interventions improve strength, balance, and dual-task abilities and consequently directly and indirectly reduce the incidence of falls effectively in older adults, such approaches are problematic in practice because they can be costly, have limited reach, can be logistically difficult to implement, and are often not scalable or generalizable. Therefore, timely identification of alternative implementation strategies that can overcome these limitations to expand delivery of fall prevention interventions to the aging population at greatest risk for falls is of high public health importance and clinical relevance. In response to implementation challenges and community care needs in fall prevention, the primary objective of this project is to evaluate a home-based virtual fall prevention exercise intervention that eliminates common barriers to older adults participating in group-based in-person intervention programs. The proposed intervention is founded on the evidence-based Tai Ji Quan: Moving for Better Balance (TJQMBB) program, which has been specifically reconfigured into a virtual format (V-TJQMBB) delivered through real-time videoconferencing at home. Supported by promising data on feasibility, acceptability, and demand, we propose a 6-month randomized controlled virtual trial to determine the comparative effectiveness of the V-TJQMBB intervention, relative to a virtual multimodal exercise intervention, in lowering the incidence of falls (primary outcome) and improving dual-task performance and physical and cognitive functioning (secondary outcomes) among at-risk older adults living across the U.S. We will also (a) evaluate whether the benefits of the V- TJQMBB intervention on falls can be sustained following formal training and (b) examine the mechanisms (mediators of improved dual-task cost and executive function) through which the V-TJQMBB intervention reduces fall rates. In addition, we will explore implementation potential by examining practical issues, including intervention fidelity, compliance, acceptability, and perceived burdens and benefits of online exercise. The proposed project is novel because it represents a paradigm shift in program delivery from in-person to virtual and is significant because the clinical value of many home-based fall prevention interventions remains inconclusive. If successful, the proposed study will extend the reach and impact of the evidence-based TJQMBB intervention beyond locally situated community-facility settings to home settings where access is not weather limited, transportation dependent, or geographically bounded. Thus, this proposal advances dissemination and implementation research by providing a scalable, flexible, and fiscally responsible means for sustainable fall prevention that potentially could be implemented across the country.

项目概要 在 65 岁及以上的人群中，跌倒是发病和死亡的主要原因，并且 对社区卫生服务和医疗保健系统造成重大的社会和经济负担。虽然 有证据表明，基于小组的面对面锻炼干预可以改善力量、平衡和双重任务 能力，从而直接和间接有效地减少老年人跌倒的发生率，例如 这些方法在实践中存在问题，因为它们可能成本高昂、覆盖范围有限、在后勤方面可能难以实现 难以实施，并且通常不可扩展或通用。因此，及时识别替代方案 可以克服这些限制以扩大跌倒预防服务范围的实施策略 对跌倒风险最大的老龄化人口进行干预具有很高的公共卫生重要性和临床意义 关联。为了应对跌倒预防的实施挑战和社区护理需求，首要任务是 该项目的目标是评估一种基于家庭的虚拟跌倒预防运动干预措施，该干预措施消除了 老年人参与基于团体的面对面干预计划的常见障碍。拟议的 干预措施建立在循证太极拳：迈向更好平衡（TJQMBB）计划的基础上， 它已被专门重新配置为通过实时传送的虚拟格式（V-TJQMBB） 在家进行视频会议。在可行性、可接受性和需求方面有希望的数据的支持下，我们建议 一项为期 6 个月的随机对照虚拟试验，以确定 V-TJQMBB 的比较有效性 相对于虚拟多模式运动干预，干预可以降低跌倒发生率（主要是 结果）并改善双重任务表现以及身体和认知功能（次要结果） 在美国各地的高危老年人中，我们还将 (a) 评估 V- TJQMBB 对跌倒的干预可以在正式培训后持续进行，并且 (b) 检查机制 （改善双任务成本和执行功能的中介）通过 V-TJQMBB 干预 降低跌倒率。此外，我们将通过研究实际问题来探索实施潜力，包括 干预的保真度、依从性、可接受性以及在线锻炼的感知负担和好处。这 拟议的项目很新颖，因为它代表了项目交付从面对面到虚拟的范式转变 其意义重大，因为许多家庭跌倒预防干预措施的临床价值仍然存在 尚无定论。如果成功，拟议的研究将扩大循证研究的范围和影响 TJQMBB 的干预范围不仅限于当地社区设施设置，还包括无法访问的家庭环境 受天气限制、交通依赖或地理限制。因此，本提案提出 通过提供可扩展的、灵活的、财政上负责的手段来传播和实施研究 可持续的跌倒预防可能会在全国范围内实施。