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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

基本信息

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
项目类别：
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

项目摘要

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.

项目总结