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.

项目摘要 在65岁及以上的人群中，福尔斯是发病率和死亡率的主要原因， 对社区卫生服务和保健系统造成重大的社会和经济负担。虽然 有证据表明，以小组为基础的亲自锻炼干预可以改善力量，平衡和双重任务 能力，从而直接和间接地有效降低老年人福尔斯的发生率， 这些方法在实践中是有问题的，因为它们可能成本高昂，覆盖范围有限， 难以实现，并且通常不可扩展或不可推广。因此，及时确定替代方案 可以克服这些限制的实施策略，以扩大跌倒预防的提供 对福尔斯风险最大的老龄化人群进行干预具有高度的公共卫生重要性和临床意义。 本案无关为了应对跌倒预防的实施挑战和社区护理需求， 本项目的目的是评估一种基于家庭的虚拟跌倒预防运动干预， 老年人参与基于团体的面对面干预计划的常见障碍。拟议 干预是建立在基于证据的太极拳：更好的平衡（TJQMBB）计划， 它已被专门重新配置为通过实时传输的虚拟格式（V-TJQMBB）， 在家视频会议在可行性、可接受性和需求方面有希望的数据支持下，我们提出 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 干预，相对于虚拟的多模式运动干预，在降低福尔斯的发生率（主要 结果）和改善双重任务表现以及身体和认知功能（次要结果） 在生活在美国各地的高危老年人中，我们还将（a）评估V- TJQMBB对福尔斯的干预可以在正式培训后持续进行，并且（B）检查机制 （改善双重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，我们亦会研究实际问题，以探讨推行计划的可行性，包括 干预的忠诚度，依从性，可接受性和感知的负担和在线练习的好处。的 拟议的项目是新颖的，因为它代表了一个范式转变，在程序交付从人到虚拟 这一点很重要，因为许多家庭预防跌倒干预措施的临床价值仍然存在， 不确定如果成功，拟议的研究将扩大循证医学的范围和影响。 TJQMBB干预超出当地社区设施设置，进入无法访问的家庭设置 受天气限制、依赖运输或地理限制。因此，该提案提出 通过提供可扩展、灵活且财务负责的手段来传播和实施研究 可持续的跌倒预防，有可能在全国范围内实施。