Improving balance and mobility in older Veterans

改善老年退伍军人的平衡和活动能力

• 批准号: 9046402
• 负责人: Leslie I. Katzel
• 金额: --
• 依托单位: BALTIMORE VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-04-01 至 2018-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9046402
• 关键词: Abdomen; Address; Adherence; Admission activity; Adult; Age; American; Award; Centers for Disease Control and Prevention (U.S.); Cessation of life; Clinical assessments; Communities; Community Practice; Community of Practice; Comorbidity; Derivation procedure; Dual-Energy X-Ray Absorptiometry; Effectiveness; Elderly; Enrollment; Environmental Hazards; Equilibrium; Exercise; Failure; Fall prevention; Gait; Health; Health Policy; Health system; Hip region structure; Hospitalization; Hospitals; Hour; Individual; Injury; Intervention; Isometric Exercise; Lateral; Lead; Lower Extremity; Mediation; Medical; Methods; Modality; Modeling; Movement; Muscle; Muscle Weakness; Musculoskeletal Equilibrium; Participant; Pilot Projects; Prevention program; Questionnaires; Randomized; Randomized Clinical Trials; Recording of previous events; Recovery; Recurrence; Research; Resources; Societies; Step Tests; Tai Ji; Testing; Thigh structure; Time; Veterans; Walking; Weight; X-Ray Computed Tomography; compare effectiveness; cost; effective intervention; exercise intervention; exercise program; exercise training; experience; fall risk; falls; group intervention; high risk; improved; intervention program; muscle strength; novel; post intervention; prevent; programs; standard of care; strength training

DESCRIPTION (provided by applicant): Background: Falls are currently the leading cause of injurious death and non-fatal injuries for adults over the age of 65. Older veterans may be at greater risk for falls due to their high burden of medical co-morbidity. The VA has made research into fall prevention a high priority. Tai Chi is currently considered to be one of the most effective fall prevention exercise interventions, with an endorsement from the CDC that widely influences health care policy. However, there are few studies comparing Tai Chi with another active intervention. Tai Chi may generally improve balance and provide general lower body strengthening however Tai Chi may not sufficiently improve gait and dynamic mobility and does little to target obstacle negotiation, one of the largest contributors to a fall. The majority of falls occur during walking, with slips and trips beng the most common causes and targeted interventions focused on improving stepping and walking ability may be even more effective at improving balance and reducing falls. Objective: The purpose of this pilot study is to evaluate two fall reduction programs in older veterans, Tai Chi and a multimodal balance intervention (MMBI) focused on dynamic stepping, obstacle negotiation, walking, and lower extremity strengthening. We propose that MMBI will provide many of the same benefits of tai chi (strengthening and improved balance) but addresses the deficits in many tai chi programs including environmental negotiation and walking. This program could also be easily implemented in community practice. Methods: We plan to enroll 56 older (age > 65 years) community dwelling veterans with a history of a fall in the last year who are at high risk for a recurrent fall. After baseline testing individuals will be randomized to either MMB or a Tai Chi intervention modeled after the Tai Chi Moving for Better Balance Program. All participants will participate in a group exercise class in their assigned intervention for 1 hour, times per week for 24 weeks. After the completion of 24 weeks of exercise group changes will be compared for 1) balance (4-square step test), 2) mobility and fall risk (functional gait assessment, clinical gait assessment and gait variability on a GAITrite), 4) questionnaires (falls efficacy and ABC) 5) lower extremity isometric strength testing (biodex), 6) a whole body DXA and CT scan of the abdomen, hips and thighs for determination of lower extremity and core muscle composition. We also plan for follow all participants for 6 months after completion of the intervention to examine differences in fall rates after the cessation of the program between the groups. Impact: This research directly benefits veterans as it may lead to new and effective interventions that could reduce fall risk, injury-related hospitalization and death in older veterans. MMBI is also readily exportable to the community and with minimal resources could be widely implemented at other VAs as part of standard of care, similar to MOVE!. Results from this award will be used to power a larger randomized clinical trial that will examine the effectiveness of the two interventions to reduce rate of falls and risk of falling in older veteran at high risk for falls.

描述（由申请人提供）： 背景：福尔斯目前是65岁以上成年人伤害性死亡和非致命性伤害的主要原因。老年退伍军人可能会在更大的风险福尔斯，由于他们的高负担 医学共病退伍军人事务部已将预防跌倒的研究列为优先事项。太极目前被认为是最有效的预防跌倒运动干预措施之一，得到了疾病预防控制中心的认可，广泛影响了医疗保健政策。然而，很少有研究将太极与另一种积极干预进行比较。太极拳通常可以改善平衡并提供一般的下半身加强，但是太极拳可能不足以改善步态和动态移动性，并且对目标障碍物谈判几乎没有帮助，这是跌倒的最大贡献者之一。大多数福尔斯跌倒发生在行走过程中，滑倒和绊倒是最常见的原因，专注于改善踏步和行走能力的有针对性的干预措施在改善平衡和减少福尔斯跌倒方面可能更有效。目的：这项试点研究的目的是评估两个减少老年退伍军人跌倒的方案，太极和多模式平衡干预（MMBI），重点是动态踏步，障碍物谈判，步行和下肢加强。我们建议，MMBI将提供太极拳的许多相同的好处（加强和改善平衡），但解决了许多太极拳项目的不足，包括环境谈判和步行。该方案也可以在社区实践中轻松实施。研究方法：我们计划招募56名年龄较大（年龄> 65岁）的社区居住退伍军人，他们在过去一年中有跌倒史，有复发性跌倒的高风险。在基线测试后，个人将被随机分配到MMB或太极干预后，太极运动更好的平衡计划建模。所有参与者都将参加指定干预措施中的团体运动课程，每次1小时，每周参加一次，持续24周。在完成24周的运动后，将对组内的变化进行比较，用于1）平衡（4-方形步测试），2）移动性和跌倒风险（功能步态评估、临床步态评估和GAITrite上的步态变异性），4）问卷调查（福尔斯功效和ABC）5）下肢等长力量测试（biodex），6）全身DXA和腹部CT扫描，臀部和大腿，用于确定下肢和核心肌肉组成。我们还计划在干预完成后对所有参与者进行6个月的随访，以检查各组之间在停止该计划后跌倒率的差异。影响：这项研究直接使退伍军人受益，因为它可能导致新的有效干预措施，可以减少老年退伍军人的跌倒风险，与受伤有关的住院治疗和死亡。MMBI也可以很容易地输出到社区，并以最少的资源在其他VA广泛实施，作为标准护理的一部分，类似于MOVE！该奖项的结果将用于一项更大规模的随机临床试验，该试验将检查两种干预措施在降低福尔斯高风险老年退伍军人的福尔斯率和跌倒风险方面的有效性。