CE-22-006 The effects of intrinsic foot muscle strengthening interventions on balance, proprioception, and fall risk in adults over age 65

内在足部肌肉强化干预对平衡、本体感觉和福尔斯跌倒的影响 65岁以上的成年人 背景：福尔斯是65岁及以上成年人受伤的主要原因。虽然福尔斯的原因是 多因素，足部功能起着至关重要的作用。内在的脚肌肉（IFM），那些起源和插入 在脚内，提供稳定性和对平衡很重要的感觉输入。老年人IFM的弱点或停用 成年人可能导致错误的脚和脚趾对齐，这被认为是福尔斯的独立预测因素。 穿着最低限度的鞋子或进行针对IFM的强化练习可能会有所改善 这些肌肉的力量，耐力，本体感受品质和脚/脚趾结构，这可能会改善 老年人的功能性活动和平衡，从而防止福尔斯跌倒。 目的：本研究的目的是分析两种IFM强化干预措施的效果 （尽量少穿鞋或加强锻炼）对IFM力量、本体感觉、脚/脚趾结构、平衡的影响 和功能活动性，以及老年人的福尔斯发生率。 设计：随机对照试验 方法：年龄> 65岁的成年人，他们可以在有或没有辅助设备的情况下在家中走动 将被邀请参加。足部感觉差、下肢截肢、受伤或手术的个人 下肢或腰椎在过去6个月，认知能力受损，遵循语言和 书面指示或前庭疾病将被排除。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)内在的足部肌肉强化练习 2)规定步行时最少穿鞋 3)内在的足部肌肉加强练习和最小的鞋类规定步行 4)非最小鞋履规定行走（对照） 将鼓励参与者进行干预，每周5天，持续16周。在最初的面对面交流之后 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 每两个月进行一次电话联系，以提醒坚持干预并记录任何福尔斯和相关细节。 参与者将被要求记录干预表现，每日步数（通过计步器测量）， 福尔斯在提供的日记中。将使用Mini-BestTest、本体感觉和功能性活动测量平衡和功能性活动。 将使用下肢位置测试测量，使用舟骨测量足部和脚趾结构 第一跖趾关节下降和外翻角度。拇展肌的横截面积（cm 2）， 将使用超声测量拇短屈肌、趾短屈肌和足底方肌 显像关于平衡和功能移动性、本体感觉、足部/脚趾结构和肌肉的测量 横截面积将出现在基线、8、10、12和16周。在16周的干预期后， 将鼓励参与者每周继续进行两次干预。正在进行的福尔斯日记和双月刊 基线后12个月，研究人员将进行电话随访，记录长期跌倒率（每人福尔斯次数 每年）。 数据分析：将使用4组x 5时间点重复测量方差分析（ANOVA）评估 平衡和功能移动性、本体感觉、脚/脚趾结构和肌肉横截面积的变化。 福尔斯数据将被测量为从日期开始的12个月内每人的福尔斯率。 基线测量。 意义：内在的足部肌肉强化干预很少在老年人中进行研究， 其作用和机制尚不明确。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，第一次使用超声成像测量， 老年人的足部肌肉加强，以及第一项研究，以分析长期影响后，福尔斯 这些干预措施的效果。本研究建议中评估的干预措施简单，安全， 负担得起，并可能对老年人的功能性活动和减少福尔斯有重大影响。

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.