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

内源性足部肌肉强化干预对老年人平衡、本体感觉和跌倒的影响 65岁以上的成年人 背景：跌倒是65岁及以上成年人受伤的主要原因。虽然跌倒的原因是 多因素综合作用，足部功能起着至关重要的作用。足部固有肌肉(IFM)，即起源和插入的肌肉 在脚部，提供稳定性和对平衡很重要的感官输入。IFM在老年人中的弱点或废止 成年人可能会导致脚和脚趾对齐错误，这被认为是跌倒的独立预测因素。 穿着衬垫最少的鞋或进行针对IFM的强化练习可能会有所改善 这些肌肉的力量、耐力、本体感觉和足部/脚趾结构可能会改善 老年人的功能性活动和平衡，因此，防止摔倒。 目的：拟议研究的目的是分析两种强化国际森林管理干预措施的效果。 (最少穿鞋或加强练习)IFM力量、本体感觉、脚/脚趾结构、平衡 和功能活动能力，以及老年人的跌倒发生率。 设计：随机对照试验 方法：65岁的成年人，可以在有或没有辅助设备的情况下走动家庭距离 将被邀请参加。足感差、双脚截肢、受伤或接受手术的个人 在过去的6个月内，对肢体或腰椎的认知能力受损 书面说明或前庭功能障碍将被排除在外。在知情同意和初步筛查之后， 参与者将被随机分配到四个干预组之一(n=120，n=30/组)： 1)固有的足部肌肉强化练习 2)规定步行时应穿最少的鞋 3)固有的足部肌肉强化练习和规定的步行最少穿鞋 4)规定步行的非最低限度鞋类(对照) 将鼓励参与者每周5天进行干预，为期16周。在最初的面对面会谈之后 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 每两个月一次的电话提醒坚持干预，并记录任何跌倒和相关细节。 参与者将被要求记录干预表现，每日步数(用计步器测量)，以及 出现在提供的日记中。平衡和功能移动性将使用最小、最好的本体感觉进行测量 将使用下肢位置测试来测量，脚和脚趾结构将使用舟骨来测量 第一跖趾关节的下垂和外翻角度。拇外展肌横截面积(Cm2)， 将使用超声波测量拇短屈肌、指短屈肌和平面四头肌 成像。关于平衡和功能活动、本体感觉、足趾结构和肌肉的测量 横截面积将在基线、8周、10周、12周和16周出现。在为期16周的干预期之后， 将鼓励参与者每周继续进行两次干预。持续下跌日记和双月刊 研究人员的电话将在基线后12个月内进行，以记录长期降落率(人均降落率 每年)。 数据分析：将使用4组×5时间点重复测量方差分析(ANOVA)来评估 平衡、功能活动、本体感觉、足趾结构和肌肉横截面积的变化。 跌倒数据将以每人在12个月内跌倒的速度来衡量，这段时间从 基线测量。 意义：在老年人和老年人中，很少有人研究内在足部肌肉强化干预措施 它们的作用和机制还没有建立起来。这将是第一个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，以及第一项分析跌倒后的长期影响的研究 这些干预措施的实施。在这项研究方案中评估的干预措施简单、安全和 负担得起，可能会对老年人的功能活动和减少跌倒产生重大影响。

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.