Quasi-experimental pilot study to improve mobility and balance in recurrently falling nursing home residents by voluntary non-targeted side-stepping exercise intervention

BMC Geriatrics - Tập 22 - Trang 1-10 - 2022
Frédéric Dierick1, Anne-France Bouché2, Serge Guérin3, Jean-Paul Steinmetz4, Carine Federspiel5, Vincent Barvaux6, Fabien Buisseret7
1Centre National de Rééducation Fonctionnelle et de Réadaptation – Rehazenter, Laboratoire d’Analyse du Mouvement et de la Posture (LAMP), Luxembourg, Luxembourg
2“Le Richemont”, Physiotherapy Department, Korian Group, Bioul-Anhée, Belgium
3INSEEC Grande Ecole, Paris, France
4Zitha, Consdorf, Luxembourg
5Zitha, Luxembourg, Luxembourg
6Haute Ecole Louvain en Hainaut, Gilly, Belgium
7CeREF-Technique, Mons, Belgium

Tóm tắt

Side-stepping is a potential exercise program to reduce fall risk in community-dwelling adults in their seventies, but it has never been tested in nursing home residents. This was a pilot quasi-experimental study to examine the feasibility and potential mobility and balance benefits of an intervention based on voluntary non-targeted side-stepping exercises in nursing home residents who fall recurrently. Twenty-two participants were recruited and non-randomly assigned to an intervention group ( $$n=$$ 11, side-stepping exercises, STEP) participating in an 8-week protocol and to a control group ( $$n =$$ 11, usual physiotherapy care, CTRL). They were clinically assessed at 4-time points: baseline, after 4 and 8 weeks, and after a 4-week follow-up period (usual physiotherapy care). Statistical differences between time points were assessed with a Friedman repeated measures ANOVA on ranks or a one-way repeated measures ANOVA. Compared to baseline, significant benefits were observed in the STEP group at 8 weeks for the Timed Up and Go ( $$p =$$ 0.020) and 6-minute walking test ( $$p =$$ 0.001) as well as for the Berg Balance Scale ( $$p =$$ 0.041) and Mini motor test ( $$p =$$ 0.026). At follow-up, the Tinetti Performance Oriented Mobility Assessment and Berg Balance Scale significantly worsened in the STEP group ( $$p =$$ 0.009 and $$p<$$ 0.001, respectively). No significant differences were found between the groups at the same time points. Our intervention was feasible and improved mobility and balance after almost 8 weeks. Studies with larger samples and randomized control trials are needed to consolidate our preliminary observations and confirm the deterioration of some tests when side-stepping exercises are discontinued. Identifier: ISRCTN13584053. Retrospectively registered 01/09/2022.

Tài liệu tham khảo

Gillespie L, Robertson M, Gillespie W, Sherrington C, Gates S, Clemson L, et al. Interventions for preventing falls in older people living in the community (Review). Cochrane Database Syst Rev. 2012;Issue 9:007146. Sherrington C, Tiedemann A, Fairhall N, Close J, Lord S. Exercise to prevent falls in older adults: an updated meta-analysis and best practice recommendations. N S W Public Health Bull. 2011;22(3–4):78–83. Okubo Y, Schoene D, Lord SR. Step training improves reaction time, gait and balance and reduces falls in older people: a systematic review and meta-analysis. Br J Sports Med. 2016;51(7):586–93. https://doi.org/10.1136/bjsports-2015-095452. Shigematsu R, Okura T. A novel exercise for improving lower-extremity functional fitness in the elderly. Aging Clin Exp Res. 2006;18:242–8. Shigematsu R, Okura T, Sakai T, Ratanen T. Square-stepping exercise versus strength and balance training for fall risk factors. Aging Clin Exp Res. 2008;20:19–24. Shigematsu R, Okura T, Nakagaichi M, Tanaka K, Sakai T, Kitazumi S, et al. Square-Stepping Exercise and Fall Risk Factors in Older Adults: A Single-Blind. Randomized Controlled Trial J Gerontol. 2008;63A:76–82. Teixeira CVL, Gobbi S, Pereira JR, Ueno DT, Shigematsu R, Gobbi LTB. Effect of square-stepping exercise and basic exercises on functional fitness of older adults. Geriatr Gerontol Int. 2013;13(4):842–8. https://doi.org/10.1111/ggi.12011. Teixeira C, Gobbi S, Pereira J, Vital T, Hernandez S, Shigematsu R, et al. Effects of square-stepping exercise on cognitive functions of older people. Psychogeriatrics. 2013;13(3):148–56. https://doi.org/10.1111/psyg.12017. Yamada M, Higuchi T, Nishiguchi S, Yoshimura K, Kajiwara Y, Aoyama T. Multitarget Stepping Program in Combination with a Standardized Multicomponent Exercise Program Can Prevent Falls in Community-Dwelling Older Adults: A Randomized. Controlled Trial J Am Geriatr So. 2013;61(10):1669–75. https://doi.org/10.1111/jgs.12453. Schoene D, Lord S, Delbaere K, Severino C, Davies T, Smith S. A Randomized Controlled Pilot Study of Home-Based Step Training in Older People Using Videogame Technology. PLoS ONE. 2013;8(3). https://doi.org/10.1371/journal.pone.0057734. Pichierri G, Murer K, de Bruin E. A cognitive-motor intervention using a dance video game to enhance foot placement accuracy and gait under dual task conditions in older adults: a randomized controlled trial. BMC Geriatrics. 2012;12:74. Morat M, Bakker J, Hammes V, Morat T, Giannouli E, Zijlstra W, et al. Effects of stepping exergames under stable versus unstable conditions on balance and strength in healthy community-dwelling older adults: A three armed randomized controlled trial. Exp Gerontol. 2019;127:110719. Hauer K, Litz E, Günther-Lange M, Ball C, de Brand Werner C. Effectiveness and sustainability of a motor-cognitive stepping exergame training on stepping performance in older adults: arandomized controlled trial. Eur Rev Aging Phys Act. 2020;17:17. Skjæret-Maroni N, Vonstad EK, Ihlen EAF, Tan XC, Helbostad JL, Vereijken B. Exergaming in Older Adults: Movement Characteristics While Playing Stepping Games. Front Psychol. 2016;7. https://doi.org/10.3389/fpsyg.2016.00964. Fung L, Lam M. Effectiveness of a progressive stepping program on lower limb function in community dwelling older adults. J Exerc Sci Fit. 2012;10(1):8–11. https://doi.org/10.1016/j.jesf.2012.04.002. Wurdeman SR, Huben NB, Stergiou N. Variability of gait is dependent on direction of progression: Implications for active control. J Biomech. 2012;45(4):653–9. https://doi.org/10.1016/j.jbiomech.2011.12.014. Winter D. Human balance and posture control during standing and walking. Gait Posture. 1995;3:193–214. Skiadopoulos A, Stergiou N. Risk-of-falling related outcomes improved in community-dwelling older adults after a 6-week sideways walking intervention: a feasibility and pilot study. BMC Geriatr. 2021;21(1). https://doi.org/10.1186/s12877-021-02010-6. Masud T, Morris RO. Epidemiology of falls. Age Ageing. 2001;30(S4):3–7. Lamb SE, Jarstad-Stein EC, Hauer K, Becker C. Development of a Common Outcome Data Set for Fall Injury Prevention Trials: The Prevention of Falls Network Europe Consensus. J Am Geriatr Soc. 2005;53(9):1618–1622. https://doi.org/10.1111/j.1532-5415.2005.53455.x. Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW. Studies of illness in the aged. The index of ADL: A standardized measure of biological and psychosocial function. JAMA. 1963;Sep 21(185):914–9. Smith R. Validation and Reliability of the Elderly Mobility Scale. Physiotherapy. 1994;80(11):744–7. Stapleton C, Hough P, Oldmeadow L, Bull K, Hill K, Greenwood K. Four-item fall risk screening tool for subacute and residential aged care: The first step in fall prevention. Australas J Ageing. 2009;28(3):139–43. https://doi.org/10.1111/j.1741-6612.2009.00375.x. Cremer G, Schoevaerdts D, de Saint-Hubert M, Jamart J, Poulain G, Toussaint É, et al. The Get-up early test, elaboration process of a new screening tool for psychomotor disadaptation syndrome. Geriatr Psychol Neur. 2012;10(2):165–73. https://doi.org/10.1684/pnv.2012.0349. Lundin-Olsson L, Nyberg L, Gustafson Y. “Stops walking when talking” as a predictor of falls in elderly people. Lancet. 1997;349(9052):617. https://doi.org/10.1016/S0140-6736(97)24009-2. Berg K, Wood-Dauphinee S, Williams JI, Gayton D. Measuring balance in the elderly: Preliminary development of an instrument. Physiother Can. 1989;41:304–11. Tinetti ME. Performance-oriented assessment of mobility problems in elderly patients. J Am Geriatr Soc. 1986;34(2):119–26. Mourey F, Camus A, d’ Athis P, Blanchon MA, Martin-Hunyadi C, Rekeneire Nd, et al. Mini motor test: a clinical test for rehabilitation of patients showing psychomotor disadaptation syndrome (PDS). Arch Gerontol Geriat. 2005;40(2):201–211. https://doi.org/10.1016/j.archger.2004.08.004. Enright PL. The Six-Minute Walk Test. Respir Care. 2003;48(8):783–5. Lam HSP, Lau FWK, Chan GKL, Sykes K. The validity and reliability of a 6-Metre Timed Walk for the functional assessment of patients with stroke. Physiother Theor Pr. 2010;26(4):251–5. Podsiadlo D, Richardson S. The Timed “Up & Go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc. 1991;39(2):142–8. Blackwood J. Reliability, Validity and Minimal Detectable Change in the Timed Up and Go and Five Times Sit to Stand Tests in Older Adults with Early Cognitive Loss. J Physiother Rehabil. 2017;1:1. Perera S, Mody SH, Woodman RC, Studenski SA. Meaningful Change and Responsiveness in Common Physical Performance Measures in Older Adults. J Am Geriatr Soc. 2006;54(5):743–9. https://doi.org/10.1111/j.1532-5415.2006.00701.x. Telenius EW, Engedal K, Bergland A. Inter-rater reliability of the Berg Balance Scale, 30 s chair stand test and 6 m walking test, and construct validity of the Berg Balance Scale in nursing home residents with mild-to-moderate dementia. BMJ Open. 2015;5(9):008321. https://doi.org/10.1136/bmjopen-2015-008321. Faber MJ, Bosscher RJ, van Wieringen PC. Clinimetric Properties of the Performance-Oriented Mobility Assessment. Phys Ther. 2006;86(7):944–954. https://doi.org/10.1093/ptj/86.7.944. Conradsson M, Lundin-Olsson L, Lindelöf N, Littbrand H, Malmqvist L, Gustafson Y, et al. Berg Balance Scale: Intrarater Test-Retest Reliability Among Older People Dependent in Activities of Daily Living and Living in Residential Care Facilities. Phys Ther. 2007;87(9):1155–63. R Core Team. R: A Language and Environment for Statistical Computing. Vienna; 2020. https://www.R-project.org/. Accessed 2 Dec 2021. Sherrington C, Whitney JC, Lord SR, Herbert RD, Cumming RG, Close JCT. Effective Exercise for the Prevention of Falls: A Systematic Review and Meta-Analysis. J Am Geriatr Soc. 2008;56(12):2234–2243. https://doi.org/10.1111/j.1532-5415.2008.02014.x. Nordin E, Rosendahl E, Lundin-Olsson L. Timed, “Up & Go” Test: Reliability in Older People Dependent in Activities of Daily Living-Focus on Cognitive State. Phys Ther. 2006;86(5):646–55. Thompson M, Medley A. Performance of Community Dwelling Elderly on the Timed Up and Go Test. Phys Occup Ther Geriatr. 1995;13(3):17–30. Hatch J, Veneri D. The effect of rolling walker use on interpretation of Timed Up and Go test scores. Int J Rehabil Res. 2020;43(1):95–98. https://doi.org/10.1097/MRR.0000000000000388. Perry J, Garrett M, Gronley J, Mulroy S. Classification of walking handicap in the stroke population. Stroke. 1995;26(6):982–9. Borowicz A, Zasadzka E, Gaczkowska A, Gawłowska O, Pawlaczyk M. Assessing gait and balance impairment in elderly residents of nursing homes. J Phys Ther. 2016;28:2486–90. Zarzeczny R, Nawrat-Szołtysik A, Polak A, Maliszewski J, Kiełtyka A, Matyja B, et al. Aging effect on the instrumented Timed-Up-and-Go test variables in nursing home women aged 80–93 years. Biogerontology. 2017;18(4):651–63. https://doi.org/10.1007/s10522-017-9717-5. Thigpen MT, Light KE, Creel GL, Flynn SM. Turning Difficulty Characteristics of Adults Aged 65 Years or Older. Physical Therapy. 2000;80(12):1174–87. https://doi.org/10.1093/ptj/80.12.1174. Porto J, Freire Júnior R, Bocarde L, Fernandes J, Marques N, Rodrigues N, et al. Contribution of Hip Abductor-Adductor Muscles on Static and Dynamic Balance of Community-Dwelling Older Adults. Aging Clin Exp Res. 2019;31:621–7. Vance RC, Healy DG, Galvin R, French HP. Dual Tasking With the Timed “Up & Go” Test Improves Detection of Risk of Falls in People With Parkinson Disease. Phys Ther. 2015;95(1):95–102. https://doi.org/10.2522/ptj.20130386. Buisseret F, Catinus L, Grenard R, Jojczyk L, Fievez D, Barvaux V, et al. Timed Up and Go and Six-Minute Walking Tests with Wearable Inertial Sensor: One Step Further for the Prediction of the Risk of Fall in Elderly Nursing Home People. Sensors. 2020;20(11):3207. https://doi.org/10.3390/s20113207. Dierick F, Stoffel PL, Schütz G, Buisseret F. High Specificity of Single Inertial Sensor-Supplemented Timed Up and Go Test for Assessing Fall Risk in Elderly Nursing Home Residents. Sensors. 2022;22(6):2339. https://doi.org/10.3390/s22062339. Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12(3):189–98. https://doi.org/10.1016/0022-3956(75)90026-6.