Accidental Fall
Conditions
Keywords
balance training, step training, perturbation-based balance training, dynamic balance, aging
Brief summary
The goal of this study was to evaluate the effects of reactive balance training (RBT) targeting slipping and tripping on laboratory-induced slips and trips. In an effort to build upon prior work, the present study included: 1) a control group receiving an alternative balance training intervention; 2) separate training and assessment sessions; 3) alternative RBT methods that may be more amenable to work outside the lab compared to prior methods, and 4) older adult participants receiving individualized training to reduce drop-out. The investigators hypothesized that slips after RBT would result in improved reactive balance kinematics, and a lower incidence of falls, compared to either initial slips before any intervention or after a control intervention. The investigators also hypothesized that trips after RBT would result in improved reactive balance kinematics, and a lower incidence of falls, compared to either initial trips before any intervention or after a control intervention. Results were intended to contribute to knowledge regarding the efficacy of alternative methods for RBT, and provide additional evidence regarding its efficacy.
Interventions
BEHAVIORALReactive balance training
Participants were exposed to simulated trips and slips under safe, controlled conditions in order to practice their reactive response to these common balance perturbations.
BEHAVIORALOtago Balance Training
Balance exercises and strength exercises using ankle weights, and were progressively increased as performance improved by increasing ankle weights or the difficulty of the balance exercises (e.g., not holding onto a wall or support).
Sponsors
Virginia Polytechnic Institute and State University
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
NONE
Intervention model description
A two-group, pretest-posttest parallel design was employed. Participants were first assigned to either the reactive balance training or control intervention using minimization. During the first week, participants completed a pre-intervention assessment involving exposure to a single laboratory-induced slip or trip based upon random assignment. During the second and third weeks, participants completed a total of four sessions of their assigned intervention (two sessions per week for two weeks). During the fourth week, participants completed a post-intervention assessment involving exposure to the other perturbation (slip or trip) that they did not experience during the pre-intervention assessment. This design was selected to evaluate gait and reactive balance prior to any training intervention, and to avoid any unintended training effects induced by exposing participants to the same perturbation more than once.
Eligibility
Sex/Gender
ALL
Age
60 Years to 80 Years
Healthy volunteers
Yes
Inclusion criteria
1\) pass a medical history and screening administered by a physician that excluded participants with osteoporosis of the lumbar spine or proximal femur as assessed by Dual Energy X-ray Absorptiometry (Lunar iDXA, GE Healthcare, Chicago, IL), or any unstable or progressive medical conditions that could contribute to imbalance or falls
Exclusion criteria
1. smoked 2. were in physical therapy 3. had a self-reported fragility fracture within the last 10 years 4. had an acute lower extremity injury within the last 3 months 5. had lower extremity surgery within the last six months 6. had an ankle arthroplasty 7. had a knee or hip arthroplasty within the last 12 months
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Peak Slip Speed | during week 1, before the intervention that spanned weeks 2 and 3 | highest instantaneous speed of slipping foot during actual slip |
| Trunk Angle at Touchdown After Tripping | during week 1, before the intervention that spanned weeks 2 and 3 | anterior-posterior trunk angle relative to vertical at instant of touchdown of initial recovery step over tripping obstacle |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Slip Distance | during week 1, before the intervention that spanned weeks 2 and 3 | distance moved by slipping foot during actual slip |
| Fall Incidence After a Laboratory-induced Slip | during week 1, before the intervention that spanned weeks 2 and 3 | the outcome of each slip was categorized as either a: fall, recovery, or harness-assisted |
| Recovery Step Length After Tripping | during week 1, before the intervention that spanned weeks 2 and 3 | anterior-posterior step distance of first step over tripping obstacle |
| Fall Incidence After a Laboratory-induced Trip | during week 1, before the intervention that spanned weeks 2 and 3 | the outcome of each trip was categorized as a: fall, recovery, or harness-assisted |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Reactive Balance Training Group of participants who were assigned to reactive balance training. | 20 |
| Control Balance Training Group of participants who were assigned to control balance training. | 14 |
| Total | 34 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Post-intervention Evaluation (1 Week) | testing error during evaluation | 0 | 2 |
| Post-intervention Evaluation (1 Week) | Withdrawal by Subject | 1 | 2 |
| Pre-intervention Evaluation (1 Week) | Did not attend due to schedule conflict | 2 | 1 |
| Pre-intervention Evaluation (1 Week) | testing error during evaluation | 1 | 2 |
Baseline characteristics
| Characteristic | Reactive Balance Training | Control Balance Training | Total |
|---|---|---|---|
| Age, Continuous | 68.9 years STANDARD_DEVIATION 4.4 | 70.0 years STANDARD_DEVIATION 4 | 69.3 years STANDARD_DEVIATION 4.2 |
| Mass | 77.8 kilograms STANDARD_DEVIATION 15.5 | 80.0 kilograms STANDARD_DEVIATION 14.7 | 78.7 kilograms STANDARD_DEVIATION 15 |
| Race and Ethnicity Not Collected | — | — | 0 Participants |
| Sex: Female, Male Female | 11 Participants | 8 Participants | 19 Participants |
| Sex: Female, Male Male | 9 Participants | 6 Participants | 15 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 11 | 0 / 5 |
| other Total, other adverse events | 1 / 11 | 1 / 5 |
| serious Total, serious adverse events | 0 / 11 | 0 / 5 |
Outcome results
Primary
Peak Slip Speed
highest instantaneous speed of slipping foot during actual slip
Time frame: during week 1, before the intervention that spanned weeks 2 and 3
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Baseline SLIP Group | Peak Slip Speed | 2.8 meters/sec | Standard Deviation 0.32 |
Primary
Peak Slip Speed
highest instantaneous speed of slipping foot during actual slip
Time frame: during week 4, after the intervention that spanned weeks 2 and 3
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Baseline SLIP Group | Peak Slip Speed | 3.15 meters/sec | Standard Deviation 0.33 |
| Post-Reactive Balance Training SLIP Group | Peak Slip Speed | 2.58 meters/sec | Standard Deviation 0.41 |
Primary
Trunk Angle at Touchdown After Tripping
anterior-posterior trunk angle relative to vertical at instant of touchdown of initial recovery step over tripping obstacle
Time frame: during week 1, before the intervention that spanned weeks 2 and 3
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Baseline SLIP Group | Trunk Angle at Touchdown After Tripping | 37 degrees | Standard Deviation 9.6 |
Primary
Trunk Angle at Touchdown After Tripping
anterior-posterior trunk angle relative to vertical at instant of touchdown of initial recovery step over tripping obstacle
Time frame: during week 4, after the intervention that spanned weeks 2 and 3
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Baseline SLIP Group | Trunk Angle at Touchdown After Tripping | 36.9 degrees | Standard Deviation 2.2 |
| Post-Reactive Balance Training SLIP Group | Trunk Angle at Touchdown After Tripping | 41.1 degrees | Standard Deviation 3.7 |
Secondary
Fall Incidence After a Laboratory-induced Slip
the outcome of each slip was categorized as either a: fall, recovery, or harness-assisted
Time frame: during week 1, before the intervention that spanned weeks 2 and 3
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Baseline SLIP Group | Fall Incidence After a Laboratory-induced Slip | 8 Participants |
Secondary
Fall Incidence After a Laboratory-induced Slip
the outcome of each slip was categorized as either a: fall, recovery, or harness-assisted
Time frame: during week 4, after the intervention that spanned weeks 2 and 3
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Baseline SLIP Group | Fall Incidence After a Laboratory-induced Slip | 3 Participants |
| Post-Reactive Balance Training SLIP Group | Fall Incidence After a Laboratory-induced Slip | 2 Participants |
Secondary
Fall Incidence After a Laboratory-induced Trip
the outcome of each trip was categorized as a: fall, recovery, or harness-assisted
Time frame: during week 4, after the intervention that spanned weeks 2 and 3
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Baseline SLIP Group | Fall Incidence After a Laboratory-induced Trip | 3 Participants |
| Post-Reactive Balance Training SLIP Group | Fall Incidence After a Laboratory-induced Trip | 1 Participants |
Secondary
Fall Incidence After a Laboratory-induced Trip
the outcome of each trip was categorized as a: fall, recovery, or harness-assisted
Time frame: during week 1, before the intervention that spanned weeks 2 and 3
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Baseline SLIP Group | Fall Incidence After a Laboratory-induced Trip | 6 Participants |
Secondary
Recovery Step Length After Tripping
anterior-posterior step distance of first step over tripping obstacle
Time frame: during week 1, before the intervention that spanned weeks 2 and 3
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Baseline SLIP Group | Recovery Step Length After Tripping | 54.3 percent body height | Standard Deviation 14.1 |
Secondary
Recovery Step Length After Tripping
anterior-posterior step distance of first step over tripping obstacle
Time frame: during week 4, after the intervention that spanned weeks 2 and 3
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Baseline SLIP Group | Recovery Step Length After Tripping | 53.7 percent body height | Standard Deviation 8.8 |
| Post-Reactive Balance Training SLIP Group | Recovery Step Length After Tripping | 64.1 percent body height | Standard Deviation 10.5 |
Secondary
Slip Distance
distance moved by slipping foot during actual slip
Time frame: during week 1, before the intervention that spanned weeks 2 and 3
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Baseline SLIP Group | Slip Distance | 80.8 centimeters | Standard Deviation 4.5 |
Secondary
Slip Distance
distance moved by slipping foot during actual slip
Time frame: during week 4, after the intervention that spanned weeks 2 and 3
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Baseline SLIP Group | Slip Distance | 74.2 centimeters | Standard Deviation 6.6 |
| Post-Reactive Balance Training SLIP Group | Slip Distance | 71.4 centimeters | Standard Deviation 4.5 |