Abstract
BackgroundVisually impaired older people (VIOP) have a higher risk of falling than their sighted peers, and are likely to avoid physical activity. The aim was to adapt the existing Falls Management Exercise (FaME) programme for VIOP, delivered in the community, and to investigate the feasibility of conducting a definitive randomised controlled trial (RCT) of this adapted intervention.MethodsTwo-centre randomised mixed methods pilot trial and economic evaluation of the adapted group-based FaME programme for VIOP versus usual care. A one hour exercise programme ran weekly over 12 weeks at the study sites (Newcastle and Glasgow), delivered by third sector (voluntary and community) organisations. Participants were advised to exercise at home for an additional two hours over the week. Those randomised to the usual activities group received no intervention.Outcome measures were completed at baseline, 12 and 24 weeks. The potential primary outcome was the Short Form Falls Efficacy Scale – International (SFES-I).Participants’ adherence was assessed by reviewing attendance records and self-reported compliance to the home exercises. Adherence with the course content (fidelity) by instructors was assessed by a researcher. Adverse events were collected in a weekly phone call.ResultsEighteen participants, drawn from community-living VIOP were screened; 68 met the inclusion criteria; 64 participants were randomised with 33 allocated to the intervention and 31 to the usual activities arm.94% of participants provided data at the 12 week visit and 92% at 24 weeks. Adherence was high. The intervention was found to be safe with 76% attending nine or more classes. Median time for home exercise was 50 min per week.There was little or no evidence that fear of falling, balance and falls risk, physical activity, emotional, attitudinal or quality of life outcomes differed between trial arms at follow-up.ConclusionsThe intervention, FaME, was implemented successfully for VIOP and all progression criteria for a main trial were met. The lack of difference between groups on fear of falling was unsurprising given it was a pilot study but there may have been other contributory factors including suboptimal exercise dose and apparent low risk of falls in participants. These issues need addressing for a future trial.Trial registrationCurrent Controlled Trials ISRCTN ID: 16949845 Registered: 21 May 2015.
Highlights
Impaired older people (VIOP) have a higher risk of falling than their sighted peers, and are likely to avoid physical activity
It is not known precisely how many potential participants were approached by Newcastle Society for Blind People (NSBP), but anecdotal information suggests that over two hundred calls were made
Over one hundred direct contacts were made by Visibility staff, and the research team received forty-eight expressions of interest
Summary
Impaired older people (VIOP) have a higher risk of falling than their sighted peers, and are likely to avoid physical activity. Costs account for 0.85–1.5% Western economies’ total health-care expenditure [5]. Older people with visual impairment have a 1.7 times higher risk of falling than the general population, requiring more hospital and nursing home admissions. More contact with their general practitioner (GP) than sighted peers is reported. Eight per cent of falls-related hospital admissions are likely to occur in people who are visually impaired [8], which accounts for approximately 21% of the total cost of treating falls. Visual impairment acts as an independent risk factor for falls [11,12,13] with falls risk factors including poor visual acuity and contrast sensitivity, decreased depth perception and reduced visual field [14,15,16,17,18], in addition to more general factors such as muscle weakness and balance
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