Abstract
ObjectivesPhysical exercise is a key intervention for improving functional ability and preventing falls in older people. However, the implemented interventions targeted balance, gait, and muscle strength, while little is known regarding motor control exercises in this population. Therefore, this study aimed to investigate the effects of a 12-week home-based motor control exercise program combined with an ergonomic home modification (the McHeELP program).Patients and methodsFifty-two older people (aged ≥65 years), who had experienced at least one fall incident in the past 12 months, were randomly assigned into two groups; the McHeELP group (McHeELP-G) (n=26) that received the McHeELP program and the control group (CG) (n=26). Physical performance measures (PPMs) and patient-reported outcomes (PROs) were used to evaluate participants. At baseline, 3rd month (post-intervention), and again at 6th month (follow up), balance control was assessed using the Tandem stance test (Tandem) and the Functional Reach Test (FRT). Functionality was assessed by the 4 meters walking test (4MWT), Timed Up and Go (TUG) test, 30 seconds-Sit to stand test and the Greek version of Lower Extremity Functional Scale (LEFS-Greek). The Greek version of the Falls Self-efficacy International scale (FES-I_GREEK) was used for the evaluation of "fear-of-falling" (FOF). The home falls and accidents screening tool (HOMEFAST) is used to identify home hazards. Two-way mixed ANOVA model, independent samples t-test, One-factor Repeated Measures ANOVA model and ANCOVA model were used for the statistical analysis of the data.ResultsHomogeneity was found between McHeELP-G and CG regarding the demographic and clinical characteristics, and no statistically significant difference was found at baseline measurements of PROs and PPMs, except HOMEFAST (p=0.031). Post-intervention (3rd month), the comparison of the absolute values between groups revealed that the McHeELP-G achieved statistically significant better balance control (longer Tandem stance test and higher values of FRT), better functionality [faster gait speed (4MWT), shorter TUG performance time, and a higher number of repetitions at 30 seconds-Sit to stand] (all p-values <0.05), while no difference was found for LEFS-Greek score (p=0.095), compared to CG. In addition, McHeELP-G reported lesser FOF than CG [lower FES-I_GREEK score (p=0.041)], and fewer home-hazards [lower HOMEFAST score (p=0.041)]. At follow up measurement (6th month), all PPMs scores of McHeELP-G, regarding balance control and functionality, were remained statistically significant (all p-values <0.005), and the FES-I_GREEK score (p=0.034), while no difference was found between groups for LEFS-Greek score (p=0.146) and HOMEFAST score (p=0.185). Sensitivity analysis (from baseline to 3rd and 6th month) revealed similar findings to the "comparison of the absolute values between groups" analysis. The within-group changes from baseline to 3rd month of McHeELP-G were statistically significant improved for all PPMs and PROs (all p-values <0.05), while in CG, statistical significant difference was found for TUG, FRT-right, and HOMEFAST (p<0.05). Those within-group changes were also preserved until 6th month.ConclusionsThe study's findings provide encouraging evidence that McHeELP program may increase functional ability and decrease FOF of older people. However, further research is required for a thorough understanding of the effect of McHeELP program.
Highlights
Fall incidents are a serious health issue that can reduce older people's independence related to daily-life activities, and quality of life
Homogeneity was found between McHeELP-G and control group (CG) regarding the demographic and clinical characteristics, and no statistically significant difference was found at baseline measurements of patient-reported outcomes (PROs) and Physical performance measures (PPMs), except HOMEFAST (p=0.031)
Post-intervention (3rd month), the comparison of the absolute values between groups revealed that the McHeELP-G achieved statistically significant better balance control, better functionality [faster gait speed (4MWT), shorter Timed Up and Go (TUG) performance time, and a higher number of repetitions at 30 seconds-Sit to stand], while no difference was found for LEFS-Greek score (p=0.095), compared to CG
Summary
Fall incidents are a serious health issue that can reduce older people's independence related to daily-life activities, and quality of life. At least 33% of all community-dwelling people aged over 65 years fall each year [1]. Fall may occur due to the age-related deterioration of balance, decreased lower limbs' muscular strength [2], or deficits in motor performance [3]. Older people's motor performance deficits include increased variability, difficulty in coordination, slowing of movement, as well as gait and balance difficulties [3]. It has been reported that motor performance deficits could be reduced through training specificity, which is the crucial element of motor learning [4]. Little is known regarding implementing motor control exercises in this population, the fall prevention interventions targeting balance, gait, and muscle strength [1]
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