Abstract
BackgroundThe ability to adjust walking to environmental context is often reduced in older adults and, partly as result of this, falls are common in this population. A treadmill with visual context projected on its belt (e.g., obstacles and targets) allows for practicing step adjustments relative to that context, while concurrently exploiting the great amount of walking practice associated with conventional treadmill training. The present study was conducted to compare the efficacy of adaptability treadmill training, conventional treadmill training and usual physical therapy in improving walking ability and reducing fear of falling and fall incidence in older adults during rehabilitation from a fall-related hip fracture.MethodsIn this parallel-group, open randomized controlled trial, seventy older adults with a recent fall-related hip fracture (83.3 ± 6.7 years, mean ± standard deviation) were recruited from inpatient rehabilitation care and block randomized to six weeks inpatient adaptability treadmill training (n = 24), conventional treadmill training (n = 23) or usual physical therapy (n = 23). Group allocation was only blind for assessors. Measures related to walking ability were assessed as the primary outcome before and after the intervention and at 4-week and 12-month follow-up. Secondary outcomes included general health, fear of falling, fall rate and proportion of fallers.ResultsMeasures of general walking ability, general health and fear of falling improved significantly over time. Significant differences among the three intervention groups were only found for the Functional Ambulation Category and the dual-task effect on walking speed, which were in favor of respectively conventional treadmill training and adaptability treadmill training.ConclusionsOverall, adaptability treadmill training, conventional treadmill training and usual physical therapy resulted in similar effects on walking ability, fear of falling and fall incidence in older adults rehabilitating from a fall-related hip fracture. Additional post hoc subgroup analyses, with stratification for pre-fracture tolerated walking distance and executive function, revealed several intervention effects in favor of adaptability and conventional treadmill training, indicating superiority over usual physical therapy for certain subgroups. Future well-powered studies are necessary to univocally identify the characteristics of individuals who will benefit most from a particular intervention.Trial registrationThe Netherlands Trial Register (NTR3222, 3 January 2012).Electronic supplementary materialThe online version of this article (doi:10.1186/s12877-016-0388-x) contains supplementary material, which is available to authorized users.
Highlights
The ability to adjust walking to environmental context is often reduced in older adults and, partly as result of this, falls are common in this population
Overall, adaptability treadmill training, conventional treadmill training and usual physical therapy resulted in similar effects on walking ability, fear of falling and fall incidence in older adults rehabilitating from a fallrelated hip fracture
The present study showed that measures of walking ability, fear of falling and general health improved over time in all groups, which is consistent with previous studies showing improved walking ability after exercise programs in older adults with hip fracture [38, 40, 41]
Summary
The ability to adjust walking to environmental context is often reduced in older adults and, partly as result of this, falls are common in this population. Safe walking requires the ability to make step adjustments in response to environmental demands, an ability that is reduced in older adults [4, 5]. Interventions that incorporate overground walking adaptability exercises have shown improved obstacle avoidance performance and reduced fall incidence in older adults [7, 8]. In line with these findings, a recent systematic review and meta-analysis showed that falls in older adults can be reduced by about 50% after stepping training in response to environmental challenges [9]. Practicing the complex and hazardous situations of everyday walking is important to prevent falls [9], but older adults have little opportunity to do so consistently and safely in a task-specific manner
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