Fall Risk Status Research Articles

Fall prevention among psychiatric patients in an Iranian hospital: a best practice implementation project.

Falls are the main cause of disability among psychiatric patients, as well as being the most common adverse event in hospitals. The aim of this evidence implementation project was to improve fall prevention and management among psychiatric patients in a neurology ward in an Iranian tertiary psychiatric hospital. This project used the JBI Evidence Implementation Framework, which recommends an audit, feedback, and re-audit strategy. A baseline audit was conducted to evaluate current fall prevention practices among 50 psychiatric patients and 20 health care professionals. The baseline audit was used to identify gaps in compliance. After the implementation of improvement strategies, a follow-up audit was conducted to measure any changes in practice. The baseline and follow-up audits revealed that compliance with best practices improved in ward transfer fall risk assessment (Criterion 2: 87% to 90%), patient participation in fall risk assessment (Criterion 3: 95% to 96%), revising patient fall risk status (Criterion 9: 50% to 86%), and person-centered education of health care providers (Criterion 11: 78% to 96%). Other audit criteria remained unchanged. However, for Criterion 6 on patient engagement in goal-setting and treatment planning, compliance dropped from 100% at baseline to 94% at follow-up. This project successfully increased evidence-based practices regarding fall prevention and management, as well as providing mechanisms for sustaining the practice changes. Future audits are required to further improve outcomes. http://links.lww.com/IJEBH/A267.

Evaluation of Nutrition, Pressure Ulcer and Fall Risk Status and Related Factors in Individuals Receiving Home Health Care Services

Objective: In this study, the aim is to evaluate the factors associated with nutrition, pressure ulcers, and fall risks in individuals receiving home health care. Methods: A retrospective study was designed by examining the files of the patients registered in the Home Health Care. Mini Nutritional Assessment Short Form, Modified Norton Scale and Itaki Fall Risk Scale scores were recorded. Results: The study included 334 patients. 197 (59%) of them were female and the mean age was 74.15±16.12 (min: 18, max: 101). The most common chronic diseases was hypertension (HT) (n=167, 50%), whereas the two most common comorbidities were DM and HT (n=77,23.1%). Patients receiving home health care were found to be at risk for malnutrition, pressure ulcers and falls. Being semi-bedridden and wheelchair bound were found to be predictors for the risk of developing pressure ulcers according to regression analysis results. Also it was identified that the age and dependency levels of the patients receiving home health care explained 12% of the falling behaviours of the older people. Conclusion: Necessary warnings should be given at every visit, so that receiving home health care should not be neglected in terms of risks and preventive measures should be taken for this patient group.

Associations of Usual and Fast Gait Speed With Physical Performance and Balance Confidence in Community-Dwelling Older Adults: Implications for Assessment.

Gait speed is a robust measure that offers many advantages clinically. However, decisions concerning its utilization exist, including whether to assess usual or fast gait speed. The current study aimed to identify whether usual or fast gait speed was more strongly associated with physical performance measures and balance confidence. A secondary aim was to explore these relationships within subgroups based on fall risk status. This was an observational study with a cross-sectional design involving 57 community-dwelling older adults (77.2% female; mean age = 68.8, SD = 6.5 years, range = 60-87 years) who were assessed on the following variables: usual and fast gait speed, knee extension strength, step execution time, 6-minute walk test (6MWT), and Activities-specific Balance Confidence Scale (ABC-6). Spearman ρ correlations were computed to determine bivariate associations of usual and fast gait speed with physical performance measures and balance confidence for the whole sample and within subgroups based on fall risk [lower fall risk (n = 28) vs higher fall risk (n = 29)]. Multiple linear regression models were estimated with either usual or fast gait speed as key predictors of knee extension strength, step execution time, 6MWT, and ABC-6. Stronger correlations were observed for fast gait speed compared with usual gait speed with all physical performance measures and balance confidence for the entire sample and within the higher fall risk group. Multiple regression results indicated that models with fast rather than usual gait speed as the key predictor explained more of the variance in 6MWT ( R2 = 64.5% vs 45.6%), ABC-6 ( R2 = 28.5% vs 25.4%), step execution time ( R2 = 24.9% vs 19.0%), and knee extension strength ( R2 = 15.7% vs 7.2%). Fast gait speed showed stronger associations and better predictive capabilities compared with usual gait speed with physical performance measures and balance confidence in older adults. Despite being measured less often than usual gait speed, fast gait speed assessment warrants additional consideration.

An observational pilot evaluation of the Walk with Ease program for reducing fall risk among older adults

BackgroundPhysical activity is an effective method of reducing fall risk among older adults. Previous evaluations of the six-week Walk with Ease (WWE) program have documented benefits to functional outcomes, but the potential effects on reducing fall risk have not been evaluated. This pilot study evaluates outcomes of a community delivered WWE program for potential suitability as a fall risk reduction program.MethodsA total of 59 older adults (age > 60) enrolled in a group version of WWE delivered by trained community-based leaders. Complete data (pre- and post-program) from functional fitness tests and behavioral instruments were obtained from 41 participants (aged 74.4 ± 6.6 years, 70% female). Functional outcomes included the 10-foot timed up and go (TUG), 30-second chair stand (CST) and 4-stage balance test (BT) included as part of STEADI, as well as a two-minute step test (ST) and normal gait speed test (GST). Survey assessments included STEADI fall risk screening, self-reported physical activity, and fear of falling measures. Analyses focused on reporting pre-post effect sizes, but paired t-tests were used to test statistical significance of differences.ResultsImprovements in functional performance approached significance for both CST (d = 0.31, p = 0.06) and ST (d = 0.26, p = 0.12), but all other tests were nonsignificant. Survey results demonstrated significant increases in self-reported walking (d = 0.54, p = 0.02) and moderate-to-vigorous physical activity (MVPA; d = 0.56, p = 0.004), but perceived fear of falling and overall fall risk scores had smaller, non-significant, effects (d ranging from 0.01 to 0.31). Stratified analysis suggested that participants screened at an elevated risk for falls at baseline consistently had larger effects on all functional and survey assessments, though the analysis was underpowered to test significance.ConclusionsWalk with Ease participation significantly increased self-reported physical activity but did not significantly improve physical function or reduce fall risk. However, consistently larger effect sizes among participants screened as at-risk for falls suggest that the program may be beneficial for those with elevated risk for falls or functional limitations. Further research is needed to document the consistency of these effects among participants with elevated fall risk status.

Wearable Sensor Systems for Fall Risk Assessment: A Review.

Fall risk assessment and fall detection are crucial for the prevention of adverse and long-term health outcomes. Wearable sensor systems have been used to assess fall risk and detect falls while providing additional meaningful information regarding gait characteristics. Commonly used wearable systems for this purpose are inertial measurement units (IMUs), which acquire data from accelerometers and gyroscopes. IMUs can be placed at various locations on the body to acquire motion data that can be further analyzed and interpreted. Insole-based devices are wearable systems that were also developed for fall risk assessment and fall detection. Insole-based systems are placed beneath the sole of the foot and typically obtain plantar pressure distribution data. Fall-related parameters have been investigated using inertial sensor-based and insole-based devices include, but are not limited to, center of pressure trajectory, postural stability, plantar pressure distribution and gait characteristics such as cadence, step length, single/double support ratio and stance/swing phase duration. The acquired data from inertial and insole-based systems can undergo various analysis techniques to provide meaningful information regarding an individual's fall risk or fall status. By assessing the merits and limitations of existing systems, future wearable sensors can be improved to allow for more accurate and convenient fall risk assessment. This article reviews inertial sensor-based and insole-based wearable devices that were developed for applications related to falls. This review identifies key points including spatiotemporal parameters, biomechanical gait parameters, physical activities and data analysis methods pertaining to recently developed systems, current challenges, and future perspectives.

Development of Data-Driven Metrics for Balance Impairment and Fall Risk Assessment in Older Adults.

Ageing incurs a natural decline of postural control which has been linked to an increased risk of falling. Accurate balance assessment is important in identifying postural instability and informing targeted interventions to prevent falls in older adults. Inertial sensor (IMU) technology offers a low-cost means for objective quantification of human movement. This paper describes two studies carried out to advance the use of IMU-based balance assessments in older adults. Study 1 (N = 39) presents the development of two new IMU-derived balance measures. Study 2 (N = 248) reports a reliability analysis of IMU postural stability measures and validates the novel balance measures through comparison with clinical scales. We also report a statistical fall risk estimation algorithm based on IMU data captured during static balance assessments alongside a method of improving this fall risk estimate by incorporating standard clinical fall risk factor data. Results suggest that both new balance measures are sensitive to balance deficits captured by the Berg Balance Scale (BBS) and Timed Up and Go test. Results obtained from the fall risk classifier models suggest they are more accurate (67.9%) at estimating fall risk status than a model based on BBS (59.2%). While the accuracies of the reported models are lower than others reported in the literature, the simplicity of the assessment makes it a potentially useful screening tool for balance impairments and falls risk. The algorithms presented in this paper may be suitable for implementation on a smartphone and could facilitate unsupervised assessment in the home.

Amputee Fall Risk Classification Using Machine Learning and Smartphone Sensor Data from 2-Minute and 6-Minute Walk Tests.

The 6-min walk test (6MWT) is commonly used to assess a person’s physical mobility and aerobic capacity. However, richer knowledge can be extracted from movement assessments using artificial intelligence (AI) models, such as fall risk status. The 2-min walk test (2MWT) is an alternate assessment for people with reduced mobility who cannot complete the full 6MWT, including some people with lower limb amputations; therefore, this research investigated automated foot strike (FS) detection and fall risk classification using data from a 2MWT. A long short-term memory (LSTM) model was used for automated foot strike detection using retrospective data (n = 80) collected with the Ottawa Hospital Rehabilitation Centre (TOHRC) Walk Test app during a 6-min walk test (6MWT). To identify FS, an LSTM was trained on the entire six minutes of data, then re-trained on the first two minutes of data. The validation set for both models was ground truth FS labels from the first two minutes of data. FS identification with the 6-min model had 99.2% accuracy, 91.7% sensitivity, 99.4% specificity, and 82.7% precision. The 2-min model achieved 98.0% accuracy, 65.0% sensitivity, 99.1% specificity, and 68.6% precision. To classify fall risk, a random forest model was trained on step-based features calculated using manually labeled FS and automated FS identified from the first two minutes of data. Automated FS from the first two minutes of data correctly classified fall risk for 61 of 80 (76.3%) participants; however, <50% of participants who fell within the past six months were correctly classified. This research evaluated a novel method for automated foot strike identification in lower limb amputee populations that can be applied to both 6MWT and 2MWT data to calculate stride parameters. Features calculated using automated FS from two minutes of data could not sufficiently classify fall risk in lower limb amputees.

Fall Prevalence and Associated Risk Factors in Geriatric Population

Aim: To determine the prevalence of fall among geriatric population and to find out risk factors associated with fall. Method: A cross-sectional study was conducted with a sample of 223, raised through non-probability convenient sampling technique. The inclusion criteria were older adults both genders, aged 60 years and above. The exclusion criteria were older persons with severe and uncontrolled co morbidities that include diabetes, hypertension, memory impairment, stroke, psychiatric disorders, and use of any walking aid. Data was collected through semi structured questionnaire. Fall risk assessment scale was used to categorize fall risk status in older persons. Data was analyzed using SPSS 24. Descriptive statistics and Chi-square test were applied. Results: The overall mean age of participants was 67.61±5.64 years. Out of 223 participants, females were 134(60.1%) and 89(39.9%) were males. The prevalence of falls reported in elderly was 42.6%. Most prevalent fall were reported under category of 1-2 falls, out of which females had 43(32.1 %) and males had 29 (32.6%) falls. Among study participants 87 (39.0%) were in high-risk group while 136(61.0%) participants were in low-risk group. Furthermore, weak eyesight, use of medications, vertigo/imbalance, and chronic medical conditions (p&lt;0.05) were considered as most significant risk factors with fall. Conclusion: The study showed significant number of older adults who had fall. Female were at high risk of fall. Weak eyesight, use of medications, vertigo/imbalance, and chronic medical conditions were found to be most prevalent risk factors associated with fall. Keywords: Fall, geriatrics, aging, fall risk, prevalence, old age

Machine Learning Prediction of Fall Risk in Older Adults Using Timed Up and Go Test Kinematics.

Falls among the elderly population cause detrimental physical, mental, financial problems and, in the worst case, death. The increasing number of people entering the higher risk age-range has increased clinicians’ attention to intervene. Clinical tools, e.g., the Timed Up and Go (TUG) test, have been created for aiding clinicians in fall-risk assessment. Often simple to evaluate, these assessments are subject to a clinician’s judgment. Wearable sensor data with machine learning algorithms were introduced as an alternative to precisely quantify ambulatory kinematics and predict prospective falls. However, they require a long-term evaluation of large samples of subjects’ locomotion and complex feature engineering of sensor kinematics. Therefore, it is critical to build an objective fall-risk detection model that can efficiently measure biometric risk factors with minimal costs. We built and studied a sensor data-driven convolutional neural network model to predict older adults’ fall-risk status with relatively high sensitivity to geriatrician’s expert assessment. The sample in this study is representative of older patients with multiple co-morbidity seen in daily medical practice. Three non-intrusive wearable sensors were used to measure participants’ gait kinematics during the TUG test. This data collection ensured convenient capture of various gait impairment aspects at different body locations.

Rural Residence, Nutrition Risk, and Falls In Community-Dwelling Older Adults

Decreasing fall risk and maintaining independence is vital for community dwelling older adults. Nutritional status and rural residence may be independent predictors of falls. The aim of this study was to evaluate if nutritional status and rurality are positively associated with fall risk and predictive of future falls in community-dwelling older adults. We used data from a health risk assessment conducted by the Support and Services at Home organization serving Medicare beneficiaries in Vermont in 2017-2019 (N=3109; 79.6 years ±8.4, 75% female). Measures included the Fall Risk Questionnaire, Determine Nutrition Risk questionnaire, and fall history. Descriptive statistics from baseline measures and logistic regression analyses were used to identify predictors of a new fall with respect to rurality, fall risk, and nutritional status. At baseline, 67% of participants lived in rural communities, 37% had high nutrition risk, and 60% had elevated fall risk. Independently, rurality and high nutrition risk were significantly associated with fall risk (p<0.001) and high nutrition risk was associated with rurality (p<0.001). In the adjusted model, rural residence was not significantly associated with a fall within one year from baseline, whereas participants at high nutrition risk had a 50% higher odds of falling (p= 0.001). These findings suggest that falls may be associated with nutrition risk, but not living in a rural setting. Community-based initiatives should consider including nutrition screens as part of fall risk assessments. Further research is needed to understand the relationship between nutrition status and falls risk.

Examining Fall Risk Assessment in Geriatric Rehabilitation Settings Using Translational Research.

The objective of this study was to identify gaps in and to improve the falls prevention strategy (FPS) of an inpatient rehabilitation facility (IRF) in Toronto, Canada. A modified version of the Stanford Biodesign Methodology was used. Chart reviews, a focus group (n = 8), and semistructured interviews (n = 8) were conducted to evaluate the FPS. Admission Functional Independence Measure score, age, and gender significantly correlated with risk for a fall. The tool used at this IRF was not effectively capturing patients who were at high risk for falls. All healthcare providers interviewed were knowledgeable of fall risks; however, a patient's fall risk status was rarely discussed as a team. The findings informed recommendations to improve the overall FPS at this IRF. Staff may require more coaching for implementing preventative measures/ensuring accountability and evaluating whether current strategies work. These insights can guide improvement initiatives at similar facilities elsewhere.

138 The use of Fall Risk-Increasing Drugs among Older People in Nursing Home

Abstract Medication use has been one of the modifiable risk factors in causing falls. Falls are the leading cause of injury among older people. The incidence of falls will greatly impact the independence of the older people to carry out normal activity. This study aimed to determine the prevalence of drugs causing falls and the fall risk status among older people residing in nursing homes. A cross-sectional study was conducted among residents in 27 long term care facilities in Malaysia from March 2018 until November 2018 using a researcher-assisted questionnaire. In this study, 212 elderly residents were recruited and further categorized into frail (6.6%, n=14), pre-frail (57.5%, n= 122) and robust (35.8%, n=76). The frailty status was found to be significantly associated with the risk of falling (p &amp;lt; 0.001). Of all residents recruited, 68.4% (n=145) were taking at least one FRIDs or orthostatic drugs. Antipsychotics and calcium channel blockers were the most frequently used FRIDs. Length of stay in facilities (&amp;lt;1 year), frailty status, number of medication, use of CCB or RAS inhibitors are associated with an increased risk of falling (p&amp;lt;0.05). Therefore majority of the older people residing in nursing homes were prone to the use of fall-risk medications, particularly ODs. Frail older people had a greater risk in falling compared to those who were non-frail.

An Investigation of the Predictors of Comfortable and Fast Gait Speed in Community-Dwelling Older Adults.

To identify the unique predictors of comfortable and fast gait speed in community-dwelling older adults using measures of physical performance (eg, lower extremity strength and balance), self-reported balance confidence, and global cognitive function. Demographic information was collected from 60 healthy, community-dwelling older adults older than 60 years. Participants completed the following assessments: Mini-Mental State Examination; Activities-Specific Balance Confidence Scale; 30-second Chair Stand (30-SCS); Functional Reach (FR); and gait speed (comfortable and fast) using the GAITRite system. Hierarchical linear regression was used to examine the relationship of both fast and comfortable gait speeds with functional performance (CST and FR), cognition (Mini-Mental State Examination), Activities-Specific Balance Confidence Scale, and demographic information (age, gender, and body mass index). Functional performance measures (30-SCS and FR) explained 55.4% and 64.7%, respectively, of the variance in comfortable and fast gait speed. Unique predictors for comfortable gait speed included 30-SCS, FR, and body mass index. Unique predictors of fast gait speed included 30-SCS, FR, gender, body mass index, and Activities-Specific Balance Confidence Scale score. These predictors explained 68.5% and 80.4% of the total variance in comfortable and fast gait speed, respectively. Global cognition was not a unique predictor of gait speed when performance measures were statistically controlled. However, the current study measured global cognitive status rather than the specific cognitive constructs, such as processing speed or executive function. Further research is needed to determine the role of cognition in the composition of gait speed. Gait speed is an important indicator for many outcomes such as fall risk, mortality, and functional status. Understanding that key variables of strength and balance comprise a large portion of gait speed allows clinicians to better direct their care and optimize rehabilitation outcomes. This study specifically used functional measures of strength and balance that can be easily implemented in the clinical setting.

Exercise-Based VRT Shows Benefits in Balance and Postural Stability in Adult Patients with Unilateral Vestibular Hypofunction

Background and Objective: Vestibular rehabilitation therapy (VRT) is an exercise-based program designed to improve balance function and alleviate problems related to dizziness, including vestibular hypofunction. This study aimed to evaluate the therapeutic effects of VRT exercises on balance function in adults with unilateral vestibular hypofunction (UVH). Methods: Thirty-one patients (mean age: 39.48 (±10.96) years old) with confirmed UVH participated in this study. The VRT program consisted of habituation and adaptation exercises in combination with gait and balance exercises. The handicapping influences of dizziness were measured with a dizziness handicap inventory (DHI) scale to measure the level of respondent’s performance on physical, emotional, and functional dimensions. Visual analogue scale (VAS) was also used to rate the severity of dizziness symptoms. The DHI and VAS scales were assessed pre-intervention and post-intervention at one, two, and four weeks follow-ups after the last rehabilitation session. Results: An analysis of variance showed a significant reduction and a consequent improvement in DHI scores after vestibular exercises in all domains: emotional, physical and functional (p &lt; 0.001). The mean total DHI score significantly decreased by 15 points after one week, 24 points after two weeks and 15 points after four weeks of the last VRT session. The mean baseline VAS score was 7.71 (±0.91) that significantly decreased at one, two, and four weeks post-intervention to 4.81 (±0.73), 3.77 (±0.61), and 3.16 (±0.97), respectively (p&lt;0.001). Conclusion: The exercise-based VRT shows benefits for adult patients with chronic dizziness concerning improvement in the vertigo symptom scale, fall risk, balance and emotional status.

Neuromodulation to improve gait and balance function using a sensory neuroprosthesis in people who report insensate feet - A randomized control cross-over study.

Peripheral neuropathy may cause loss of sensory information from plantar cutaneous mechanoreceptors that is important for balance control and falls management. The current study investigated short-term effects of using Walkasins, an external lower-limb sensory neuroprosthesis, on clinical outcomes of balance and gait in persons who reported peripheral neuropathy and balance problems. The device replaces lost plantar sensation with tactile balance information that modulates cutaneous mechanoreceptors above the ankle where sensation is intact. Thirty-one male community-dwelling Veterans, 56–84 years old with insensate feet and balance problems participated. Initial Functional Gait Assessment, gait speed, and 4-Stage Balance Test outcomes were assessed. After initial assessment, subjects were randomly assigned to either wearing Walkasins turned ON, or OFF, and outcomes were re-assessed following a set of standardized balance exercises. Following a one-hour rest and washout period, treatments were crossed-over between groups and a third outcomes assessment was performed. Before cross-over, 10 of 15 subjects in the ON-then-OFF group improved their Functional Gait Assessment score by at least four points, the Minimal Clinically Important Difference, compared to 5 of 16 in the OFF-then-ON group. After cross-over, 7 of 16 subjects in the OFF-then-ON group improved by at least four points versus 2 of 15 in the ON-then-OFF group. ON treatment was associated with a Functional Gait Assessment improvement of 4.4 ± 3.7 points versus 1.5 ± 1.2 for the OFF treatment (p<0.01). Overall, Functional Gait Assessment scores changed from 15.2 ± 4.8 at initial assessment to 21.1 ± 5.2 after final assessment (p<0.001). At the end of the two treatment sessions, 16 of the 31 individuals had improved their Functional Gait Assessment score beyond 23, indicating normal fall-risk status. Future studies should investigate long-term benefits of the device to reduce fall risk and actual falls in patients with peripheral neuropathy and balance problems.

Use of a Dual mobility cup to prevent hip early arthroplasty dislocation in patients at high falls risk

IntroductionHip fracture is a common serious injury that occurs mainly in elderly. Dual-mobility hip arthroplasty or bipolar emiarthroplasty for its treatment remains a controversial decision. Co-morbidities and risk of fall represent additional aspects to be considered. The aim of our study was to determine the rate of mechanical complications for these two types of implants related to fall risk status of patients. Patients and methodsOur study is a retrospective clinical trial of patients operated with a biarticular hemiarthroplasty or a dual-mobility total hip arthroplasty. Primary outcome was dislocation rate and need for any revision procedure. Patients were treated in a single center from January 2013 to March 2017. In all cases Morse Fall Scale (MSF) was calculated at patient admission to evaluate the risk of postoperative fall. Inclusion criteria to the study were: subcapital or femoral neck fracture of non-pathologic nature, patients with neuromuscular disorders or cognitive dysfunction, age > 75 years with MFS ≥ 45. The patients were reviewed postoperatively at 8 weeks, 6 months, 12 months, and then annually. Patients had clinical (Harris hip score) and radiological assessment. ResultsThe mean duration of the follow-up was 283 months. There were five dislocations in Group A (5,6%) and no dislocations in Group B (0%). All dislocations occurred within the first 6 months after surgery. The mean Harris Hip score was 81,7 in Group A patients and 79, 8 in Group B patients. DiscussionTreatment of hip fractures on non-cooperative patients still represents a dilemma. Falls and runaway motions represent high risk factors of dislocation. Use of dual-mobility cup has been found to be associated with a not statistically proved decrease of dislocation compared to traditional cups. ConclusionDual-mobility cups might be considered a valuable option to prevent postoperative dislocation but further study is needed before extending the indications for dual-mobility following a fracture of the femoral neck, to assess the potential cost and complications of a longer procedure. So far, despite a lower dislocation risk, the authors actually cannot recommend widely use of a dual-motility cup instead of emiarthroplasty in high falls risk patients.

The effectiveness of exercise-based vestibular rehabilitation in adult patients with chronic dizziness: A systematic review.

Background: Dizziness is a non-specific term used by patients to describe several symptoms ranging from true vertigo, light headedness, disorientation or sense of imbalance. Vestibular rehabilitation (VR) is a specific form of exercise-based therapy programme aimed at alleviating the primary and secondary problems of a vestibular pathology. The aim of this study was to investigate the effectiveness of exercise-based vestibular rehabilitation in adult patients with chronic dizziness. Methods: The following five databases were searched: the Cochrane Central Register of Controlled Trials (CENTRAL, the Cochrane Library), MEDLINE, PubMed, the Physiotherapy Evidence Database (PEDro) and Scopus (Elsevier). Two investigators independently reviewed all articles and a systematic review of literature was performed using the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). The articles were included if they met the following inclusion criteria: (1) randomised controlled trial, (2) people with chronic dizziness, (3) adults aged 18 or over, (4) exercise-based VR, (5) VR exercises compared with sham or usual care, non-treatment or placeboand (6) only studies published full text in English. Results:The initial search identified 304 articles,fourof whichmet the criteria for analysis.All studies involved some form ofvestibular rehabilitation, includingvestibular compensation,vestibular adaptation and substitution exercises. These exercises were compared with usual medical care (threestudies) or placebo eye exercise (onestudy). The Vertigo Symptom Scalewas the most commonly usedoutcome measureto assess subjective perception of symptoms of dizziness (threestudies).According to thePEDroscale, threestudies were considered to be of highquality,and one was rated as fair. Conclusions: This review suggests that exercise-based vestibular rehabilitation shows benefits for adult patients with chronic dizziness with regard to improvement in the vertigo symptom scale, fall risk, balance and emotional status.

The effects of a multicomponent intervention program on clinical outcomes associated with falls in healthy older adults.

Multicomponent intervention programs have been shown to be effective in reducing risk factors associated with falls, but the primary target population of these interventions is often low-functioning older adults. The purpose of this study was to investigate the effectiveness of a multicomponent intervention program focusing on balance and muscle strength for independently functioning community-dwelling older adults. Fifty-three independently functioning older adults, aged 80.09 ± 6.62 years, participated in a group exercise class (conducted 2 times/week for 8 weeks) emphasizing balance. Outcome measures were balance performance using the Fullerton Advanced Balance (FAB) scale and muscle strength using the Senior Fitness Test (SFT). The intervention improved balance (P < 0.001), and older adults who were classified as having high fall risks based on the FAB scores at pre-testing improved more than older adults who were classified as having low fall risks (P = 0.017). As a result, 22 participants transitioned from a high fall risk group at pre-testing to a low fall risk group at post-testing (P < 0.001). The intervention also enhanced both upper and lower muscle extremity strength based on SFT results (P < 0.001) regardless of participants' classification of fall risk status. The multicomponent intervention conducted two times per week for 8 weeks was effective in improving balance and enhancing muscle strength of independently functioning older adults. The results underscore the importance of providing fall prevention interventions to healthy older adults, a population often not a target of balance interventions.

Effectiveness of patient-centered interventions on falls in the acute care setting compared to usual care: a systematic review.

Unintentional falls during hospitalization remain a concern for healthcare institutions globally despite implementation of various improvement strategies. Although the incidence of falls has been of heightened focus for many years and numerous studies have been done evaluating different approaches for fall prevention, fall rates remain high in acute care settings. Patient fall risk scales tend to address only particular intrinsic and extrinsic factors but do not adequately assess a patient's current fall risk status, subsequently warranting more patient-centered risk assessments and interventions. To evaluate the effectiveness of patient-centered interventions on falls in the acute care setting. All adult patients admitted to medical or surgical acute care units for any condition or illness. Patient-centered intervention strategies to reduce falls compared to usual care. Randomized control trials. Primary outcome: fall rates or number of falls. Secondary outcome: fall-related injuries. A comprehensive search strategy aimed to find relevant published and unpublished quantitative, English language studies from the inception of databases through July 30, 2016 was undertaken. Databases searched included: PubMed, CINAHL, Embase and Health Source: Nursing/Academic Edition. A search for unpublished studies was also performed using ProQuest Dissertations and Theses, the New York Academy of Medicine and the Virginia Henderson e-Repository. Reviewers evaluated the included studies for methodological quality using the standardized critical appraisal instrument form from the Joanna Briggs Institute. Quantitative data were extracted from papers included in the review using the standardized data extraction form from the Joanna Briggs Institute. Due to clinical and methodological heterogeneity among the included studies, a meta-analysis was not possible. The findings of this review have been presented in narrative form. Five randomized control trials were included. Three studies demonstrated statistically significant reductions in fall rates (p < 0.04) while two studies showed no difference in fall rates between groups (p > 0.5). In the three studies that demonstrated reduced fall rates, personalized care plans and patient-centered education based on patients' fall risk results were utilized. Three studies measured the secondary outcome of fall-related injuries; however, results demonstrated no difference in fall-related injuries between groups (p > 0.5). Evidence of this review indicates patient-centered interventions in addition to tailored patient education may have the potential to be effective in reducing falls and fall rates in acute care hospitals. There is limited high quality evidence demonstrating the effectiveness of patient-centered fall prevention interventions so novel solutions are urgently needed and warrant more rigorous, larger scale randomized trials for more robust estimates of effect.

Changes in fall risk and functional status in women aged 50 years and older after distal radius fracture: A prospective 1-year follow-up study

Study DesignProspective cohort study. IntroductionFew studies have evaluated the course of recovery after distal radius fracture (DRF) when functional decline and fracture risk may be affected. Purpose of the StudyThe purpose of this study was to determine changes in overall functional status over the first year after a DRF in women aged 50 years and older. MethodsSeventy-eight women were assessed for balance, balance confidence, lower extremity strength, gait speed, fall history, physical activity levels, and self-reported wrist pain and function (Patient-Rated Wrist Evaluation) at weeks 1, 3, 9, 12, 26, and 52 after DRF. Descriptive data were generated for all variables; a 3-way mixed analysis of variance with repeated measures was used to compare differences between participants aged 50-65 years and 65 years and older. ResultsThere was a significant improvement in functional status measures for both age categories except single-leg balance and fast gait speed, from 1 week after fracture extending up to 1 year after fracture (ranging from 6.1% improvement to 25% improvement, P < .05). There was no significant time × age interaction, as both age groups had the same pattern of recovery; however, there was significantly lower functional status in the older group across all time points. ConclusionRegardless of age, monitoring and addressing functional status including upper limb function, overall strength, balance, confidence, usual gait speed, and physical activity right up to 1 year after fracture is an important consideration for clinicians treating women recovering from DRF. Given the high future fracture risk for these women, identifying functional recovery patterns can help to direct future research and determine preventative strategies.