TY  - JOUR
PY  - 2020//
TI  - Surface perturbation training to prevent falls in older adults: a highly pragmatic, randomized controlled trial
JO  - Physical therapy
A1  - Lurie, Jon D.
A1  - Zagaria, Alexandra B.
A1  - Ellis, Lisa
A1  - Pidgeon, Dawna
A1  - Gill-Body, Kathleen M.
A1  - Burke, Christina
A1  - Armbrust, Kurt
A1  - Cass, Sharil
A1  - Spratt, Kevin F.
A1  - McDonough, Christine M.
SP  - ePub
EP  - ePub
VL  - ePub
IS  - ePub
N2  - BACKGROUND: Falls are the leading cause of injuries among older adults and trips and slips are major contributors to falls. <br><br>OBJECTIVE: Compare the effectiveness of adding a component of surface-perturbation training to usual gait/balance training for reducing falls and fall-related injury in high-risk older adults referred to physical therapy. <br><br>DESIGN: This was a multi-center, pragmatic, randomized, comparative effectiveness trial. SETTING: Treatment took place within 8 outpatient physical therapy clinics. PATIENTS: This study included 506 patients aged 65+ at high fall risk referred for gait/balance training. INTERVENTION: This trial evaluated surface-perturbation treadmill training integrated into usual multimodal exercise-based balance training at the therapist's discretion versus usual multimodal exercise-based balance training alone. MEASUREMENTS: Falls and injurious falls were assessed with a prospective daily fall diary, which was reviewed via telephone interview every 3 months for 1 year. <br><br>RESULTS: 211/253 (83%) of patients randomized to perturbation-training and 210/253 (83%) randomized to usual treatment provided data at 3-month follow-up. At 3 months, the perturbation-training group had significantly reduced chance of fall-related injury (5.7% vs. 13.3%; relative risk 0.43, p < 0.01) but no significant reduction in the risk of any fall (28% vs. 37% ST; relative risk 0.78 p<0.07) compared to usual treatment. Time to first injurious fall showed reduced hazard in the first 3 months, but no significant reduction when viewed over the entire first year (p=0.67). LIMITATIONS: The limitations of this trial included lack of blinding and variable application of interventions across patients based on pragmatic study design. <br><br>CONCLUSION: The addition of some surface perturbation training to usual physical therapy significantly reduced injurious falls up to 3 months post-treatment. Further study is warranted to determine the optimal frequency, dose, progression and duration of surface perturbation aimed at training postural responses for this population.<br><br>© 2020 American Physical Therapy Association.<p />  <p>Language: en</p>
LA  - en
SN  - 0031-9023
UR  - http://dx.doi.org/10.1093/ptj/pzaa023
ID  - ref1
ER  -