Improving balance and mobility in older Veterans

改善老年退伍军人的平衡和活动能力

基本信息

批准号：
9493290
负责人：
Leslie I. Katzel
金额：
--
依托单位：
BALTIMORE VA MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2015
资助国家：
美国
起止时间：
2015-04-01 至 2018-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9493290
关键词：
Abdomen Address Adherence Admission activity Adult Age American Award Centers for Disease Control and Prevention (U.S.)Cessation of life Clinical Communities Community Practice Community of Practice Comorbidity Dangerousness Derivation procedure Dual-Energy X-Ray Absorptiometry Effectiveness Elderly Enrollment Environmental Hazards Equilibrium Exercise Failure Fall prevention Gait Health Policy Health system Hip region structure Hospitalization Hospitals Hour Impairment Individual Injury Intervention Isometric Exercise Lateral Lead Lower Extremity Mediation Medical Methods Modality Modeling Movement Muscle Muscle Weakness Musculoskeletal Equilibrium Participant Pilot Projects Prevention program Questionnaires Randomized Randomized Clinical Trials Recording of previous events Recovery Recurrence Research Resources Societies Step Tests Tai Ji Testing Thigh structure Time Trauma Veterans Walking Weight X-Ray Computed Tomography compare effectiveness cost effective intervention exercise intervention exercise program exercise training experience fall risk falls group intervention high risk improved intervention program multimodality muscle strength novel post intervention programs public health relevance spatiotemporal standard of care strength training

项目摘要

DESCRIPTION (provided by applicant): Background: Falls are currently the leading cause of injurious death and non-fatal injuries for adults over the age of 65. Older veterans may be at greater risk for falls due to their high burden of medical co-morbidity. The VA has made research into fall prevention a high priority. Tai Chi is currently considered to be one of the most effective fall prevention exercise interventions, with an endorsement from the CDC that widely influences health care policy. However, there are few studies comparing Tai Chi with another active intervention. Tai Chi may generally improve balance and provide general lower body strengthening however Tai Chi may not sufficiently improve gait and dynamic mobility and does little to target obstacle negotiation, one of the largest contributors to a fall. The majority of falls occur during walking, with slips and trips beng the most common causes and targeted interventions focused on improving stepping and walking ability may be even more effective at improving balance and reducing falls. Objective: The purpose of this pilot study is to evaluate two fall reduction programs in older veterans, Tai Chi and a multimodal balance intervention (MMBI) focused on dynamic stepping, obstacle negotiation, walking, and lower extremity strengthening. We propose that MMBI will provide many of the same benefits of tai chi (strengthening and improved balance) but addresses the deficits in many tai chi programs including environmental negotiation and walking. This program could also be easily implemented in community practice. Methods: We plan to enroll 56 older (age > 65 years) community dwelling veterans with a history of a fall in the last year who are at high risk for a recurrent fall. After baseline testing individuals will be randomized to either MMB or a Tai Chi intervention modeled after the Tai Chi Moving for Better Balance Program. All participants will participate in a group exercise class in their assigned intervention for 1 hour, times per week for 24 weeks. After the completion of 24 weeks of exercise group changes will be compared for 1) balance (4-square step test), 2) mobility and fall risk (functional gait assessment, clinical gait assessment and gait variability on a GAITrite), 4) questionnaires (falls efficacy and ABC) 5) lower extremity isometric strength testing (biodex), 6) a whole body DXA and CT scan of the abdomen, hips and thighs for determination of lower extremity and core muscle composition. We also plan for follow all participants for 6 months after completion of the intervention to examine differences in fall rates after the cessation of the program between the groups. Impact: This research directly benefits veterans as it may lead to new and effective interventions that could reduce fall risk, injury-related hospitalization and death in older veterans. MMBI is also readily exportable to the community and with minimal resources could be widely implemented at other VAs as part of standard of care, similar to MOVE!. Results from this award will be used to power a larger randomized clinical trial that will examine the effectiveness of the two interventions to reduce rate of falls and risk of falling in older veteran at high risk for falls.

描述（由申请人提供）：背景：瀑布目前是65岁以上成年人造成伤害性死亡和非致命伤害的主要原因。年长的退伍军人可能由于高负担而面临更大的跌倒风险医疗合并症。弗吉尼亚州已将预防秋季的研究成为很高的优先事项。 Tai Chi目前被认为是最有效的预防运动干预措施之一，CDC的认可对医疗保健政策产生了广泛影响。但是，很少有研究将太极拳与另一种主动干预进行比较。太极拳通常可以改善平衡并提供一般的下半身加强，但是太极拳可能无法充分提高步态和动态活动能力，并且对障碍谈判的目标无济于事，这是跌倒的最大贡献者之一。大部分跌倒在步行期间发生，随着班的滑倒和旅行，最常见的原因和针对提高步进能力的目标干预措施可能更有效地改善平衡和减少跌倒。目的：这项试验研究的目的是评估老年退伍军人，太极拳和多式联运平衡干预（MMBI）的两个秋季减少计划（MMBI），该计划着重于动态阶梯，障碍谈判，步行和下肢强化。我们建议MMBI将提供Tai Chi（增强和改善平衡）的许多相同好处，但解决了许多Tai Chi计划的缺陷，包括环境谈判和步行。该计划也很容易在社区实践中实施。方法：我们计划注册56岁（年龄> 65岁）社区的老兵，其历史在去年跌倒的历史较高，他们的反复跌倒风险很高。在基线测试之后，将随机将MMB或以Tai Chi移动以获得更好平衡计划的MMB或TAI CHI干预措施。所有参与者将参加分配的干预措施1小时，每周24周的时间参加小组锻炼课程。 After the completion of 24 weeks of exercise group changes will be compared for 1) balance (4-square step test), 2) mobility and fall risk (functional gait assessment, clinical gait assessment and gait variability on a GAITrite), 4) questionnaires (falls efficacy and ABC) 5) lower extremity isometric strength testing (biodex), 6) a whole body DXA and CT scan of the abdomen, hips and大腿确定下肢和核心肌肉组成。我们还计划在干预措施完成后6个月关注所有参与者，以检查小组之间计划停止后跌倒率的差异。影响：这项研究直接受益于退伍军人，因为它可能导致新的有效的干预措施，从而减少老年退伍军人的跌倒风险，与伤害有关的住院和死亡。 MMBI也很容易出口到社区，并且以最少的资源可以在其他VAS作为护理标准的一部分中广泛实施，类似于Move！。该奖项的结果将用于为更大的随机临床试验提供动力，该试验将研究两种干预措施的有效性，以降低跌倒率和跌倒年龄高的老兵的风险。