Optimizing a technology-based body and mind intervention to prevent falls and reduce health disparities in low-income populations

优化基于技术的身心干预措施，以预防跌倒并减少低收入人群的健康差距

• 批准号: 10570625
• 负责人: Ladda Thiamwong
• 金额: $ 60.28万
• 依托单位: UNIVERSITY OF CENTRAL FLORIDA
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-26 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10570625
• 关键词: Accelerometer; Address; Adoption; Aging; Balance training; Categories; Cognitive; Community Health; Control Groups; Data; Education; Effectiveness; Elderly; Enrollment; Equilibrium; Exercise; Fall prevention; Feedback; Goals; Home; Hospitalization; Independent Living; Injury; Intention; Intervention; Interview; Low Income Population; Low income; Mind; Motivation; Outcome Measure; Participant; Perception; Performance; Physical activity; Physiological; Pilot Projects; Prevention program; Psyche structure; Public Health; Publishing; Randomized Controlled Trials; Reduce health disparities; Research; Resource-limited setting; Resources; Risk Reduction; Sampling; Self Perception; Single-Blind Study; Structure; System; Technology; Time; acceptability and feasibility; arm; barrier to care; base; body-mind; community living; cost; disability; exercise program; experience; fall risk; falls; fear of falling; follow-up; health disparity; health organization; healthy aging; home test; implementation cost; improved; innovative technologies; intervention effect; intervention program; moderate-to-vigorous physical activity; novel; peer; personalized approach; portability; prevent; preventive intervention; programs; racial diversity; screening; sedentary; strength training

PROJECT SUMMARY/ABSTRACT Falls and fear of falling (FOF) are the leading cause of injury, disability, and hospitalization in racially diverse low-income older adults (LOA). Lack of motivation, limited resources, low education, and inconvenience remain barriers to participate in fall prevention programs. More than half of older adults have maladaptive fall risk appraisal (FRA), a condition in which there is a discrepancy between perceived fall risk (levels of FOF) and physiological fall risk (balance performance) which may impede physical activity (PA). To help address maladaptive FRA; we developed a fall risk appraisal matrix, a graphical grid categorizing levels of FOF (Mind) and levels of balance (Body) into four quadrants: 1) rational FRA (low FOF and normal balance), 2) incongruent FRA (low FOF despite poor balance), 3) irrational FRA (high FOF despite normal balance), and 4) congruent FRA (high FOF and poor balance). We developed a novel, 8-week technology-based, individualized, in-home Physio-fEedback Exercise pRogram (PEER), which includes a) physio-feedback using a real-time portable innovative technology—the BTrackS Balance System: BBS; b) cognitive reframing based on a novel fall risk appraisal matrix; and c) peer-led exercise by focusing on balance and strength training. Our R03 findings support the feasibility and acceptability of using BBS technology on screening LOA with maladaptive FRA, highlight the importance of reducing sedentary time and increasing moderate to vigorous physical activity (MVPA) time to help shift from maladaptive to adaptive FRA. Critically, we found that none of our LOA had ever had their fall risk and FOF assessed before our study and their data reveal a strong relationship between FOF and negative self-perceptions of aging. In our published pilot study, we found that the technology-based PEER intervention had significant improvements in dynamic balance, reduced fall risk, and facilitated maladaptive to adaptive shifting; however, our limited sample of LOA (40% of total) prevents strong conclusions about effectiveness in this group. We use a clustered randomized controlled trial, and the intervention will be offered at the low-income independent living communities/units in Orlando, FL through our partnership with community-based & public health organizations. We will collect data at baseline (T1) and measure outcomes after program completion (T2), follow up at 3-months (T3), and 6-months (T4). Low-income older adults (n=340) will be enrolled if they are ≥60 years old, cognitive intact, and able to stand without assistance. We aim to 1) examine the effects of the technology-based PEER intervention on fall risk, dynamic balance, and accelerometer-based physical activity; 2) examine the effects of the intervention on fall risk appraisal shifting and negative self-perceptions of aging; and 3) explore participants’ experiences with the intervention and potential barriers to access and adoption of technology-based PEER intervention. This study addresses the public health problem with the optimization of a technology - driven tailored approach that can operate in low-resource environments with unlimited users to prevent falls and reduce health disparities.

项目摘要/摘要 跌倒和恐惧（FOF）是种族潜水员受伤，残疾和住院的主要原因 低收入老年人（LOA）。缺乏动力，资源有限，教育低下和不便 参加秋季预防计划的障碍。超过一半的老年人患有适应不良的跌倒风险 评估（FRA），在这种情况下，感知到的跌倒风险（FOF水平）和 物理跌倒风险（平衡表现）可能会阻碍体育活动（PA）。帮助解决 适应不良的FRA；我们开发了秋季风险评估矩阵，这是一个将FOF级别分类的图形网格（思维） 平衡水平（身体）分为四个象限：1）合理的FRA（低FOF和正常平衡），2） 不一致的FRA（低FOF目的地余额），3）非理性FR​​A（高FOF目的地正常平衡）和4） 一致的FRA（高FOF和差的平衡）。我们开发了一个基于8周的小说，个性化的，个性化的， 家庭内物理反馈锻炼计划（PEER），其中包括a）使用实时的物理反馈 便携式创新技术 - Btracks平衡系统：BBS； b）基于小说的认知重塑 跌倒风险评估矩阵； c）专注于平衡和力量训练，以同伴为主导的练习。我们的R03 调查结果支持使用BBS技术在筛查LOA的情况下的可行性和可接受性 FRA，强调减少久坐时间并增加现代为剧烈的体育锻炼的重要性 （MVPA）有助于从适应不良转移到适应性FRA的时间。至关重要的是，我们发现我们的LOA都没有 在我们的研究之前，对他们的跌倒风险和FOF进行了评估，他们的数据显示 衰老的FOF和负面自我感知。在我们已发表的试点研究中，我们发现基于技术的 同伴干预在动态平衡，降低风险降低并促进方面取得了显着改善 适应不良的自适应转移；但是，我们有限的LOA样本（总计40％）可防止强大 关于该组有效性的结论。我们使用聚类的随机对照试验， 干预将在我们的佛罗里达州奥兰多的低收入独立生活社区/单位通过我们的 与基于社区和公共卫生组织的合作伙伴关系。我们将在基线（T1）和 测量程序完成后的结果（T2），在3个月（T3）和6个月（T4）下进行跟进。低收入 如果老年人（n = 340），如果他们年龄≥60岁，认知能力，并且能够站立 协助。我们的目标是1）检查基于技术的同伴干预对跌倒风险，动态的影响 平衡和基于加速度计的体育活动； 2）检查干预对跌倒风险的影响 评估转移和衰老的负面自我感知； 3）探索参与者的经验 干预和潜在的基于技术的同行干预的障碍。这项研究 通过技术的优化解决了公共卫生问题 - 启动量身定制的方法 在与无限用户的低资源环境中运行，以防止下降并减少健康分布。