A Remotely Delivered Tai Ji Quan Intervention to Reduce Incidence of Falls in High Risk Community-Dwelling Older Adults

远程太极拳干预可降低高危社区老年人跌倒发生率

• 批准号: 10628517
• 负责人: FUZHONG LI
• 金额: $ 66.6万
• 依托单位: OREGON RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-04-01 至 2028-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10628517
• 关键词: Address; Adoption; Adult; American; Behavior; Binding; COVID-19 pandemic; Cessation of life; Clinical; Clinical Practice Guideline; Communication; Communities; Community Health Services; Community Healthcare; Country; Data; Dissemination and Implementation; Economic Burden; Effectiveness; Elderly; Equilibrium; Evaluation; Exercise; Fall prevention; Geography; Goals; Healthcare Systems; Home; Incidence; Injury; Intervention; Life; Mediator; Morbidity - disease rate; Participant; Performance; Persons; Physical Function; Physical Performance; Prevention strategy; Public Health; Randomized; Randomized, Controlled Trials; Research; Resources; Risk; Schedule; Social Environment; Tai Ji; Target Populations; Task Performances; Technology; Testing; Time; Training; Transportation; Treatment Efficacy; Videoconferencing; Walking; Work; aged; aging population; clinical care; clinically relevant; cognitive function; cognitive performance; community living; community setting; comparative effectiveness; cost; cost effective; effective intervention; effectiveness evaluation; evidence base; executive function; exercise intervention; exercise program; fall risk; falls; flexibility; follow-up; high risk; human old age (65+); implementation barriers; implementation research; implementation strategy; improved; innovation; instructor; intervention program; mode of exercise; mortality; multi-component intervention; multimodality; novel; novel strategies; post intervention; preventive intervention; primary outcome; programs; remote delivery; response; secondary outcome; social; social media; success; videoconference; virtual

PROJECT SUMMARY Among persons aged 65 and older, falls are the leading cause of morbidity and mortality and impose significant social and economic burdens on community health services and healthcare systems. Although evidence shows that group-based, in-person exercise interventions improve strength, balance, and dual-task abilities and consequently directly and indirectly reduce the incidence of falls effectively in older adults, such approaches are problematic in practice because they can be costly, have limited reach, can be logistically difficult to implement, and are often not scalable or generalizable. Therefore, timely identification of alternative implementation strategies that can overcome these limitations to expand delivery of fall prevention interventions to the aging population at greatest risk for falls is of high public health importance and clinical relevance. In response to implementation challenges and community care needs in fall prevention, the primary objective of this project is to evaluate a home-based virtual fall prevention exercise intervention that eliminates common barriers to older adults participating in group-based in-person intervention programs. The proposed intervention is founded on the evidence-based Tai Ji Quan: Moving for Better Balance (TJQMBB) program, which has been specifically reconfigured into a virtual format (V-TJQMBB) delivered through real-time videoconferencing at home. Supported by promising data on feasibility, acceptability, and demand, we propose a 6-month randomized controlled virtual trial to determine the comparative effectiveness of the V-TJQMBB intervention, relative to a virtual multimodal exercise intervention, in lowering the incidence of falls (primary outcome) and improving dual-task performance and physical and cognitive functioning (secondary outcomes) among at-risk older adults living across the U.S. We will also (a) evaluate whether the benefits of the V- TJQMBB intervention on falls can be sustained following formal training and (b) examine the mechanisms (mediators of improved dual-task cost and executive function) through which the V-TJQMBB intervention reduces fall rates. In addition, we will explore implementation potential by examining practical issues, including intervention fidelity, compliance, acceptability, and perceived burdens and benefits of online exercise. The proposed project is novel because it represents a paradigm shift in program delivery from in-person to virtual and is significant because the clinical value of many home-based fall prevention interventions remains inconclusive. If successful, the proposed study will extend the reach and impact of the evidence-based TJQMBB intervention beyond locally situated community-facility settings to home settings where access is not weather limited, transportation dependent, or geographically bounded. Thus, this proposal advances dissemination and implementation research by providing a scalable, flexible, and fiscally responsible means for sustainable fall prevention that potentially could be implemented across the country.

项目摘要 在65岁及以上的人中，跌倒是发病率和死亡率的主要原因，并施加 社区卫生服务和医疗系统的巨大社会和经济负担。虽然 有证据表明，基于小组的，面对面的运动干预措施可改善强度，平衡和双重任务 能力，因此直接和间接地降低了老年人有效跌倒的发生率， 实际上，方法是有问题的，因为它们的成本可能很高，覆盖范围有限，可以从逻辑上处于逻辑上 难以实施，通常无法扩展或可推广。因此，及时确定替代方案 实施策略可以克服这些限制以扩大预防秋季预防的交付 对衰老风险最大的老龄化人口的干预是公共健康的很高重要性和临床 关联。为了应对预防秋季的实施挑战和社区护理需求，主要 该项目的目的是评估家庭基于家庭的虚拟秋季预防运动干预措施，以消除 参加基于团体的面对面干预计划的老年人的常见障碍。提议 干预措施建立在基于证据的太极拳：提高平衡（TJQMBB）计划的基础上， 已专门重新配置通过实时交付的虚拟格式（V-TJQMBB） 在家视频会议。在有前途的可行性，可接受性和需求的数据支持下，我们建议 一个为期6个月的随机对照虚拟试验，以确定V-TJQMBB的比较有效性 相对于虚拟多模式运动干预的干预措施降低跌倒的发生率（主要 结果）并提高双重任务表现以及身体和认知功能（次要结果） 在居住在美国各地的高危老年人中，我们还将（a）评估V-的益处是否 在正式训练后可以维持对跌倒的TJQMBB干预，并且（b）检查机制 （提高双任务成本和执行功能的调解人）V-TJQMBB干预 降低跌倒率。此外，我们将通过检查实用问题，包括 干预保真度，合规性，可接受性以及在线锻炼的负担和益处。这 拟议的项目是新颖的，因为它代表了从面对面到虚拟的程序交付的范式转变 而且很重要，因为许多基于家庭的秋季预防干预措施的临床价值仍然存在 尚无定论。如果成功，拟议的研究将扩大基于证据的覆盖范围和影响 TJQMBB干预以外的本地社区式设置超出了无法访问的家庭环境 天气有限，依赖运输或地理上的限制。因此，该提议的进步 通过提供可扩展，灵活和承担责任的手段来传播和实施研究 可以在全国实施的可持续秋季预防。