Surface Perturbation Training to Prevent Falls in Older Adults: A Highly Pragmatic, Randomized Controlled Trial

作者：Jon D. Lurie, Alexandra B. Zagaria, Lisa Ellis, Dawna Pidgeon, Kathleen M Gill-Body, Christina Burke, Kurt W. Armbrust, Sharil Cass, Kevin F. Spratt, Christine M. McDonough · 发表于：Physical Therapy · 年份：2020 · DOI：10.1093/ptj/pzaa023 · 被引用次数：76 · 研究领域：Balance, Gait, and Falls Prevention、Cardiovascular and exercise physiology、Cerebral Palsy and Movement Disorders

BACKGROUND: Falls are the leading cause of injuries among older adults, and trips and slips are major contributors to falls. OBJECTIVE: The authors sought to 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. 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 65+ years of age 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.A total of 211/253 (83%) 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 a significantly reduced chance of fall-related injury (5.7% versus 13.3%; relative risk 0.43) but no significant reduction in the risk of any fall (28% versus 37%, relative risk 0.78) compared with usual treatment. Time to first injurious fall showed reduc...