A balance retraining program reduces injurious falls and improves physical function in older women at risk of falling [commentary]

摘要

Summary of: El-Khoury F, Cassou B, Latouche A, Aegerter P, Charles M-A, Dargent-Molina P. Effectiveness of two year balance training programme on prevention of fall induced injuries in at risk women aged 75-85 living in community: Osse?bo randomised controlled trial. BMJ. 2015;351:h3830. Question: Does progressive balance training reduce injurious falls and improve physical function, fear of falling or quality of life in older women at risk of falling? Design: Randomised, controlled trial with concealed allocation, intention-to-treat analysis, and blinded assessment. Setting: Twenty community sites (usually senior citizens clubs) throughout France. Participants: Women aged 75 to 85 years, living in their own homes, who took 7 to 12.5 seconds to walk 6 metres, or were unable to take four consecutive tandem (heel to toe) steps. Exclusion criteria were: inability to stand with the feet together for 10 seconds, and major neuromuscular, skeletal or cardiovascular comorbidities. Rando- misation of 706 participants allocated 352 to the exercise group and 354 to a control group. Interventions: Both groups received brochures (covering advice on physical activity, diet, vitamin D supplementation, home hazards and managing drugs) and news- letters (discussing major fall risk factors and prevention). Only the intervention group participated in free, supervised sessions of balance, co-ordination, reaction time and strengthening exercises in small groups supplemented by individually prescribed home exercises. Group sessions of 1 hour were offered once a week for about 2 years. In addition to the exercises targeting factors that increase fall risk (including balance, reaction time and muscle1836-9553/ 2015 Australian Physiotherapy Association. Published by Elsevier B creativecommons.org/licenses/by-nc-nd/4.0/).strength), the program also raised awareness of ways to reduce fall risk through behavioural changes. Outcome measures: The primary outcome was the rate of injurious falls. Secondary outcome measures were the rate of all falls, physical functional capacity (Timed Up and Go test, time to walk 6 metres, time for five chair stands, single-leg stance time), fear of falling, physical activity level and quality of life. Results: A total of 600 participants completed the study. Over the 2-year intervention period, the injurious fall rate was 19% lower in the intervention group than in the control group (hazard ratio 0.81, 95% CI 0.67 to 0.99). The estimated effect of the intervention for all falls was weaker (hazard ratio 0.88, 95% CI 0.77 to 1.00). At 2 years, women in the intervention group performed significantly better on all physical tests and had significantly better perception of their overall physical function than women in the control group. The groups did not significantly differ on the remaining secondary outcomes. Conclusion: A program of progressive balance retraining, educa- tion and behaviour change reduced injurious falls, and improved measured and perceived physical function in women aged 75 to 85 at risk of falling. Provenance: Invited. Not peer-reviewed. Mark Elkins Editor, Journal of Physiotherapy http://dx.doi.org/10.1016/j.jphys.2015.09.002.