A randomized controlled trial to investigate the effects of water-based exercise to improve falls risk and physical function in older adults with lower-extremity osteoarthritis

摘要

Objective: To investigate the efficacy of a water-based exercise program specifically targeting balance to reduce falls risk and improve measures of balance and physical function in older adults with osteoarthritis (OA). Design: Randomized controlled trial. Setting: Community. Participants: Persons (N=39; mean±SD age, 74±6y; 26 women) with mild to moderate OA and at risk for falling met study criteria, were measured at baseline, and were randomly assigned to the intervention (n=23) and control groups (n=16). Interventions: Water-based program (12wk, twice weekly; intervention group) or a time-matched computer training program (control group). Main Outcome Measure: The primary outcome was the short-form Physiological Profile Assessment (PPA). Secondary outcomes included the Step Test, Timed Up and Go Test, Western Ontario and McMaster Universities OA Index (Likert 3.0 version), Arthritis Impact Measurement Scales 2, and Activity-specific Balance Confidence Scale. Results: No statistically significant between-group differences were found for any outcome measured (n=35; 4 lost to follow-up). Within-group analysis indicated that Step Test results improved significantly in both groups (mean change: control group, left leg, 2.07; 95% confidence interval, 3.19-.95; P=.002; intervention group, 2.14; 95% confidence interval, 3.20-1.08; P=.000). Two PPA item scores (reaction time, contrast sensitivity) improved significantly (86.83; 95% confidence interval, 9.86-163.79; P=.03; 1.43; 95% confidence interval, 2.35-.50; P=.005, respectively) in the control group, resulting in a lower falls risk score. Conclusions: Water-based exercise did not reduce falls risk in our sample compared with attending a computer skills training class. Our study is, to our knowledge, the first to compare water-based exercise in this population with a control group that attended a time-dose-equivalent seated community-based activity. Whether gaining computer skills and going out into the community twice weekly is adequate stimulus to reduce falls risk in people with OA requires further investigation.