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Reduction of falls in older people by improving balance with vestibular rehabilitation (ReFOVeRe study): design and methods

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Abstract

Main objective

Evaluate the effectiveness of vestibular rehabilitation (VR) to improve the balance in older people, assessed immediately afterwards.

Secondary objectives

(a) To verify the maintenance of improvement of the balance achieved in the medium term (6–12 months). (b) To consider whether this improvement results in a reduction in the number of falls. (c) To compare among themselves the effectiveness of three different methods of VR in improving balance and to explore whether there are differences to achieve a reduction in the number of falls.

Methodology

Design: Experimental study, single-centre, open, randomised (balanced blocks of patients) in four branches in parallel, in 220 elderly patients (over 64 years) with high risk of falls and a follow-up period of 12 months. Setting: Department of Otolaryngology of the University Hospital of Santiago. Participants: People over 64 years, fulfilling one of the following requirements: (a) At least one fall in the last year. (b) Take at least 16 s or require some support in perform the test “timed up and go”. (c) A percentage of average balance in the sensory organisation test (SOT) in the dynamic posturography (CDP) <68 %. (d) At least one fall in any of the conditions in the SOT of CDP. Intervention: Three different protocols of VR. Main outcome measure: The percentage of average balance in the SOT in CDP. Secondary measures: time and supports in the test of “timed up and go”, scores of the dynamic posturography and SwayStar system, and rate of falls.

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References

  1. Padilla Ruiz F, Bueno Cavanillas A, Peinado Alonso C et al (1998) Frequency, characteristics and consequences of falls in a cohort of institutionalized elderly patients. Aten Primaria 21(7):437–442 (445)

    CAS  PubMed  Google Scholar 

  2. Bueno-Cavanillas A, Padilla-Ruiz F, Jiménez-Moleón JJ et al (2000) Risk factors in falls among the elderly according to extrinsic and intrinsic precipitating causes. Eur J Epidemiol 16(9):849–859

    Article  CAS  PubMed  Google Scholar 

  3. Gillespie LD, Robertson MC, Gillespie WJ et al (2012) Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev 9:CD007146. doi:10.1002/14651858.CD007146.pub3

    PubMed  Google Scholar 

  4. Ungar A, Rafanelli M, Iacomelli I et al (2013) Fall prevention in the elderly. Clin Cases Miner Bone Metab 10(2):91–95

    PubMed Central  PubMed  Google Scholar 

  5. Boelens C, Hekman EE, Verkerke GJ (2013) Risk factors for falls of older citizens. Technol Health Care 21(5):521–533. doi:10.3233/THC-130748

    CAS  PubMed  Google Scholar 

  6. Murphy SL, Williams CS, Gill TM (2002) Characteristics associated with fear of falling and activity restriction in community-living older persons. J Am Geriatr Soc 50(3):516–520

    Article  PubMed Central  PubMed  Google Scholar 

  7. Rubenstein LZ (2006) Falls in older people: epidemiology, risk factors and strategies for prevention. Age Ageing 35(Suppl 2):ii37–ii41

    PubMed  Google Scholar 

  8. Pasquetti P, Apicella L, Mangone G (2014) Pathogenesis and treatment of falls in elderly. Clin Cases Miner Bone Metab 11(3):222–225

    PubMed Central  PubMed  Google Scholar 

  9. Cano-de la Cuerda R, Macías-Jiménez AI, Cuadrado-Pérez ML et al (2004) Posture and gait disorders and the incidence of falling in patients with Parkinson. Rev Neurol 38(12):1128–1132

    CAS  PubMed  Google Scholar 

  10. Rey-Martínez JA, Boleas-Aguirre MS, Pérez N (2005) Postural analysis of the test “timed-up-and-go” in patients with vertigo. Acta Otorrinolaringol Esp 56(3):107–111

    Article  PubMed  Google Scholar 

  11. Berg KO, Maki BE, Williams JI et al (1992) Clinical and laboratory measures of postural balance in an elderly population. Arch Phys Med Rehabil 73(11):1073–1080

    CAS  PubMed  Google Scholar 

  12. Faraldo-García A, Santos-Pérez S, Crujeiras R et al (2012) Comparative study of computerized dynamic posturography and the SwayStar system in healthy subjects. Acta Otolaryngol 132(3):271–276. doi:10.3109/00016489.2011.637177

    Article  PubMed  Google Scholar 

  13. Faraldo-García A, Santos-Pérez S, Labella-Caballero T et al (2013) Age-adjusted normality patterns for posturography by Sway Star system. Eur Arch Otorhinolaryngol 270(12):3169–3175. doi:10.1007/s00405-013-2508-y

    Article  PubMed  Google Scholar 

  14. Day L, Fildes B, Gordon I et al (2002) Randomised factorial trial of falls prevention among older people living in their own homes. BMJ 325(7356):128

    Article  PubMed Central  PubMed  Google Scholar 

  15. Frick KD, Kung JY, Parrish JM et al (2010) Evaluating the cost-effectiveness of fall prevention programs that reduce fall-related hip fractures in older adults. J Am Geriatr Soc 58(1):136–141. doi:10.1111/j.1532-5415.2009.02575.x

    Article  PubMed  Google Scholar 

  16. Black FO, Angel CR, Pesznecker SC et al (2000) Outcome analysis of individualized vestibular rehabilitation protocols. Am J Otol 21(4):543–551

    CAS  PubMed  Google Scholar 

  17. Cohen HS, Kimball KT (2003) Increased independence and decreased vertigo after vestibular rehabilitation. Otolaryngol Head Neck Surg 128(1):60–70

    Article  PubMed  Google Scholar 

  18. Rossi-Izquierdo M, Santos-Pérez S, Soto-Varela A (2011) What is the most effective vestibular rehabilitation technique in patients with unilateral peripheral vestibular disorders? Eur Arch Otorhinolaryngol 268(11):1569–1574. doi:10.1007/s00405-011-1532-z

    Article  PubMed  Google Scholar 

  19. Rossi-Izquierdo M, Soto-Varela A, Santos-Pérez S et al (2009) Vestibular rehabilitation with computerised dynamic posturography in patients with Parkinson’s disease: improving balance impairment. Disabil Rehabil 31(23):1907–1916. doi:10.1080/09638280902846384

    Article  PubMed  Google Scholar 

  20. Rossi-Izquierdo M, Ernst A, Soto-Varela A et al (2013) Vibrotactile neurofeedback balance training in patients with Parkinson’s disease: reducing the number of falls. Gait Posture 37(2):195–200. doi:10.1016/j.gaitpost.2012.07.002

    Article  PubMed  Google Scholar 

  21. Kao C-L, Chen L-K, Chern C-M et al (2010) Rehabilitation outcome in home-based versus supervised exercise programs for chronically dizzy patients. Arch Gerontol Geriatr 51(3):264–267. doi:10.1016/j.archger.2009.11.014

    Article  PubMed  Google Scholar 

  22. Kristinsdottir EK, Baldursdottir B (2014) Effect of multi-sensory balance training for unsteady elderly people: pilot study of the “Reykjavik model”. Disabil Rehabil 36(14):1211–1218. doi:10.3109/09638288.2013.835452

    Article  PubMed  Google Scholar 

  23. Pérez N, Garmendia I, Martín E et al (2000) Cultural adaptation of 2 questionnaires for health measurement in patients with vertigo. Acta Otorrinolaringol Esp 51(7):572–580

    PubMed  Google Scholar 

  24. Kempen GI, Yardley L, van Haastregt JC et al (2008) The Short FES-I: a shortened version of the falls efficacy scale-international to assess fear of falling. Age Ageing 37(1):45–50

    Article  PubMed  Google Scholar 

  25. Rossi M, Soto A, Santos S et al (2009) A prospective study of alterations in balance among patients with Parkinson’s Disease. Protocol of the postural evaluation. Eur Neurol 61(3):171–176. doi:10.1159/000189270

    Article  CAS  PubMed  Google Scholar 

  26. R Development Core Team (2009) R: A Language and Environment for Statistical Computing. R Foundation for Statistical Computing, Vienna, Austria. ISBN 3-900051-07-0, Available from http://www.R-project.org

  27. Wagner EH, LaCroix AZ, Grothaus L et al (1994) Preventing disability and falls in older adults: a population-based randomized trial. Am J Public Health 84(11):1800–1806

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  28. Tinetti ME, Baker DI, McAvay G et al (1994) A multifactorial intervention to reduce the risk of falling among elderly people living in the community. N Engl J Med 331(13):821–827

    Article  CAS  PubMed  Google Scholar 

  29. Close J, Ellis M, Hooper R et al (1999) Prevention of falls in the elderly trial (PROFET): a randomised controlled trial. Lancet 353(9147):93–97

    Article  CAS  PubMed  Google Scholar 

  30. Campbell AJ, Robertson MC, Gardner MM et al (1997) Randomised controlled trial of a general practice programme of home based exercise to prevent falls in elderly women. BMJ 315(7115):1065–1069

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  31. Rizzo JA, Baker DI, McAvay G et al (1996) The cost-effectiveness of a multifactorial targeted prevention program for falls among community elderly persons. Med Care 34(9):954–969

    Article  CAS  PubMed  Google Scholar 

  32. Macias JD, Massingale S, Gerkin RD (2005) Efficacy of vestibular rehabilitation therapy in reducing falls. Otolaryngol Head Neck Surg 133(3):323–325

    Article  PubMed  Google Scholar 

  33. Hansson EE, Månsson N-O, Ringsberg KA et al (2008) Falls among dizzy patients in primary healthcare: an intervention study with control group. Int J Rehabil Res 31(1):51–57. doi:10.1097/MRR.0b013e3282f28e2c

    Article  PubMed  Google Scholar 

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Acknowledgments

This study was funded by a FIS PI11-01328 Research Project from ISCIII (Instituto de Salud Carlos III), Spain.

Conflict of interest

None.

Human and Animal Rights

The experimental protocol was designed in accordance with the Declaration of Helsinki (1964) and was approved by the Independent Ethics Committee of Galicia (protocol 2010/139).

Informed consent

All study participants provided informed consent.

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Correspondence to Andrés Soto-Varela.

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Soto-Varela, A., Gayoso-Diz, P., Rossi-Izquierdo, M. et al. Reduction of falls in older people by improving balance with vestibular rehabilitation (ReFOVeRe study): design and methods. Aging Clin Exp Res 27, 841–848 (2015). https://doi.org/10.1007/s40520-015-0362-z

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