Evidence-based Exercise Programme to Reduce Falls in an Elderly Population
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Physiotherapy November 2000/vol 86/no 11 594 Effect of a Hinged Ankle Foot Orthosis on Hemiplegic Gait S F Tyson Brunel University H Thornton Northwick Park Hospital Trust Objective To assess the effect of a hinged ankle foot orthosis (AFO) on functional mobility and gait impairments in people with a severe hemiplegia undergoing rehabilitation, and to investigate the patients’ views of the hinged AFO. Design With/without group comparison, and face-to-face questionnaire. Analysis Paired t-tests, Wilcoxon’s signed rank test and descriptive statistics. Subjects and setting Twenty-five subjects over 18 years, with hemiplegia following CVA undergoing rehabilitation in a regional rehabilitation unit. Outcome measures Functional ambulation categories as a measure of disability. Paper walkways to measure gait impairments – stride length, step length, symmetry, cadence and velocity. Face-to-face questionnaire to determine the users’ opinion of the hinged AFO. Results Comparison of gait with and without the hinged AFO showed significant improvement in functional mobility (p = 0.000) and in some gait impairments; stride length of the weak (p < 0.005, 95% CI – 8.1, --1.6) and sound legs (p < 0.014, 95% CI –8, --1), velocity (p = 0.00, 95% CI –0.03) and cadence (P , 0.002. 95% CI 15.1, --3.8. No effect was found for step length in the weak or sound leg or symmetry. The subjects’ response was positive, 24 (96%) said they walked better with the AFO and found it comfortable. 23 (92%) were unbothered by the appearance and 16 (64%) could doff and don it. Conclusion The hinged AFO improved objective measures of gait impairments and disability and patients were very positive about it. Evidence-based Exercise Programme to Reduce Falls in an Elderly Population J C Adams, S L Mitchell Lightburn Hospital, Glasgow Introduction There is mounting evidence to suggest that physical exercise reduces the risk of falling in older people. The purpose of this service development project was to investigate if a more structured measurable format of physiotherapy input would help to reduce the incidence of falls in an elderly community-dwelling population. Methods A six-week evidence-based programme was initiated targeting fallers. Outcome measures used were leg extensor power (LEP), elderly mobility scale (EMS), functional reach (FR), one repetition maximum (1RM) and Tinetti balance assessment scale. Measurements were taken at weeks 1 and 6. Home exercises, advice and telephone follow-up were continued for three months after the programme finished. Results Using paired t-test analysis there were significant improvements for all measures used. Mean change of EMS was 2.9, SD 2.7, P = 0.000; FR mean change of 4.1 cm, SD 8.2, P = 0.002; LEP mean change of 8.9 watts, SD 12.4, P = 0.000; 1RM mean change of 4.6 kg, SD 0.9, P = 0.000; and Tinetti mean change of 3.7, SD 09, P = 0.002. A retrospective comparison of earlier physiotherapy input to a similar population showed only changes of 2.1, SD 2.6 for the EMS and 1.3, SD 1.3 for the FR. In terms of falls at the end of the three-month follow-up, 63% of the group had had no further falls. Discussion Our data suggest that there are greater improve- ments in both the EMS and FR when a structured exercise programme is implemented, when compared to our earlier data. Conclusion The development of an integrated pathway and falls clinic to be established, followed by a randomised controlled trial for a definitive analysis.
Transcript of Evidence-based Exercise Programme to Reduce Falls in an Elderly Population
Physiotherapy November 2000/vol 86/no 11
594
Effect of a Hinged Ankle FootOrthosis on Hemiplegic Gait
S F TysonBrunel University
H ThorntonNorthwick Park Hospital TrustObjective To assess the effect of a hinged ankle foot orthosis(AFO) on functional mobility and gait impairments in peoplewith a severe hemiplegia undergoing rehabilitation, and toinvestigate the patients’ views of the hinged AFO.
Design With/without group comparison, and face-to-facequestionnaire.
Analysis Paired t-tests, Wilcoxon’s signed rank test anddescriptive statistics.
Subjects and setting Twenty-five subjects over 18 years, withhemiplegia following CVA undergoing rehabilitation in aregional rehabilitation unit.
Outcome measures Functional ambulation categories as ameasure of disability. Paper walkways to measure gaitimpairments – stride length, step length, symmetry, cadenceand velocity. Face-to-face questionnaire to determine the users’opinion of the hinged AFO.
Results Comparison of gait with and without the hinged AFOshowed significant improvement in functional mobility (p =0.000) and in some gait impairments; stride length of the weak(p < 0.005, 95% CI – 8.1, --1.6) and sound legs (p < 0.014, 95%CI –8, --1), velocity (p = 0.00, 95% CI –0.03) and cadence (P ,0.002. 95% CI 15.1, --3.8. No effect was found for step length inthe weak or sound leg or symmetry. The subjects’ response waspositive, 24 (96%) said they walked better with the AFO andfound it comfortable. 23 (92%) were unbothered by theappearance and 16 (64%) could doff and don it.
Conclusion The hinged AFO improved objective measures ofgait impairments and disability and patients were very positiveabout it.
Evidence-based ExerciseProgramme to Reduce Falls in anElderly Population
J C Adams, S L MitchellLightburn Hospital, GlasgowIntroduction There is mounting evidence to suggest thatphysical exercise reduces the risk of falling in older people. Thepurpose of this service development project was to investigate ifa more structured measurable format of physiotherapy inputwould help to reduce the incidence of falls in an elderlycommunity-dwelling population.
Methods A six-week evidence-based programme was initiatedtargeting fallers. Outcome measures used were leg extensorpower (LEP), elderly mobility scale (EMS), functional reach(FR), one repetition maximum (1RM) and Tinetti balanceassessment scale. Measurements were taken at weeks 1 and 6.Home exercises, advice and telephone follow-up werecontinued for three months after the programme finished.
Results Using paired t-test analysis there were significantimprovements for all measures used. Mean change of EMS was2.9, SD 2.7, P = 0.000; FR mean change of 4.1 cm, SD 8.2, P =0.002; LEP mean change of 8.9 watts, SD 12.4, P = 0.000; 1RMmean change of 4.6 kg, SD 0.9, P = 0.000; and Tinetti meanchange of 3.7, SD 09, P = 0.002. A retrospective comparison ofearlier physiotherapy input to a similar population showed onlychanges of 2.1, SD 2.6 for the EMS and 1.3, SD 1.3 for the FR. Interms of falls at the end of the three-month follow-up, 63% ofthe group had had no further falls.
Discussion Our data suggest that there are greater improve-ments in both the EMS and FR when a structured exerciseprogramme is implemented, when compared to our earlierdata.
Conclusion The development of an integrated pathway and fallsclinic to be established, followed by a randomised controlledtrial for a definitive analysis.
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