Abstract
Introduction
In older adults, the inability to rise independently after a fall increases the risk of long-lies and associated complications. Up to 65% of individuals attended by ambulance crews post-fall are assisted up without requiring further medical intervention. This study investigated the effectiveness of Floor-Rise Training (FRT) in improving floor-rise ability and reducing fear of falling in community-dwelling older adults.
Method
This pilot cluster-randomised controlled trial was conducted within five existing Otago exercise classes. Sixty-one participants aged ≥65 years were enrolled; classes were randomised to FRT (n=28) or control (n=33) in a 3:2 ratio. The FRT group completed five weekly 20-minute sessions using the backwards-chaining method. The control group viewed a demonstration video and joined a discussion, without physical practice. The primary outcome was the Falls Efficacy Scale - International (FES-I). Secondary outcomes included timed floor-rise from supine, sitting, and kneeling; perceived ability to manage a fall (PAMF); fear of falling and activity avoidance (via visual analogue scales); and ability to rise independently from each position.
Results
Forty-nine participants completed follow-up (FRT: n=22; Control: n=27). No significant group differences were found for FES-I, fear of falling, or activity avoidance. The FRT group showed significantly greater improvements in floor-rise time from supine (13.1s to 7.1s, p=0.001), sitting (8.0s to 4.6s, p=0.046), and kneeling (3.9s to 1.5s, p<0.001). PAMF scores improved in the FRT group (p=0.033). After the intervention, 100% of FRT participants could rise from supine, compared to 63% of controls.
Conclusions
A brief, class-based FRT intervention improved floor-rise ability and PAMF in older people already taking part in Otago classes. Incorporating FRT into fall prevention programmes may reduce long-lie risks. Larger, blinded trials are warranted, including people who have not undertaken Otago sessions previously.
Comments
Future plans
Hello. Thank you for presenting your work on this subject. How would you determine which people were at high risk of long lies, when should the intervention take place and who do you think should be undertaking the intervention? How would you measure the impact of this intervention on emergency service usage or on the length of time on the floor?
Identifying High-Risk Individuals and Evaluating Interventions
Hello, thank you for your comment.
Those who have already experienced a long lie are at high risk of recurrence, making them a possible group to target. The intervention should be initiated as soon as possible after the first event, since around half of long lies are followed by another within two weeks.
I believe that any medically stable older adult at high risk of a long lie, and who can follow simple instructions, could undertake the intervention. Delivery could be led by physiotherapists or suitably trained exercise professionals.
Impact could be measured by assessing floor-rise ability before and after the intervention, tracking the number of ambulance call outs resulting in picking up the person but without conveyance to hospital (i.e. lift assists) and recording time spent on the floor following a fall.
Thank you for your poster, I…
Thank you for your poster, I wonder what your thoughts are as to whether this intervention could be delivered without supervision or virtually?
Intervention without Supervision
Hi there,
Thank you for your comment. It’s a really interesting question.
I do think this training could be delivered without direct professional supervision or virtually, provided appropriate safeguards are in place. The main challenge lies in the ethical considerations. During my sessions, I had a lifting cushion available in case someone was unable to return to standing safely. When I have discussed potential self-management solutions with postural stability instructors and physiotherapists, opinions have been mixed. Some emphasise the risks of unsupervised training, while others see real potential if clear safety measures are in place. I believe older adults should be supported to make informed decisions about these risks, so they can weigh up the benefits of engaging in, or not engaging in, this type of training.
On/Off the floor
I personally have implemented on and off the floor training for my patients in balance classes. I do them collectively as a group and it is optional as no one is forced. We verbally talk through each step and I have noted that this increases the confidence of my clients. We also go out to the community and do fall prevention talks and demonstrate on/off the floor techniques. Would highly recommend as a fall prevention measure.
Including On/Off the Floor Training
Hi there,
Thank you for sharing this. I agree that practising on/off the floor can really help build confidence and reduce the risk of long lies after a fall. Despite the World Falls Guidelines recommending it, this skill isn’t routinely taught by physiotherapists, isn’t included in Otago, and can sometimes be left out of FaME classes. Your experience highlights how valuable it can be when it is actively incorporated.
Guide to FRT
Thank you for this poster, very interesting. Is there a specific method / guide you would recommend for floor rise training for suitable professionals to use?
Backwards-Chaining
Hi there,
Thank you for your comment.
We used the backwards-chaining method, which has been shown to have higher acceptability than the conventional approach. A helpful guide is available on NHS Inform: What to do if you fall (https://www.nhsinform.scot/healthy-living/preventing-falls/dealing-with-a-fall/what-to-do-if-you-fall/), which can be used both by patients and by suitable professionals. I’d be very happy to arrange a call if you would like more information.
FRT video
What an interesting study! Could you share what was in the FRT video that you showed - and how long it was - was it a full set of all the exercises that should be done if the participant had attended the group session?