Effectiveness and Generalisability of Fall-resisting Skills Training in Older Adults: Protocol for a Randomised Controlled Trial

Introduction

Falls are a major concern in our ageing society. General exercise interventions like strength and balance training show limited community-wide impact due to poor adherence and low dose. Task-specific interventions such as perturbation-based balance training and gait adaptability training have demonstrated great effectiveness, targeting distinct fall-resisting skills: proactive gait adaptability (PGA), gait robustness (GR), and reactive gait recovery (RGR). This study protocol investigates whether task-specific training of one of the three fall-resisting skills leads to improvements in the trained and untrained skills in older adults, compared to a placebo-control group, and how this is retained over six months. The design of this protocol was informed by our pilot study on design considerations for fall-resisting skill training trials. 

Methods

This single-blind randomised controlled trial will include 112 healthy, community-dwelling older adults (≥60 years), randomised into one of four groups. Three groups will each train one fall-resisting skill: PGA by avoiding projected obstacles, GR by walking with small perturbations, and RGR by walking with large perturbations. The placebo-controlled group will receive a general, non-task-specific balance training of weight shifting tasks and dual-task walking. Training will consist of four 30-minute sessions at the Computer Assisted Rehabilitation Environment (CAREN, Motek Medical, NL). Performance on each fall-resisting skill will be assessed at baseline, post-intervention, and six months follow-up, including the number of obstacles hit (PGA), the percentage increase in belt speed tolerated before deviation from steady-state gait stability (GR), and the number of recovery steps (RGR). Secondary outcomes include biomechanical measures, falls efficacy, daily life falls over 6 months using falls calendars, and training acceptability and feasibility via questionnaires, adherence, and adverse events. 

Discussion

The results of this RCT will provide deeper insight into the training, retention and generalisability of fall-resisting skills and help optimize interventions for more effective fall prevention.