Effectiveness and Generalisability of Fall-resisting Skills Training in Older Adults: Protocol for a Randomised Controlled Trial
Abstract
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.
Comments
great protocol
Congratulations to the authors on this brilliant and innovative protocol! Shifting the focus toward task-specific training like perturbation-based balance and gait adaptability is highly promising. I am incredibly interested in this methodology and would love to look into implementing this protocol within my own practice/setting once the results are available. I look forward to following your progress and findings
A question about the choice of placebo-control intervention
This is very interesting and novel work and really well presented - the use of images to describe the training groups really brought the poster to life. I wonder if the authors could clarify the rationale for classifying dual-task walking as a placebo-control condition. While the authors describe it as non-task-specific, dual-task walking has an established evidence base for improving gait stability in older adults and shares some cognitive-motor demands with the active intervention arms described in the protocol. It would be interesting to know what criteria was used to distinguish this condition from an active comparator, and whether alternative placebo-control conditions were considered (e.g., seated upper-limb exercise, or a genuine attention-only task). If dual-task walking does confer some benefit to the primary outcomes, this has implications for the interpretation of between-group effect sizes.
Placebo-control intervention
Thank you for your question. We wanted to keep the placebo-control as similar to the intervention groups, so that we could eliminate differences caused by other, non task-specific factors such as visual or cognitive stimulation. In addition, we wanted to match the time the participants walk on the treadmill to control for this factor as well.