K. Hauer et al., Exercise training for rehabilitation and secondary prevention of falls in geriatric patients with a history of injurious falls, J AM GER SO, 49(1), 2001, pp. 10-20
Citations number
73
Categorie Soggetti
Public Health & Health Care Science","General & Internal Medicine
OBJECTIVE: To determine the safety and efficacy of an exercise protocol des
igned to improve strength, mobility, and balance and to reduce subsequent f
alls in geriatric patients with a history of injurious falls.
DESIGN: A randomized controlled 3-month intervention trial, with an additio
nal 3-month follow-up.
SETTING: Out-patient geriatric rehabilitation unit.
PARTICIPANTS: Fifty-seven female geriatric patients (mean age 82 +/- 4.8 ye
ars; range 75-90) admitted to acute care or inpatient rehabilitation with a
history of recurrent or injurious falls including patients with acute fall
-related fracture.
INTERVENTION: Ambulatory training of strength, functional performance, and
balance 3 times per week for 3 months. Patients of the control group attend
ed a placebo group 3 times a week for 3 months. Both groups received an ide
ntical physiotherapeutic treatment 2 times a week, in which strengthening a
nd balance training were excluded.
MEASUREMENTS: Strength, functional ability, motor function, psychological p
arameters, and fall rates were assessed by standardized protocols at the be
ginning (T1) and the end (T2) of intervention. Patients were followed up fo
r 3 months after the intervention (T3).
RESULTS: No training-related medical problems occurred in the study group.
Forty-five patients (79%) completed all assessments after the intervention
and follow-up period. Adherence was excellent in both groups (intervention
85.4 +/- 27.8% vs control 84.2 +/- 29.3%). The patients in the intervention
group increased strength, functional motor performance, and balance signif
icantly. Fall-related behavioral and emotional restrictions were reduced si
gnificantly. Improvements persisted during the 3-month follow-up with only
moderate losses. For patients of the control group, no change in strength,
functional performance, or emotional status could he documented during inte
rvention and follow-up. Fall incidence was reduced nonsignificantly by 25%
in the intervention group compared with the control group (RR:0.753 CI:0.45
5-1.245).
CONCLUSIONS: Progressive resistance training and progressive functional tra
ining are safe and effective methods of increasing strength and functional
performance and reducing fall-related behavioral and emotional restrictions
during ambulant rehabilitation in frail, high-risk geriatric patients with
a history of injurious falls.