A Novel Dual-Task Balance Challenge to Prevent Falls in Older Adults: A Randomized Pilot Study

Abstract

Background: A Matter of Balance (MOB) is a national community-based fall prevention program focusing on cognitive restructuring to manage concerns about falling, though does not include a balance-training component. A dual-task balance challenge (DTBC) comprising weight transfer using fixed and random ordering of ankle-reaching balance tasks was added to MOB, to determine if this would lead to reduced fall risk. The study aims were to assess acceptance, satisfaction, safety and adherence to the interventions, examine changes in fall risk, and monitor incident falls for 3-months post-intervention. Methods: A single-blind, two-group, randomized pilot study with community-dwelling older adults assigned to MOB (2-hours, twice/week for 4 weeks) with 15 minutes of social time or MOB plus DTBC (15 minutes of fixed and random ordering of ankle-reaching balance tasks). Acceptability and satisfaction obtained by self-report, safety and adherence monitored during class by study staff. Fall risk included objectively assessed balance and gait (LEGSysTM, BioSensics, LLC), and fear of falling (Falls Efficacy Scale International). Monthly fall calendars with phone follow-ups for incident falls. Results: At high fall risk older adults (n = 16, mean age = 74 ± 8 years), mainly retired (95%), women (88%), with > 13 years education (81%), completed the study (drop-outs, n = 1). Acceptability and satisfaction (mean score = 9.0 ± 1.3, 1 = least, 10 = most) were high, no safety issues, and very high adherence rates (> 94%), regardless of group assignment. The MOB group (n = 7) had no within group changes in fall risk post-intervention (p > 0.05). Conversely, the MOB plus DTBC group (n = 9) had significant improvements in balance (p < 0.05) and gait (p < 0.05) with less fear of falling (p = 0.04) post-intervention, when compared to baseline. Conclusions: Reducing fall risk factors and preventing falls are essential for older adults, to ensure that they continue to live safely and independently. The addition of DTBC to the nationally-used MOB curriculum may enhance both balance and gait, and lead to reduced fall risk.