Understanding the implementation and efficacy of a home-based strength and balance fall prevention intervention in people aged 50 years or over with vision impairment: a process evaluation protocol

Abstract

BackgroundA nested process evaluation, within a randomised controlled trial, will explore relationships between program outcomes and quality of intervention implementation of the Lifestyle-Integrated Functional Exercise Program in older people with vision impairment. The Lifestyle-Integrated Functional Exercise Program is a home-based strength and balance program that has been shown to reduce falls in high risk populations. A pilot study showed positive trends in improvements in physical function in older people with vision impairment after participation in the program. The program will be delivered by Orientation and Mobility Specialists, who are experienced in working with people with vision impairment.MethodsThe process evaluation has a mixed methods design. This includes quantitative (fidelity checklist score, number of completed sessions, survey data and a habit formation scale), as well as qualitative (open responses from program staff and semi-structured interviews with study participants) data. Process evaluation measures include program adherence (fidelity), complete delivery (dose delivered), participant receipt (dose received) and participant enactment. Using the Behaviour Change Wheel, a logic model was built to explain the intended inputs, outputs, outcomes and relationships to the behaviour change techniques in the Lifestyle-Integrated Functional Exercise Program in older people with vision impairment.DiscussionThe findings of the process evaluation will inform the provision of fall prevention programs in older people with vision impairment by Orientation and Mobility Specialists. To date, there are no proven falls prevention programs which aim to improve physical function and reduce falls in older people with vision impairment. This process evaluation will contribute new knowledge about the implementation of a strength and balance program in this population.Trial registrationACTRN12616001186448. Registered 29 August 2016.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3304-6) contains supplementary material, which is available to authorized users.

Postural control and balance in a cohort of healthy people living in Europe

“…[5,7,8] The postural control variables may be reduced when sensory systems are altered. [9,10] A common method of studying standing balance is to record body segment motion equilibrium, which is unstable, and small fluctuations are seen in balance measurements that reflect continuous and intermittent muscle activity. [11] Balance is defined as the maintenance of the vertical projection of the body's center of mass (COM) onto the support area formed by the feet.…”

Recipient and instructor perspectives of an adapted exercise-based fall prevention programme for adults aged 50+ years with vision impairment: a qualitative study nested within a randomised controlled trial

“…This will include fidelity of delivery, number of sessions required, and associations between participants' demographic, functional, clinical and visual function characteristics with participants' receipt and enactment of programme activities. 27 The current study has the potential to inform developers of exercise programmes for the prevention of falls in older adults with vision impairment or those looking to include people with vision impairment into existing programmes. This includes eligibility criteria, particularly in terms of what age range or physical ability would suit the programme in its current form.…”

Therapeutic Exercises in Fall Prevention among Older Adults

“…A good number of studies with multifaceted intervention strategies have reported significant positive effects on falls [73][74][75]. Some other studies reported no significant impact of multifaceted interventions on falls [76,77], while another study found no apparent overall effects of these interventions on falls [78]. A standard, consistent component of multiple interventions significantly associated with reducing the number of fallers and falls rate were exercise, assistive technology, environmental assessment with modifications, quality of life improvement strategies, and basic fall risk assessment.…”