Protocol of a 12-month multifactorial eHealth programme targeting balance, dual-tasking and mood to prevent falls in older people: the StandingTall+ randomised controlled trial

Abstract

IntroductionFalls have a multifactorial aetiology, which may limit the effectiveness of the common approach of exercise as the sole intervention strategy. Multifactorial interventions could be more effective in people at high risk of falling; however, the focus of such interventions has traditionally been quite narrow. This paper describes the design of a randomised controlled trial that will evaluate the effectiveness of an eHealth programme, which addresses cumulative effects of key fall-risk factors across the triad of physical, affective and cognitive functions on falls in older people.Methods and analysis518 older people aged 65 years and over with high fall risk, defined as having a history of falls in the past 6 months, self-reported fear of falling or being aged 80 years or over, will be recruited via local advertisements, newsletters and presentations, and randomised to an intervention or health education control group. The intervention comprises balance exercise, cognitive-motor exercise and cognitive–behavioural therapy, with their dosage based on participant’s baseline balance, executive function and mood. The primary outcome is the rate of falls in the 12 months after randomisation. Secondary outcomes at 6 and 12 months comprise programme adherence, healthcare use, physical activity, balance and mobility, cognitive function, psychological well-being, quality of life, health literacy and user experience and attitudes towards the programme. Data will be analysed following intention to treat to gauge real-world effectiveness. We will further determine complier averaged causal effects to correct for varying adherence and conduct economic analyses to gain insight into cost-effectiveness and cost–utility.Ethics and disseminationEthical approval was obtained from the University of New South Wales (UNSW) Human Research Ethics Committee in December 2017. Outcomes will be disseminated via peer-reviewed articles, conference presentations, community events and media releases.Trial registration numberACTRN12619000540112.

New Strategies to Improve the Quality of Life for Normal Aging versus Pathological Aging

“…The tools are correlated with the well-being of life given by the individual’s ability to be or do things that are important in life. The questionnaire includes questions about affection, friendship, security, satisfaction, or independence [ 18 , 28 , 29 ]. Moreover, in this sense, other instruments, such as SUS, MSEQ, LQS, LSS, SRSE, or MRSE have been defined, correlated with the satisfaction of the quality of life with certainty and a good mobility of evolution [ 11 , 14 , 18 , 30 ].…”

“…Fall risk scores are investigated by FRAT, FaB, FRM, and PROFANE [ 4 , 14 , 43 ]. Fear of falling was evaluated through FES-I and Short FES [ 10 , 13 , 14 , 28 , 31 , 32 , 40 , 41 ]. Different physical activities may be accompanied by risks of falling after several stages of training that can be assessed by: FSST and Mini BEST 28 [ 36 ].…”

“…Mental disorders will intervene in the evaluation DSMV and MoCA [ 22 , 30 ]. The evaluation of the psychological profile is performed by PPA and FCSRT [ 13 , 22 , 28 , 30 ]. Other tools will investigate the varying degrees of depression, such as GDS, PHQ-9, and CES-D [ 10 , 11 , 13 , 19 , 22 , 25 , 28 , 43 ].…”

“…The evaluation of the psychological profile is performed by PPA and FCSRT [ 13 , 22 , 28 , 30 ]. Other tools will investigate the varying degrees of depression, such as GDS, PHQ-9, and CES-D [ 10 , 11 , 13 , 19 , 22 , 25 , 28 , 43 ]. PDSS-2 assesses by 15 items on a visual scale the quality of sleep in older adults with PD [ 32 ] and the degrees of mental disorder are assessed by CRIq and D-QOL [ 22 , 30 , 38 ].…”

“…Programs such as “Standing Tall” or “Back to my Best” intervened by telerehabilitation with devices that delivered cognitive behavioral or motor training, that improved quality of life through decreasing rate of falls. At the same time, there has been an increase in physical activity that has promoted balance, motor skills and even cooperative functions [ 13 , 16 , 28 ]. Exercises performed for balance and strength were applied by the Pisando Fuerte protocol and by Tai Ji Quan multimodal exercises and stretching program are used.…”