outcomes for inpatient rehabilitation participants: a randomised - - PowerPoint PPT Presentation

Additional circuit classes can improve balance

• utcomes for inpatient rehabilitation participants: a

randomised controlled trial

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The University of Sydney

Treacy D1,2, Schurr K2 ,Lloyd B3, Sherrington C1

1 The George Institute for Global Health, University of Sydney, NSW 2 Bankstown-Lidcombe Hospital, SWSLHD, NSW 3 Center for Education and Workforce Development

Background

• Poor balance and mobility leads to an increased risk of

falling

• Specific balance exercise has been shown to improve

balance and reduce falls within the community setting

• Systematic reviews
• - Howe et al 2007
• - Sherrington et al 2008

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Standing balance circuit classes

• Seven different stations
• - All stations aim to challenge people’s balance with minimal

hand usage for support

• 6 minutes each
• Patients perform 6 of the 7 stations
• 2 therapists
• Maximum of 8 participants
• Therapist encourage to increase difficulty
• 3 times a week for 1 hour
• Participants count number of repetitions of exercise

performed

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Research Question

Does two weeks of standing balance circuit classes, in addition to usual therapy, lead to greater improvements in balance among rehabilitation inpatients than usual therapy alone

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Eligibility Criteria

• Admitted to the ward for rehabilitation
• No multi-resistant organism infection
• Be able to fully weight bear as ordered by a medical
• fficer
• Suitable for a group exercise class with minimal

supervision as determined by the treating physiotherapist.

• Able to stand for 30 seconds without physical

assistance or the help of an assistive device

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Recruitment and flow of participants

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Admitted to rehabilitation ward (n = 384) Eligible for trial (n = 202) Intervention group (n = 81) Control group (n = 81) Lost to follow up at 2 weeks (n = 1) Lost to follow up at 2 weeks (n = 0) Lost to follow up at 3 months (n = 13) Lost to follow up at 3 months (n = 11)

Compliance

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Number of classes completed n (%)

Six 33 (41) Five 26 (32) Four 13 (16) Three or less 9 (11)

Reason for not attending classes n (%)

Discharged 47 (58) Not on ward 6 (7) Medically unwell 11(14) Refused 6 (7) Public holiday 11 (14)

Demographics

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Intervention Control Age (years), mean (SD) 82.6 (7.3) 81.4 (7.8) Gender, n female (%) 51 (62) 53 (65) MMSE (score/30), n (SD) 24.7 (3.1) 25.3 (3.2) Co-morbidities, n (%) Cerebrovascular accident 12 (15) 9 (11) Congestive cardiac failure 8 (10) 10(12) Ischemic heart disease 7 (9) 9 (11) Chronic obstructive pulmonary disease 12 (15) 11 (14) Dementia 8 (10) 7(9) Fall in the previous 12 months (83) (88)

Amount of practice

Average (median) Range

Repetitions per class 427 (412) 149 - 748 Repetitions per intervention period 2156 (2140) 433 - 4318

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Primary outcomes

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Secondary outcomes - mobility

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Secondary outcomes – self reported physical functioning

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Secondary outcomes – falls

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Intervention (n = 81) Control (n = 81) Between-group differences*

Falls at two weeks 7 11 0.64 (0.21 to 1.99) p = 0.446 Falls at three months 60 54 1.13 (0.65 to 1.96) p = 0.662

* Incident Rate Ratio

Secondary outcomes – LOS and re- admissions

Intervention (n = 81) Control (n = 81) Between- group differences 95% CI p

Rehabilitation length of stay 22.7 26.8

• 4.1
• 8.3 to 0.16

p = 0.059 Hospital re- admissons 30 44 0.70* 0.42 to 1.18 p = 0.184

* Incident Rate Ratio

Conclusion

• Two weeks of additional balance exercises delivered

within a group environment in addition to usual therapy resulted in improved balance at two weeks and these improvement may be maintained at three months

• A high intensity challenging balance exercise program

can be provided safely in a group environment setting

• Elderly patients with a high number of co-morbidities

are able to perform a high number of repetitions of exercise

• Effects on falls is inconclusive

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