1. Effect of the Otago Exercises on Postural balance and
Fear of falling among Older fallers with knee OA
Sumaiyah Mat1, Ng Chin Teck2, Tan Maw Pin1
1Department of Medicine, Faculty of Medicine, University of Malaya, Malaysia, 2Singapore General Hospital, Singapore, Singapore
Introduction
Methods
Tables & Graphs
Total elderly fallers enrolled and randomized into MyFAIT, N=229
One in every three adults age 65 and older and almost 50% of those over 80, experience at least one fall each year.
Osteoarthritis (OA) has been reported as an important risk factor for falls .
However very few studies conduct intervention trial on reducing falls risk among older adults with OA.
While Tai Chi and aerobic studies had shown significant positive effect in improving balance and falls risk, none of the previous studies includes falls outcome.
Balance; TUG
OA determination: X-ray
Psychological
Vision
Initial Assessments
OEP
Control group,
n=33
OEP
Intervention group, n=34
Maximal Excursion
Directional Control
Fear of falling
Objective
Subjects with OA
(followed-up)
Intervention: 17
Control: 24
Figure 4: Mean difference changes at 6- month within group
Table 2: Mean changes preceding 6-months in both group
To evaluate the effect of an individualized home-based exercise program to improve postural balance, falls risk and fear of falling in older fallers with knee osteoarthritis (OA).
Group
Test
Mean difference (95% CI)
Sig.
Control (n=24)
Standing Sway, mCTSIB
0.15 ( )
0.096
Sway velocity, STS
-0.18 ( )
0.458
Reaction time, LOS
-0.03 ( )
0.395
End Point, LOS
-0.39 ( )
0.878
Maximal Excursion, LOS
-4.35 ( )
0.160
Directional control, LOS
-3.36 ( )
0.111
Short FES-I score
3.42 ( )
0.175
Intervention (n=17)
-0.33 ( )
0.161
0.42 ( )
0.101
-0.15 ( )
0.048
3.63 ( )
0.131
6.88 ( )
0.032
10.13 ( )
0.012
-3.12 ( )
Figure 2: Flow chart for Otago Exercise Intervention in myFAIT study
Results
Results from 41 participants (exercise= 17; control= 24) were included.
Methods
A sub-study of the single blind (assessor) randomized controlled trial study “Malaysian Falls Assessment and Intervention Trial (MyFAIT)”.
Selection criteria:
Had two history of fallers or one injurious fall in the past 12 months (Faller)
Timed Up and Go (TUG) test score>13.5s
Diagnosed with radiological knee OA (KL-grade 2-4)
Intervention: Otago exercise programme (OEP), 6-months home-based exercise balance & strength retraining program which consists of 17 exercises
Assessment: Baseline and after 6 months
Outcome measured: Posturagraphy test, Knee Injury and Osteoarthritis outcome score (KOOS) and short FES-I were completed at baseline and 6 months. Falls recurrence (Monthly diary),
Table 1: Baseline and after 6months performance score
 Baseline
 After 6 months*
Variable
Control
Intervention
Adj diff†
Postural control
Standing sway, mCTSIB
1.23 (0.34)
1.64
(0.86)
1.38 (0.49)
1.32
(0.83)
0.206
Sway velocity , STS
3.59 (0.97)
3.53
(1.23)
3.77 (1.26)
3.12
(1.14)
0.107
Reaction time, LOS
0.85 (0.15)
0.91
(0.16)
0.82 (0.13)
0.77
(0.19)
0.251
End Point, LOS
56.83 (11.88)
44.44 (13.86)
56.43 (13.10)
48.06 (11.60)
0.824
Maximal Excursion, LOS
73.39 (14.99)
56.50 (13.61)
69.04 (13.26)
63.38 (11.12)
0.647
Directional control, LOS
64.82 (10.15)
53.38 (11.19)
61.45 (14.14)
63.50 (9.22)
0.044
KOOS score
Symptoms
75.85 (18.84)
70.53 (17.95)
80.56 (13.83)
80.35 (18.80)
0.790
Pain
80.25 (17.65)
73.29 (20.12)
79.95 (15.38)
81.18 (22.12)
0.463
Function
79.67 (17.41)
65.07 (24.88)
80.44 (15.77)
75.00 (21.93)
0.751
Sport
57.08 (30.85)
33.82 (29.24)
62.34 (30.21)
44.12 (38.58)
0.616
QoL
53.58 (26.63)
40.90 (27.80)
61.96 (26.10)
55.88 (31.85)
0.951
Short FES-I score
12.42 (5.04)
17.00
(5.55)
15.83 (11.20)
13.88 (4.91)
0.326
Conclusion
Home-based strengthening exercise benefited older fallers with OA and gait and balance disorders in improving their directional control.
It also helped in reducing fear of falling and improving postural balance. Our study was not powered for falls outcomes.
Future research should therefore consider evaluating targeted exercise interventions in fallers with OA and gait and balance disorders in a larger randomized-controlled study.
Literature Cited
Mat S, Tan MP, Kamaruzzaman SB, Ng CT. Physical therapies for improving balance and reducing falls risk in osteoarthritis of the knee: a systematic review. Age Ageing. 2015; 44(1):16–24. Epub 2014/08/26. doi: /ageing/afu112 PMID:
Arms
Mean of days for remaining fall-free
Intervention
130 days
Control
133 days
Contact information
Figure 1 (a) the modified mCTSIB
Figure 1 (b) Sit to stand test
Figure 3: Kaplan Meier plots showing the probability of remaining fall-free preceding 6-months (180 days)