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Feasibility and effect of supplementing a modified Otago intervention with multisensory balance exercises in older people who fall: a pilot randomized controlled trial [with consumer summary]
Liston MB, Alushi L, Bamiou D-E, Martin FC, Hopper A, Pavlou M
Clinical Rehabilitation 2014 Apr 28;28(8):784-793
clinical trial
5/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: No; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

OBJECTIVE: To investigate the feasibility and comparative effect of supplementing a modified Otago falls rehabilitation programme with multisensory balance exercises and informed sample size calculation for a definitive trial. DESIGN: Single-blinded randomized controlled trial with pre/postcomparisons using a per-protocol analysis. SETTING: Secondary care-based falls clinic, London, UK. SUBJECTS: Community-dwelling older people (n = 21) experiencing >= 2 non-syncopal falls during previous 12 months. INTERVENTION: Modified Otago exercise classes supplemented with supervised home-based rehabilitation consisting of multisensory balance or stretching exercises. Group classes and home sessions each occurred twice-weekly for eight weeks. MEASUREMENTS: A computerised randomization was used for group allocation. A rater, blinded to intervention, performed the assessment including the Functional Gait Assessment (primary outcome), Physiological Profile Assessment, and questionnaires relating to symptoms, balance confidence, and psychological state (secondary outcomes). RESULTS: Significant within-group improvements were noted for the Functional Gait (p < 0.01, r = -0.63) and Physiological Profile Assessments (p < 0.05, r = -0.63) in the Otago+multisensory rehabilitation group only and for balance confidence scores in the Otago+stretching group (p < 0.01, r = -0.63). Between-group differences were noted for the Functional Gait (p < 0.01, r = -0.71) and Physiological Profile (p < 0.05, r = -0.54) assessments with the Otago+multisensory group showing significantly greater improvement. The drop-out rate was similar for both groups (about 30%). No serious adverse events were reported. CONCLUSIONS: Supplementing the Otago programme with multisensory balance exercises is feasible in older people who fall and may have a beneficial effect on falls risk as measured using the Functional Gait and Short-form Physiological Profile Assessments. An adequately powered randomized controlled trial would require 36 participants to detect an effect size of 1.35 on the Functional Gait Assessment.

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