Falls are the leading cause of fatal and non-fatal injuries in the elderly. Each year an estimated 1/3 of older adults fall with the likelihood of falling increasing substantially with advancing age. Our primary objective is to evaluate the comparative effectiveness of a perturbation-based dynamic stability intervention for fall prevention (using the ActiveStep(r) training system) compared to a traditional physical therapy program in reducing the incidence and severity of falls in a geriatric population by performing a multi-center, randomized clinical trial. In 2005, 15,802 elderly patients (>65 years of age) died as the result of fall-related injuries. According to the 2006 Behavioral Risk Factor Surveillance System (BRFSS) survey, 5.8 million persons aged 65 or older fell at least once during a 3 month period, which represents nearly 16 percent of the elderly population;furthermore nearly a third of those who fell (1.8 million) sustained some form of injury which resulted in either a doctor's visit or restricted activity for at least 1 day. In 2000, the direct medical costs for fall related injuries were estimated to be $19 billion. The burden of fall related injuries is expected to grow such that by the year 2020, the total cost is estimated to become approximately $54.9 billion. External perturbations such as tripping are a major contributor to falls and trip-related falls account for as many as 20% of all hip fractures. The ActiveStep(r) fall prevention training program was developed with NIH funding and consists of a series of increasingly challenging postural disturbances using a microprocessor controlled servo motor that drives a treadmill belt at defined acceleration, velocity, and distance profiles. Initial biomechanical testing of the ActiveStep(r) training program showed significant improvement in trunk kinematics during a single training session. The ActiveStep(r) training program is currently available and billable under Medicare, however there is a lack of direct clinical data showing reduced falls compared to standard physical therapy interventions.
Our Specific Aims are to: 1) conduct a multi-central randomized prospective trial comparing a standard physical therapy gait and balance program with a perturbation-based dynamic stability intervention using the ActiveStep(r) training system. The main outcome measure will be the number of subjects who report a fall during the follow-up period;2) to assess the longevity of any improvement with the two types of fall prevention programs to gain insight into the potential need for and timing of "retraining" for fall prevention;and 3) to evaluate underlying patient characteristics which may predict successful prevention of falls help determine the appropriate selection of patients into different types of fall prevention programs.

Public Health Relevance

Falls are the leading cause of fatal and non-fatal injuries in the elderly. Each year an estimated 1/3 of older adults fall and by the year 2020, the total cost of fall related injuries is estimated to be approximately $54.9 billion. The proposed randomized comparative effectiveness trial will evaluate a newly approved fall prevention program (ActiveStep(R) training system) compared to a traditional physical therapy program for reducing the incidence and severity of falls in a geriatric population.

Agency
National Institute of Health (NIH)
Institute
Agency for Healthcare Research and Quality (AHRQ)
Type
Research Project (R01)
Project #
5R01HS018459-05
Application #
8512586
Study Section
Health Care Technology and Decision Science (HTDS)
Program Officer
Wittenberg, Kim
Project Start
2009-09-30
Project End
2014-07-31
Budget Start
2013-08-01
Budget End
2014-07-31
Support Year
5
Fiscal Year
2013
Total Cost
Indirect Cost
Name
Dartmouth College
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
041027822
City
Hanover
State
NH
Country
United States
Zip Code
03755