Clinical Interventions in Aging (Aug 2019)
Balance training using virtual reality improves balance and physical performance in older adults at high risk of falls
Abstract
Steven Phu,1,2 Sara Vogrin,1,2 Ahmed Al Saedi,1,2 Gustavo Duque1,21Department of Medicine, Melbourne Medical School – Western Health, The University of Melbourne, St. Albans, VIC, Australia; 2Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St. Albans, VIC, AustraliaCorrespondence: Gustavo DuqueAustralian Institute for Musculoskeletal Science (AIMSS), Melbourne Medical School – Western Health, The University of Melbourne, 176 Furlong Road, St. Albans, VIC 3021, AustraliaTel +61 38 395 8121Fax +61 38 395 8258Email [email protected]: Exercise programs designed for falls prevention have been proven effective in reducing falls by approximately 21%. Virtual reality may provide a viable alternative intervention for falls prevention. This study compared the effects of virtual reality training using the Balance Rehabilitation Unit (BRU) versus exercise using a modified Otago Exercise Programme (EX) on improving balance and physical performance in the short-term restorative care setting of the Gait and Balance Gym (Gabagym).Patients and methods: This was a pre- and post-intervention study of 195 participants (median age 78 years, IQR 73–84; 67% female) who presented with a risk and/or history of falls. Participants were assigned to either EX (n=82) or BRU (n=63). Supervised sessions occurred twice a week for 6 weeks. Participants receiving interventions were compared to a separate group (n=50) with similar characteristics who did not receive any intervention. Balance and physical performance were assessed at initial and final attendance and included the 5 Times Sit to Stand (5STS) test, Timed Up and Go (TUG), gait speed and posturography assessment using the BRU. Fear of falling was assessed using the Falls Efficacy Scale. Handgrip strength and adherence were also monitored.Results: Post-intervention, EX and BRU groups achieved similar improvements and reported similar adherence rates (71% vs 72%, respectively). Both intervention groups improved in balance and physical performance measures. Both interventions showed significantly better improvement than the non-intervention group in TUG (p<0.001), gait speed (p=0.021), limits of stability in posturography assessment (p=0.008), FES-I score (p=0.013) and handgrip strength (p=0.021). Only the BRU group improved control of static posture in the eyes closed (p=0.002) and foam eyes closed (p=0.006) tasks.Conclusion: This study highlights the potential use of virtual reality as a practical alternative to improve outcomes of balance training for reduction of falls risk in older adults.Keywords: posture, falls, fractures, virtual reality, exercise
