Reducing Rate of Falls in Older People by Means of Vestibular Rehabilitation (ReFOVeRe Study)

NCT ID: NCT03034655

Last Updated: 2018-02-22

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

NA

Total Enrollment

220 participants

Study Classification

INTERVENTIONAL

Study Start Date

2016-01-01

Study Completion Date

2018-12-31

Brief Summary

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The aim of this study is to evaluate and compare the effectiveness of vestibular rehabilitation developed using computerized dynamic posturography or a mobile posturographic system with vibrotactile stimulation, to improve the balance in older people and reduce the number of falls.

Detailed Description

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Accidental falls, particularly in the elderly, are one of the most important socio-healthcare problems of ageing western societies. Many factors condition and favour falls; one of them is old age, usually related to a decline in sensorial functions and worsening of balance Vestibular rehabilitation has been shown to be effective to improve balance and reduce the number of falls in older people. Previous studies have demonstrated that exercises in computerized dynamic posturography (CDP) are more effective than other vestibular rehabilitation strategies in this group of age. But CDP is very expensive and not widespread. It would be important to minimize cost of posturographic vestibular rehabilitation.

This study compare vestibular rehabilitation with two different posturographic devices (CDP and mobile posturographic system with vibrotactile stimulation), in people over 65 years. Additionally, we try to assess whether the reduction in the number of vestibular rehabilitation sessions (five) leads to an improvement in balance and in reducing the number of falls similar to those obtained with ten sessions.

Conditions

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Dizziness Chronic Fall

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Experimental study, single-center, open, randomized (balanced blocks of patients) in four branches in parallel, in 220 elderly patients (over 65 years) with high risk of falls; follow-up period: twelve months.
Primary Study Purpose

PREVENTION

Blinding Strategy

DOUBLE

Investigators Outcome Assessors
After the first screening visit, the patients who grant their consent will be included in the study and randomised to one of the following study arms. Randomisation will be performed by C.H.U de Santiago Clinical Epidemiology and Biostatistics Unit. Once the informed consent form is signed, the care provider will contact the unit, which will give him the code of the arm to which the patient is assigned. A n= 20 block balanced randomisation sequence will be used. The investigator will analyse results and evolution, being blind type and duration of vestibular rehabilitation.

Study Groups

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CDP exercises (10 sessions)

Group A. The Smart Equitest program was used with a protocol of 10 exercises per session, which were customized depending on each patient´s deficit. The exercises involve visual biofeedback together with sensitive, real-time monitoring of movement. In some exercises, patients must maintain their center of gravity (COG) over the base of support, while in others the COG must be moved to a series of targets. In addition, the support surface and/or visual surround may also move in response to the patient´s own movement. The exercise difficulty was progressively increased throughout the rehabilitation sessions. The duration of each session was approximately 15 minutes. The distribution of sessions was one per day and five per week (2 weeks).

Group Type EXPERIMENTAL

CDP

Intervention Type DEVICE

Vestibular rehabilitation using CDP

10 sessions

Intervention Type OTHER

Vestibular rehabilitation, ten sessions

CDP exercises (5 sessions)

Group B. Same as group A, except for the number of sessions (5) and the distribution of sessions (one daily, every other day, two weeks).

Group Type EXPERIMENTAL

CDP

Intervention Type DEVICE

Vestibular rehabilitation using CDP

5 sessions

Intervention Type OTHER

Vestibular rehabilitation, five sessions

Mobile posturography exercises (10 sess)

Group C. Up to six tasks with the most prominent deviations from normative control values were included in the training program. Training was performed by using the training function of Vertiguard1-RT device. This neurofeedback system contains one vibration stimulator on the front, back, left and right side, respectively. Training was performed daily under supervision of a physician over 2 weeks (10 sessions, weekend was excluded). A training session consisted of 5 repetitions of six selected training tasks. The patient received a vibrotactile feedback signal during training in those directions which showed a higher body sway than preset thresholds. Vibration was reinforced with increasing sway No vibrotactile feedback was applied if the patient's sway was below preset thresholds. The exercise difficulty was progressively increase throughout the rehabilitation sessions.

Group Type EXPERIMENTAL

Mobile posturography

Intervention Type DEVICE

Vestibular rehabilitation using mobile posturography

10 sessions

Intervention Type OTHER

Vestibular rehabilitation, ten sessions

Mobile posturography exercises (5 sess)

Group D. Same as group A, except for the number of sessions (5) and the distribution of sessions (one daily, every other day, two weeks).

Group Type EXPERIMENTAL

Mobile posturography

Intervention Type DEVICE

Vestibular rehabilitation using mobile posturography

5 sessions

Intervention Type OTHER

Vestibular rehabilitation, five sessions

Interventions

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CDP

Vestibular rehabilitation using CDP

Intervention Type DEVICE

Mobile posturography

Vestibular rehabilitation using mobile posturography

Intervention Type DEVICE

10 sessions

Vestibular rehabilitation, ten sessions

Intervention Type OTHER

5 sessions

Vestibular rehabilitation, five sessions

Intervention Type OTHER

Other Intervention Names

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Computerized Dynamic Posturography Vertiguard's Mobile Posturography

Eligibility Criteria

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Inclusion Criteria

Persons with a high risk of falling shall meet at least two of the following requirements:

* Having fallen at least once in the last 12 months.
* Using more than 15 seconds or needing support in the TUG test.
* Obtaining a mean CDP SOT balance score of \< 68%.
* Having fallen at least once in the CDP SOT.
* A score in Mobile posturography gSBDT \> 60 %.

Exclusion Criteria

* Cognitive decline or reduce cultural level that prevents the patient from understanding the assessment, vestibular rehabilitation exercises and granting informed consent.
* Organic conditions that prevent standing on two feet, necessary for assessment of balance and performance of VR exercises.
* Balance disorders caused by conditions other than age (neurologic, vestibular,....).
* Current treatment with drugs that potentially disturb balance.
Minimum Eligible Age

65 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Instituto de Salud Carlos III

OTHER_GOV

Sponsor Role collaborator

European Regional Development Fund

OTHER

Sponsor Role collaborator

Hospital Clinico Universitario de Santiago

OTHER

Sponsor Role lead

Responsible Party

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Andrés Soto-Varela

Professor and Attending Physician

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Andrés Soto-Varela, PhD

Role: PRINCIPAL_INVESTIGATOR

Hospital Clinico Universitario de Santiago

Locations

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Complexo Hospitalario Universitario

Santiago de Compostela, A Coruña, Spain

Site Status RECRUITING

Countries

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Spain

Central Contacts

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Andrés Soto-Varela, PhD

Role: CONTACT

0034981951155

Facility Contacts

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Andrés Soto-Varela, PhD

Role: primary

0034981951155

Sofía Santos-Pérez, PhD

Role: backup

0034981951155

References

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Soto-Varela A, Rossi-Izquierdo M, Del-Rio-Valeiras M, Faraldo-Garcia A, Vaamonde-Sanchez-Andrade I, Lirola-Delgado A, Santos-Perez S. Vestibular rehabilitation with mobile posturography as a "low-cost" alternative to vestibular rehabilitation with computerized dynamic posturography, in old people with imbalance: a randomized clinical trial. Aging Clin Exp Res. 2021 Oct;33(10):2807-2819. doi: 10.1007/s40520-021-01813-2. Epub 2021 Mar 7.

Reference Type DERIVED
PMID: 33677737 (View on PubMed)

Soto-Varela A, Rossi-Izquierdo M, Del-Rio-Valeiras M, Vaamonde-Sanchez-Andrade I, Faraldo-Garcia A, Lirola-Delgado A, Santos-Perez S. Presbyvestibulopathy, Comorbidities, and Perception of Disability: A Cross-Sectional Study. Front Neurol. 2020 Oct 30;11:582038. doi: 10.3389/fneur.2020.582038. eCollection 2020.

Reference Type DERIVED
PMID: 33250848 (View on PubMed)

Soto-Varela A, Rossi-Izquierdo M, Del-Rio-Valeiras M, Vaamonde-Sanchez-Andrade I, Faraldo-Garcia A, Lirola-Delgado A, Santos-Perez S. Vestibular Rehabilitation Using Posturographic System in Elderly Patients with Postural Instability: Can the Number of Sessions Be Reduced? Clin Interv Aging. 2020 Jun 26;15:991-1001. doi: 10.2147/CIA.S263302. eCollection 2020.

Reference Type DERIVED
PMID: 32617000 (View on PubMed)

Soto-Varela A, Rossi-Izquierdo M, Del-Rio-Valeiras M, Faraldo-Garcia A, Vaamonde-Sanchez-Andrade I, Lirola-Delgado A, Santos-Perez S. Modified Timed Up and Go Test for Tendency to Fall and Balance Assessment in Elderly Patients With Gait Instability. Front Neurol. 2020 Jun 12;11:543. doi: 10.3389/fneur.2020.00543. eCollection 2020.

Reference Type DERIVED
PMID: 32595593 (View on PubMed)

Soto-Varela A, Gayoso-Diz P, Faraldo-Garcia A, Rossi-Izquierdo M, Vaamonde-Sanchez-Andrade I, Del-Rio-Valeiras M, Lirola-Delgado A, Santos-Perez S. Optimising costs in reducing rate of falls in older people with the improvement of balance by means of vestibular rehabilitation (ReFOVeRe study): a randomized controlled trial comparing computerised dynamic posturography vs mobile vibrotactile posturography system. BMC Geriatr. 2019 Jan 3;19(1):1. doi: 10.1186/s12877-018-1019-5.

Reference Type DERIVED
PMID: 30606112 (View on PubMed)

Other Identifiers

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PI1500329

Identifier Type: -

Identifier Source: org_study_id

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