Reducing Rate of Falls in Older People by Means of Vestibular Rehabilitation: Preliminary Study

NCT ID: NCT03317353

Last Updated: 2017-10-24

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

COMPLETED

Clinical Phase

NA

Total Enrollment

139 participants

Study Classification

INTERVENTIONAL

Study Start Date

2012-01-01

Study Completion Date

2015-12-17

Brief Summary

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The aim of this study is to evaluate the effectiveness of vestibular rehabilitation to improve the balance in older people and reduce the number of falls, comparing three arms with different vestibular rehabilitation strategies (dynamic posturography exercises, optokinetic stimuli and exercises at home) and a control group.

Detailed Description

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Vestibular rehabilitation has been shown to be effective in compensating patients with residual instability as a result of vestibular system disorders or Parkinson's disease. It is also useful for treating lack of balance in the elderly (presbivertigo). However, there is no systematic, controlled and prospective analysis of whether vestibular rehabilitation is effective in reducing the number of falls in the elderly, or whether its effects in this age group are temporary or persist over time.

This study compare vestibular rehabilitation with three different strategies (dynamic posturography exercises, optokinetic stimuli and exercises at home) and a control group, in people over 65 years. Balance tests are performed before vestibular rehabilitation and three weeks, six months and one year after it. Number of falls are quantified one year after vestibular rehabilitation.

Conditions

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Dizziness Chronic Fall Elderly

Keywords

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Vestibular Rehabilitation Falls in elderly Computerized Dynamic Posturography Optokinetic stimuli

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 139 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
Double (Investigator, Outcomes Assessor)

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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Vestibular rehabil.: CDP

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

Vestibular rehabil.: CDP

Intervention Type DEVICE

Vestibular rehabilitation, ten sessions

Vestibular rehabil.: optokinetic stimuli

Group B. Patient has to stand in a dark room, wiht optokinetic stimuli around him/her. Ten sessions (one per day, five per week, two weeks), with progressive increase of stimulus speed (from 30º/sec the first day to 100º/sec the last), duration of session (from 5 minutes the first day to 15 minutes the last), stimulus complexity (horizontal stimuli in the first sessions, progressively adding vertical and rotating stimuli) and support surface difficulty (initially hard surface, last sessions on foam).

Group Type EXPERIMENTAL

Vestibular rehabil.: optokinetic stimuli

Intervention Type DEVICE

Vestibular rehabilitation, ten sessions

Vestibular rehabil.: home exercises

Group C. The patient is given a list of exercises (and explained how to do them) to stabilise eye position and improve postural control. They are to be performed twice a day for two weeks. Approximate duration of each session: 15 minutes. The exercises must be supervised by a family member to verify adherence to the programme.

Group Type EXPERIMENTAL

Vestibular rehabil.: home exercises

Intervention Type OTHER

Exercises performed twice a day for two weeks. Approximate duration of each session: 15 minutes

Control group

Group D. No vestibular rehabilitation is developed.

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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Vestibular rehabil.: CDP

Vestibular rehabilitation, ten sessions

Intervention Type DEVICE

Vestibular rehabil.: optokinetic stimuli

Vestibular rehabilitation, ten sessions

Intervention Type DEVICE

Vestibular rehabil.: home exercises

Exercises performed twice a day for two weeks. Approximate duration of each session: 15 minutes

Intervention Type OTHER

Other Intervention Names

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Computerized Dynamic Posturography

Eligibility Criteria

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Inclusion Criteria

Persons with a high risk of falling shall meet at least one 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 (normal limit calculated in previous studies).
* Obtaining a mean CDP SOT balance score of \< 68% (normal limit calculated in previous studies).
* Having fallen at least once in the CDP SOT.

Exclusion Criteria

* Cognitive decline that prevents the patient from understanding the examinations and vestibular rehabilitation exercises.
* Organic conditions that prevent standing on two feet, necessary for assessment of balance and performance of vestibular rehabilitation exercises.
* Balance disorders caused by conditions other than age (neurologic, vestibular...).
* Reduced cultural level that prevents the patient from understanding the examinations and from granting informed consent.
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

References

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Rossi-Izquierdo M, Santos-Perez S, Del-Rio-Valeiras M, Lirola-Delgado A, Faraldo-Garcia A, Vaamonde-Sanchez-Andrade I, Gayoso-Diz P, Soto-Varela A. Is there a relationship between objective and subjective assessment of balance in elderly patients with instability? Eur Arch Otorhinolaryngol. 2015 Sep;272(9):2201-6. doi: 10.1007/s00405-014-3122-3. Epub 2014 Jun 12.

Reference Type RESULT
PMID: 24916738 (View on PubMed)

Soto-Varela A, Faraldo-Garcia A, Rossi-Izquierdo M, Lirola-Delgado A, Vaamonde-Sanchez-Andrade I, del-Rio-Valeiras M, Gayoso-Diz P, Santos-Perez S. Can we predict the risk of falls in elderly patients with instability? Auris Nasus Larynx. 2015 Feb;42(1):8-14. doi: 10.1016/j.anl.2014.06.005. Epub 2014 Sep 4.

Reference Type RESULT
PMID: 25194853 (View on PubMed)

Soto-Varela A, Gayoso-Diz P, Rossi-Izquierdo M, Faraldo-Garcia A, Vaamonde-Sanchez-Andrade I, del-Rio-Valeiras M, Lirola-Delgado A, Santos-Perez S. Reduction of falls in older people by improving balance with vestibular rehabilitation (ReFOVeRe study): design and methods. Aging Clin Exp Res. 2015 Dec;27(6):841-8. doi: 10.1007/s40520-015-0362-z. Epub 2015 Apr 25.

Reference Type RESULT
PMID: 25911608 (View on PubMed)

Rossi-Izquierdo M, Santos-Perez S, Faraldo-Garcia A, Vaamonde-Sanchez-Andrade I, Gayoso-Diz P, Del-Rio-Valeiras M, Lirola-Delgado A, Soto-Varela A. Impact of obesity in elderly patients with postural instability. Aging Clin Exp Res. 2016 Jun;28(3):423-8. doi: 10.1007/s40520-015-0414-4. Epub 2015 Jul 18.

Reference Type RESULT
PMID: 26187012 (View on PubMed)

del-Rio-Valeiras M, Gayoso-Diz P, Santos-Perez S, Rossi-Izquierdo M, Faraldo-Garcia A, Vaamonde-Sanchez-Andrade I, Lirola-Delgado A, Soto-Varela A. Is there a relationship between short FES-I test scores and objective assessment of balance in the older people with age-induced instability? Arch Gerontol Geriatr. 2016 Jan-Feb;62:90-6. doi: 10.1016/j.archger.2015.09.005. Epub 2015 Sep 18.

Reference Type RESULT
PMID: 26412554 (View on PubMed)

Soto-Varela A, Rossi-Izquierdo M, Faraldo-Garcia A, Vaamonde-Sanchez-Andrade I, Gayoso-Diz P, Del-Rio-Valeiras M, Lirola-Delgado A, Santos-Perez S. Balance Disorders in the Elderly: Does Instability Increase Over Time? Ann Otol Rhinol Laryngol. 2016 Jul;125(7):550-8. doi: 10.1177/0003489416629979. Epub 2016 Feb 4.

Reference Type RESULT
PMID: 26848036 (View on PubMed)

Faraldo-Garcia A, Santos-Perez S, Rossi-Izquierdo M, Lirola-Delgado A, Vaamonde-Sanchez-Andrade I, Del-Rio-Valeiras M, Soto-Varela A. Posturographic limits of stability can predict the increased risk of falls in elderly patients with instability? Acta Otolaryngol. 2016 Nov;136(11):1125-1129. doi: 10.1080/00016489.2016.1201591. Epub 2016 Jul 4.

Reference Type RESULT
PMID: 27376710 (View on PubMed)

Soto-Varela A, Faraldo-Garcia A, Del-Rio-Valeiras M, Rossi-Izquierdo M, Vaamonde-Sanchez-Andrade I, Gayoso-Diz P, Lirola-Delgado A, Santos-Perez S. Adherence of older people with instability in vestibular rehabilitation programmes: prediction criteria. J Laryngol Otol. 2017 Mar;131(3):232-238. doi: 10.1017/S0022215116009932. Epub 2017 Jan 16.

Reference Type RESULT
PMID: 28088930 (View on PubMed)

Rossi-Izquierdo M, Gayoso-Diz P, Santos-Perez S, Del-Rio-Valeiras M, Faraldo-Garcia A, Vaamonde-Sanchez-Andrade I, Lirola-Delgado A, Soto-Varela A. Short-term effectiveness of vestibular rehabilitation in elderly patients with postural instability: a randomized clinical trial. Eur Arch Otorhinolaryngol. 2017 Jun;274(6):2395-2403. doi: 10.1007/s00405-017-4472-4. Epub 2017 Mar 1.

Reference Type RESULT
PMID: 28251319 (View on PubMed)

Other Identifiers

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PI11/01328

Identifier Type: -

Identifier Source: org_study_id