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. 2019 Sep 13:10:865.
doi: 10.3389/fneur.2019.00865. eCollection 2019.

Educational and Exercise Intervention to Prevent Falls and Improve Participation in Subjects With Neurological Conditions: The NEUROFALL Randomized Controlled Trial

Davide Cattaneo  1 , Elisa Gervasoni  1 , Elisabetta Pupillo  2 , Elisa Bianchi  2 , Irene Aprile  1 , Isabella Imbimbo  1 , Rita Russo  3 , Arianna Cruciani  1 , Andrea Turolla  4 , Johanna Jonsdottir  1 , Michela Agostini  4 , Ettore Beghi  2 ; NEUROFALL Group
Collaborators, Affiliations

Educational and Exercise Intervention to Prevent Falls and Improve Participation in Subjects With Neurological Conditions: The NEUROFALL Randomized Controlled Trial

Davide Cattaneo et al. Front Neurol. .

Abstract

Background: Falls, mobility impairments and lack of social support lead to participation restrictions in people with neurological conditions. The aim of this multicenter, single blinded randomized controlled trial was to test whether an educational program focusing on fall prevention and safe mobility reduces falls and increases social participation among people with neurological conditions. Methods: Ninety people with Stroke (n = 25), multiple sclerosis (n = 33) and Parkinson disease (n = 32), median age 63 (31-89), were randomized. A permuted block algorithm stratified by field center was used to allocate participants to an education group (EG, n = 42) consisting of an educational program focused on fall prevention and tailored balance exercises and a control group (CG, n = 48) receiving usual treatments. After baseline assessment, each participants was followed for 6 months with telephone contacts by blinded interviewers. Being fallers (>1 fall) and time to become a faller were used as primary outcomes. Community Integration Questionnaire (CIQ) and Instrumental Activities of Daily Living (IADL) scales assessed treatment effects on social integration and daily living activities. Results: Over a median (Interquartile Range) follow-up of 189 (182-205) days, [EG = 188 (182-202), CG = 189 (182-209)] fallers were 10 in the CG and 11 in the EG (hazard ratio 0.95, 95% confidence interval (CI) 0.45 to 2.5; P = 0.94). At follow-up the EG scored significantly better than CG on the CIQ (+1.7 points, CI: 0.1 to 3.3) and IADL (+2.2 points, CI: 0.4 to 4.0). Conclusions: This educational program did not reduce the risk of falls but it improved the ability to carry out activities of daily living and decreased participation restrictions in people with neurological conditions.

Keywords: falls; neurological disease; participation; prevention; rehabilitation.

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Figures

Figure 1
Figure 1
CONSORT flow chart.
Figure 2
Figure 2
Cumulative hazard of falling over time in the two groups.
Figure 3
Figure 3
Relationship between participation, activity of daily living and number of falls in education and control group at baseline and during follow-up. IADL, Instrumental Activity of Daily Living; CIQ, Community Integration Questionnaire; Exp, Experimental Group; Ctrl, Control Group.
Figure 4
Figure 4
Participation and activity of daily living post-scores adjusted for pre-scores. CIQ, Community Integration Questionnaire; IADL, Instrumental Activities of Daily Living; Control, home-based stretching exercises group; Education, combined education and tailored home-based exercises (experimental) group.
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