Views and experiences of visually impaired older people and exercise instructors about the Falls Management Exercise programme: a qualitative study

Codesigning a Home-Based Exercise Program With and for People With Visual Impairments: A Needs Assessment

This needs-assessment study evaluated the physical activity levels, needs, preferences, and requirements for exercise among individuals with visual impairments, aiming to establish evidence for the codesign of a subsequent home-based exercise program. The questionnaire, comprising 35 questions, was developed by a research team of disability and adapted physical activity experts. It was implemented for the online survey, collecting data from 145 adults with severe low vision and blindness between January 15 and January 29, 2024. Descriptive statistical analysis and content analysis were employed. Seventy-five participants (62.5%) were classified as overweight or obese, and only 15 participants reported engaging in the recommended levels of physical activity. Regarding the requirements for future home-based exercise programs, seven themes were identified: accessibility, nonvisual learning support, safety management, personalization, motivation, education, and technology. The results emphasized the urgent need for adapted home-based exercise programs that align with individuals' specific health conditions and abilities.

Facilitators and barriers in the implementation of a fall prevention program based on physical activity for elderly people living in the community: A qualitative study

BACKGROUND

Physical activity is recognized as beneficial for older individuals in preventing falls. Achieving high adherence to exercise programs among the elderly poses challenges for administrations and healthcare systems. This study explored the facilitators and barriers perceived by both the participants and nurse trainers involved in an exercise program aimed at preventing falls in primary healthcare.

METHODS

Sixteen semi-structured interviews with elderly people who had participated in the Otago Exercise Program and a focus group of nurse trainers of this program were conducted between October 2018 and September 2019 in primary health care centers in Lleida, Spain. Interviews were transcribed and analyzed using inductive thematic analysis with Atlas.ti 8 software.

RESULTS

Analysis revealed five overarching categories and 17 subcategories. Key facilitators included personal motivation, the perceived benefits of exercise, and the supportive role of nurse trainers. Primary barriers encompassed factors such as the excessive duration of the program, not considering personal preferences for individual or group participation, and differences in physical condition among group participants.

CONCLUSIONS

To increase participation and adherence to exercise programs, it is necessary to consider the important role of the nursing professionals that recommend program enrolment and the participants' personal motivations. The program with group sessions is a model that is easy to integrate into Primary Healthcare centers, which must always take into account the preferences and physical conditions of the participants.

Physical activity and sport practice to improve balance control of visually impaired individuals: a narrative review with future perspectives

Visual disability negatively impacts balance, everyday self-efficacy, and mobility and often leads affected subjects to perceive physical exercise as a burdensome challenge thus discouraging them from practicing. Despite the well-proven benefits of regular physical activity in visually impaired people, especially addressing postural control, there are no specific guidelines and most of the available literature seems to be flawed by critical issues. Given the wide heterogeneity and the multidimensional needs of this population, a more realistic and target-specific perspective is needed in order to properly investigate and promote exercise practice and adherence for balance improvement. On this basis, through a critical overview of the recent literature, the present article aimed to enrich the current knowledge about this topic by providing innovative suggestions, both practical and methodological, and specifically deepening the disability-related deficits and peculiarities of different age ranges. Moreover, since a multidisciplinary approach is advisable when designing and leading exercise protocols tailored to visually impaired individuals, such innovative hints also highlighted the central role of the adapted physical activity specialist, hence contributing to foster its official professional recognition and involvement in this field.

Environmental and behavioural interventions for reducing physical activity limitation and preventing falls in older people with visual impairment

BACKGROUND

Impairment of vision is associated with a decrease in activities of daily living. Avoidance of physical activity in older adults with visual impairment can lead to functional decline and is an important risk factor for falls. The rate of falls and fractures is higher in older people with visual impairment than in age-matched visually normal older people. Possible interventions to reduce activity restriction and prevent falls include environmental and behavioral interventions.

OBJECTIVES

We aimed to assess the effectiveness and safety of environmental and behavioral interventions in reducing physical activity limitation, preventing falls and improving quality of life amongst visually impaired older people.

SEARCH METHODS

We searched CENTRAL (including the Cochrane Eyes and Vision Trials Register) (Issue 2, 2020), Ovid MEDLINE, Embase and eight other databases to 4 February 2020, with no language restrictions.

SELECTION CRITERIA

Eligible studies were randomized controlled trials (RCTs) and quasi-randomized controlled trials (Q-RCTs) that compared environmental interventions, behavioral interventions or both, versus control (usual care or no intervention); or that compared different types of environmental or behavioral interventions. Eligible study populations were older people (aged 60 and over) with irreversible visual impairment, living in their own homes or in residential settings. To be eligible for inclusion, studies must have included a measure of physical activity or falls, the two primary outcomes of interest. Secondary outcomes included fear of falling, and quality of life.

DATA COLLECTION AND ANALYSIS

We used standard Cochrane methods. We assessed the certainty of the evidence using the GRADE approach.

MAIN RESULTS

We included six RCTs (686 participants) conducted in five countries (Australia, Hungary, New Zealand, UK, US) with follow-up periods ranging from two to 12 months. Participants in these trials included older adults (mean age 80 years) and were mostly female (69%), with visual impairments of varying severity and underlying causes. Participants mostly lived in their homes and were physically independent. We classified all trials as having high risk of bias for masking of participants, and three trials as having high or unclear risk of bias for all other domains. The included trials evaluated various intervention strategies (e.g. an exercise program versus home safety modifications). Heterogeneity of study characteristics, including interventions and outcomes, (e.g. different fall measures), precluded any meta-analysis. Two trials compared the home safety modification by occupational therapists versus social/home visits. One trial (28 participants) reported physical activity at six months and showed no evidence of a difference in mean estimates between groups (step counts: mean difference (MD) = 321, 95% confidence interval (CI) -1981 to 2623; average walking time (minutes): MD 1.70, 95% CI -24.03 to 27.43; telephone questionnaire for self-reported physical activity: MD -3.68 scores, 95% CI -20.6 to 13.24; low-certainty of evidence for each outcome). Two trials reported the proportion of participants who fell at six months (risk ratio (RR) 0.76, 95% CI 0.38 to 1.51; 28 participants) and 12 months (RR 0.59, 95% CI 0.43 to 0.80, 196 participants) with low-certainty of evidence for each outcome. One trial (28 participants) reported fear of falling at six months, using the Short Falls Efficacy Scale-International, and found no evidence of a difference in mean estimates between groups (MD 2.55 scores, 95% CI -0.51 to 5.61; low-certainty of evidence). This trial also reported quality of life at six months using 12-Item Short Form Health Survey, and showed no evidence of a difference in mean estimates between groups (MD -3.14 scores, 95% CI -10.86 to 4.58; low-certainty of evidence). Five trials compared a behavioral intervention (exercise) versus usual activity or social/home visits. One trial (59 participants) assessed self-reported physical activity at six months and showed no evidence of a difference between groups (MD 9.10 scores, 95% CI -13.85 to 32.5; low-certainty of evidence). Three trials investigated different fall measures at six or 12 months, and found no evidence of a difference in effect estimates (RRs for proportion of fallers ranged from 0.54 (95% CI 0.29 to 1.01; 41 participants); to 0.93 (95% CI 0.61 to 1.39; 120 participants); low-certainty of evidence for each outcome). Three trials assessed the fear of falling using Short Falls Efficacy Scale-International or the Illinois Fear of Falling Measure from two to 12 months, and found no evidence of a difference in mean estimates between groups (the estimates ranged from -0.88 score (95% CI -2.72 to 0.96, 114 participants) to 1.00 score (95% CI -0.13 to 2.13; 59 participants); low-certainty of evidence). One trial (59 participants) assessed the European Quality of Life scale at six months (MD -0.15 score, 95% CI -0.29 to -0.01), and found no evidence of a clinical difference between groups (low-certainty of evidence).

AUTHORS' CONCLUSIONS

There is no evidence of effect for most of the environmental or behavioral interventions studied for reducing physical activity limitation and preventing falls in visually impaired older people. The certainty of evidence is generally low due to poor methodological quality and heterogeneous outcome measurements. Researchers should form a consensus to adopt standard ways of measuring physical activity and falls reliably in older people with visual impairments. Fall prevention trials should plan to use objectively measured or self-reported physical activity as outcome measures of reduced activity limitation. Future research should evaluate the acceptability and applicability of interventions, and use validated questionnaires to assess the adherence to rehabilitative strategies and performance during activities of daily living.

Evaluating a Novel Multifactorial Falls Prevention Activity Programme for Community-Dwelling Older People After Stroke: A Mixed-Method Feasibility Study

Purpose

The overall purpose of this study was to explore participants’ and physiotherapists’ experiences regarding the acceptability, implementation, and practicality of a novel group-based multifactorial falls prevention activity programme for community-dwelling older people after stroke. Specifically, the purpose was to explore if and how participating could impact on the participants’ health-related quality of life (HRQoL) in terms of their daily lived experience regarding physical, mental, emotional and social well-being. A secondary purpose was to explore whether participating in the programme could positively influence participants’ balance, strength, falls efficacy, mobility and motor impairment of the trunk.

Materials and Methods

This was an exploratory mixed-method Phase I feasibility study. A convenience sample of five older community-dwelling people after stroke participated in a novel eight-week multifactorial activity programme which included falls education, a mix of individually tailored and group-based strength and balance exercises, exploring limits of stability and safe landing techniques and a social element. Qualitative data from post-intervention interview transcripts with the participants and the physiotherapists who delivered the programme were thematically analysed using both deductive and inductive approaches to explore the participants’ and therapists’ experiences with the programme. Quantitative outcomes included balance, strength, falls efficacy, mobility and motor impairment of the trunk.

Results

The programme was deemed feasible in terms of acceptability, implementation and practicality by the participants as well as the physiotherapists delivering the programme. The overarching theme regarding HRQoL identified that participating in the programme was perceived to empower the participants living with stroke and positively influenced their daily physical, mental, emotional and social well-being. Participant outcomes showed a change in the direction of improvements in balance, strength, mobility, motor impairment of the trunk and reduced concerns about falling. Subjectively, participants only reported perceived improvements in balance and strength.

Conclusion

Running a novel multifactorial falls prevention activity programme for older community-dwelling people after stroke was feasible. Participating in the programme helped participants to perceive improved balance, strength and empower them to make meaningful changes, improving their daily lived experiences. A future fully powered study could build on these results to investigate physical improvements, prevention of falls and improvements to domains of HRQoOL.

Stakeholder perspectives of fall prevention for older Australians with vision impairment: "it's just a matter of adapting them accordingly"

AIM

To investigate stakeholders' perspectives of fall prevention programs for older adults with vision impairment.

METHODS

Twenty-two stakeholders (client facing professionals, service managers, and policy makers), with expertise in fall prevention or vision impairment, from organisations in south-eastern Australia, participated in this study. Individual semi-structured interviews were conducted over-the-phone (n = 19) and face-to-face (n = 3), and analysed deductively using content analysis into the following system level factors for health promotion interventions seen within the behaviour change wheel: Fiscal measures; Guidelines; Communication and marketing; and Service provision.

RESULTS

Five key themes were identified: (1) insufficient guidelines or referral pathways; (2) ongoing funding to secure service delivery and best practice implementation; (3) marketing approach: honouring consumer's perceptions of themselves; (4) practical suggestions for program delivery; and (5) incorporation into existing services. Stakeholders considered fall prevention for those with vision impairment as essential in preventative healthcare, but did not have a clear understanding of where to refer or how to deliver a fall prevention service for this population.

CONCLUSIONS

This study supports the delivery of fall prevention programs in older adults with vision impairment, but highlights the need to incorporate stakeholder perspectives into the design and delivery of such programs to ensure barriers to implementation in real world settings.Implications for RehabilitationOlder adults with vision impairment are at a high risk of falls but currently have very little access to fall prevention programs.Results support the delivery of fall prevention programs to older adults with vision impairment through existing services, as long as professionals are provided with adequate service delivery guidelines, referral pathways, and fall prevention specific education and professional development opportunities.A variety of service provision, such as group and home-based programs, or using technology, may be cost-effective and improve older adults with vision impairments' adherence to fall prevention programs.