Feasibility and effect of supplementing a modified OTAGO intervention with multisensory balance exercises in older people who fall: a pilot randomized controlled trial

Objective: To investigate the feasibility and comparative effect of supplementing a modified OTAGO falls rehabilitation programme with multisensory balance exercises and informed sample size calculation for a definitive trial.

Design: Single-blinded randomized controlled trial with pre/postcomparisons using a per-protocol analysis.

Setting: Secondary care-based falls clinic, London, UK.

Subjects: Community-dwelling older people (n = 21) experiencing 2 non-syncopal falls during previous 12 months.

Intervention: Modified OTAGO exercise classes supplemented with supervised home-based rehabilitation consisting of multisensory balance or stretching exercises. Group classes and home sessions each occurred twice-weekly for eight weeks.

Measurements: A computerised randomization was used for group allocation. A rater, blinded to intervention, performed the assessment including the Functional Gait Assessment (primary outcome), Physiological Profile Assessment, and questionnaires relating to symptoms, balance confidence, and psychological state (secondary outcomes).

Results: Significant within-group improvements were noted for the Functional Gait (p <0.01, r = -0.63) and Physiological Profile Assessments (p <0.05, r = -0.63) in the OTAGO+multisensory rehabilitation group only and for balance confidence scores in the OTAGO+stretching group (p <0.01, r = -0.63). Between-group differences were noted for the Functional Gait (p <0.01, r = -0.71) and Physiological Profile (p <0.05, r = -0.54) assessments with the OTAGO+multisensory group showing significantly greater improvement. The drop-out rate was similar for both groups (similar to 30%). No serious adverse events were reported.

Conclusions: Supplementing the OTAGO programme with multisensory balance exercises is feasible in older people who fall and may have a beneficial effect on falls risk as measured using the Functional Gait and Short-form Physiological Profile Assessments. An adequately powered randomized controlled trial would require 36 participants to detect an effect size of 1.35 on the Functional Gait Assessment.