A comparison of outcomes associated with adding a home-based exercise program via two home visits, to a group exercise program and home exercise program for clients attending outpatient rehabilitation with balance deficits.

INTERVENTION: The intervention group received usual care (see in control treatment) and two home visits to individually tailor a home exercise program which was provided and shown to them at their home. They received a visit from a physiotherapist who was not involved in delivering any of the exercise groups. The physiotherapist chose suitable exercises from a subset of the Otago Balance Program (Campbell et al, 1997) based on the participant’s assessment results. Exercises included things such as sit to stand, 1/4 squats, calf rasies, toe raises, sideways walking, leg curl, standing hip abduction, single leg stand, walking, walking and turning around, heel/toe standing, heel/toe walking, heel walking, toe walking and stair walking. The initial home visit was conducted the week before or after commencing usual care, and was followed by a visit between weeks four and five of the intervention to continue to motivate the participant, encourage adherence with the home exercise program, and to follow up and progress the home exercise program as necessary. Participants were shown the exercise in their home environment, received a written copy of their exercises, and were asked to complete an exercise diary each day to record which exercises were completed. They were asked to complete exercises for between 30 mins to 1 hour per day from the time of the first home visit until the 3 month follow‐up asessment. Home visit were approximately 1 hour in duration. CONDITION: Decreased balance/falls PRIMARY OUTCOME: Balance Outcome Measure for Elder Rehabilitation (BOOMER) ; The BOOMER is a combination of four clinical balance tests: the step test, Timed Up and Go test, Functional Reach Test, and static standing balance with feet together and eyes closed. The step test assesses participant’s ability to place one foot onto a 7.5‐cm‐high step and then back down to the floor repeatedly, as fast as possible, for 15 seconds. The score is the number of steps completed in the 15‐second period for each lower extremity (Mercer et al, 2009). An average of 2 trials is recorded. Participants unable to stand unsupported are given a score of 0 for both lower extremities (Mercer et al, 2009). The Timed Up and Go (TUG) test assesses the time that a participant takes to rise from a chair, walk three meters, turn around, walk back to the chair, and sit down. The Functional Reach test assesses the maximum distance participant’s can reach forward while standing in a fixed position.Two practice trials are completed and then one trial with distance recorded. The Static Standing with feet together and eyes closed test assesses the time a participant can stand unsupported with their feet together and eyes closed to a maximum of 30 seconds. Three trials are completed. However, if a participant achieves 30 seconds on the first trial, remaining trials are automatically scored as 30 seconds. Times from three trials are added together. A score out of sixteen is determined by scoring each item out of four according to the table below. Refer to attachement with table illustrating the scoring system used. ; The test takes approximately 10 minutes to complete. Each component of the test has established reliability and the overall measure has high internal consistency with a minimum clinically significant change of three points (Haines et al 2007). Refer to attachment 1 for BOOMER table of scoring. ; SECONDARY OUTCOME: Force Platform measures of balance ; ; A Neurocom Balance Master (Liston &Brouwer, 1996) will be used and three tests will be performed – 1) Clinical Test of Sensory Interaction of Balance (CTSIB) ‐ which is a test of postural sway of 30 seconds duration, assessing steadiness during standing on a firm surface with eyes open and then eyes closed; then on a foam surface with eyes open and eyes closed; 2) Limits of Stability test – in this test the participant stands and leans in eight different directions as far as possible towards targets (set at straight ahead, to the left, to the right, backwards, and 45 degrees between each of these targets); 3) Step and Quick Turn – where the participant takes two steps, turns then returns to the starting position. This was repeated 3 times turning to the right and then turning to the left. Sit to stand task: ; This is a functional test were participants are asked to stand up and sit down five times as quickly as possible from a 45cm high chair and the time taken to complete the task is documented. Participants are allowed to push up on their arms if required. INCLUSION CRITERIA: Patients were included if they met the following criteria: were clients at the rehabilitation centre and were referred for management of balance and strength problems. Participants were not excluded if their first language was other than English; interpreters were available at the centre for participants from culturally and linguistically diverse backgrounds.