The effects of a long-term care walking program on balance, falls and well-being
1 School of Rehabilitation Sciences, McMaster University, 1400 Main Street West, 403/E, Hamilton, Ontario, L8S 1C7, Canada
2 Department of Community Health & Epidemiology, College of Medicine, 103 Hospital Drive, Royal University Hospital, Saskatoon, SK, S7N 0W8, Canada
3 Department of Psychiatry, College of Medicine, 103 Hospital Drive, Saskatoon City Hospital, 701 Queen Street, Saskatoon, Saskatchewan, S7K 0M7, Canada
4 Department of Community Health Sciences, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, R3E 0W3, Canada
5 School of Physical Therapy, University of Saskatchewan, 1124 College Drive, Saskatoon, Saskatchewan, S7N 0W3, Canada
6 Department of Psychology, University of Regina, Regina, Saskatchewan, S4S 0A2, Canada
BMC Geriatrics 2012, 12:76 doi:10.1186/1471-2318-12-76Published: 18 December 2012
The effects of a regular and graduated walking program as a stand-alone intervention for individuals in long-term care are unclear. Exercise and fall prevention programs typically studied in long-term care settings tend to involve more than one exercise mode, such as a combination of balance, aerobic, strengthening, and flexibility exercises; and, measures do not always include mental health symptoms and behaviors, although these may be of even greater significance than physical outcomes.
We are randomly assigning residents of long-term care facilities into one of three intervention groups: (1) Usual Care Group - individuals receive care as usual within their long-term care unit; (2) Interpersonal Interaction Group - individuals receive a comparable amount of one-on-one stationary interpersonal interaction time with study personnel administering the walking program; and, (3) Walking Program Group – individuals participate in a supervised, progressive walking program five days per week, for up to half an hour per day. Assessments completed at baseline, 2 and 4 months during intervention, and 2 and 4 months post-intervention include: gait parameters using the GAITRite® computerized system, grip strength, the Berg Balance Scale, the Senior Fitness Test, the Older Adult Resource Services Physical Activities of Daily Living, the Geriatric Depression Scale Short Form, the Cornell Scale for Depression in Dementia, the Revised Memory and Behavior Problems Checklist, the Short Portable Mental Status Questionnaire, the Coloured Analogue Scale, pain assessment scales, and the number and nature of falls. Sophisticated data analytic procedures taking into account both the longitudinal nature of the data and the potential for missing data points due to attrition, will be employed.
Residents in long-term care have a very high number of comorbidities including physical, mental health, and cognitive. The presence of dementia in particular makes standardized research protocols difficult to follow, and staff shortages, along with inconsistencies related to shift changes may impact on the accuracy of caregiver-rated assessment scales. Practical challenges to data collection validity and maintenance of inter-rater reliability due to the large number of research staff required to implement the interventions at multiple sites are also posed.