The effectiveness of e-interventions on fall, neuromuscular functions and quality of life in community-dwelling older adults: A systematic review and meta-analysis

doi:10.1016/j.ijnurstu.2020.103784

International Journal of Nursing Studies

Volume 113, January 2021, 103784

https://doi.org/10.1016/j.ijnurstu.2020.103784 Get rights and content

Abstract

Background

Falls in older adults result in serious, life-limiting consequences. An increasing number of fall prevention interventions have used technology to reduce the number of falls in community-dwelling adults. Various types of e-interventions are being tested in clinical trials and in the community. These include telehealth, exergames, cognitive games, socialized training, smart home systems and non-conventional balance training. Currently, no systematic review and meta-analysis has assessed the overall effectiveness of e-interventions and compared the effectiveness of the different types.

Objectives

The aim of this review was to synthesize best available evidence concerning the effectiveness of e-interventions on fall, neuromuscular functions and quality of life in community-dwelling older adults.

Methods

A rigorous three-step search was conducted in nine online databases for published and unpublished randomized controlled trials studying e-interventions. Studies were screened and assessed for individual and overall risk of bias by two independent reviewers. Six fall-related outcomes were evaluated in the meta-analysis: fall risk, balance, lower extremity strength, fall efficacy, cognitive function and health-related quality of life. Subgroup and sensitivity analysis were conducted during meta-analysis.

Results

Thirty-one studies fit the eligibility criteria and had an overall 74.7% low risk of bias. A total of 4,877 older adults from 17 countries were included in narrative synthesis and meta-analysis. Telehealth combined with exercise programmes and smart home systems were able to reduce fall risk significantly (risk ratio=0.79, 95% CI [0.72, 0.86]). E-interventions also significantly improved balance and fall efficacy (standardized mean difference=0.28, 95% CI [0.04, 0.53]). However, lower extremity strength, cognitive function and health-related quality of life did not show significant improvements.

Conclusion

Telehealth combined with exercise and smart home systems demonstrated the best evidence of effectiveness in reduction of falls in community-dwelling older adults. Future research should focus on forecasting falls using smart home technology and Artificial Intelligence, and testing promising e-interventions on larger samples to improve the strength of evidence of fall prevention by e-interventions.

Section snippets

What is already known about the topic?

•
Preventing falls in older adults is important to ensure that they can live in a fulfilling and meaningful manner with high quality of life.
•
Both traditional and electronic interventions have shown effectiveness on fall prevention.
•
Currently, there is no systematic review and meta-analysis evaluated the overall effect of different e-interventions for fall prevention.

What this paper adds

•
This review filled in a gap in existing literature by assessing the effectiveness of various types of e-interventions for the prevention of falls in community-dwelling older adults.
•
E-interventions significantly reduce fall incidence, improve balance, fall efficacy. However, e-interventions were not able to significantly improve lower extremity strength, cognitive function or health-related quality of life.
•
Telehealth and exercise, and smart home systems showed the best evidence of effectiveness

Method

This systematic review followed the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) (Moher, Liberati, Tetzlaff, Altman and PRISMA Group, 2009). To prevent duplication of reviews, a search for previous and ongoing systematic reviews (SRs) similar to this study was conducted. This SR has been registered with PROSPERO (CRD42020203930).

Study selection

A total of 1,702 records were gathered from various databases and four from hand searching. After removing duplicates, 1,311 records remained. Screening by two independent authors resulted in 1,017 records removed for not having key words in the title and another 175 records removed for not meeting the inclusion criteria after reading abstracts. Finally, 119 records with corresponding full texts were screened according to the eligibility criteria. Reasons for exclusion are listed in full in the

Discussion on the findings

This review investigated the effectiveness of e-interventions on proportion of fallers, balance, lower extremity strength, fall efficacy, cognitive function, and quality of life among community-dwelling older adults. Six types of e-interventions were reviewed: telehealth, exergames, cognitive games training, NCBT, smart home systems and socialized training. In this review, telehealth significantly improved fall outcomes in decreasing fall risk by 21% compared to controls. The fall risk ratio

Conclusion

This review examined the best available evidence of the effectiveness of various e-interventions in preventing falls in community-dwelling older adults. Six fall-related outcomes were investigated. Limited studies were found for four out of six types of interventions. E-interventions were able to improve four of the six fall-related outcomes. E-interventions significantly reduced fall risk. Balance and fall efficacy scores were significantly improved by e-interventions, barring small effect

Conflict of Interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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À l’ère du développement numérique, le développement récent de jeux d’exercice (exergames) pourrait représenter une alternative d’entraînement efficace pour le contrôle de l’équilibre statique en position debout et l’amélioration de la marche chez la personne âgée saine. L’objectif de cet article était d’évaluer l’acceptation, le niveau de satisfaction et l’utilisabilité des jeux d’exercice par les seniors afin de réduire le risque de chutes.
Au total, 91 seniors luxembourgeois (moyenne (écart-type)) : 68,7 (8,5) ans) ont participé à un atelier de formation d’une seule séance, avec une série de jeux d’exercice délivrés via Nintendo® Wii Fit et une balance d’équilibre statique Wii™ (deux sessions de 20 minutes chacune) et ont rempli divers questionnaires.
Le score moyen au system usability scale était de 72,5 (14,6), ce qui montre un bon usage des jeux d’exercice. Le score moyen au PACES-8 items était de 46,7 (7,7), ce qui équivaut à 83,5 % de satisfaction. Les trois premiers éléments du TAM présentaient un score d’acceptation de 6,0 (1,1) de moyenne générale, mais le score du quatrième élément était de 4,6 (1,6), ce qui laisse penser que les participants étaient moins favorables à utiliser les jeux d’exercice de façon autonome.
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Healthy ageing is a continuous concern in developed countries and new technologies via digitalization are emerging. The recent development of exercise games (exergames) can represent an effective training alternative for balance and gait improvement. The aim of the events was to evaluate the acceptability, satisfaction, and usability of exergames for older adults used as a fall prevention training.
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Citation Excerpt :
Secondly, dance enhances the flexibility and muscle strength of both upper and lower limbs, balance and coordination of movements (Douka et al., 2019). The increased muscle strengths and balance then minimize the risk of fall among elderly individuals (Chan et al., 2020; Chua et al., 2019). Depression is a risk factor for cognitive decline in older adults with mild cognitive impairment (Laird et al., 2018).
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Seven databases were systematically searched from their respective inception dates to 31 March 2020. Relevant randomized controlled trials (RCTs) were screened and assessed for risk of bias. Eight RCTs evaluating dance interventions were included.
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The effectiveness of e-interventions on fall, neuromuscular functions and quality of life in community-dwelling older adults: A systematic review and meta-analysis

Abstract

Background

Objectives

Methods

Results

Conclusion

Section snippets

What is already known about the topic?

What this paper adds

Method

Study selection

Discussion on the findings

Conclusion

Conflict of Interest

J. Am. Med. Dir. Assoc.

J. Nutrition, Health Ageing

Hong Kong J. Occupational Ther.

Appl. Ergon.

Physiotherapy

Arch Phys Med Rehabil

Int. J. Med. Inf.

Lancet North Am. Ed.

J. Physiother.

Intelligence

Arch. Gerontol. Geriatr.

Effects of online group exercises for older adults on physical, psychological and social wellbeing: a randomized pilot trial

PeerJ

Effects of long-term balance training with vibrotactile sensory augmentation among community-dwelling healthy older adults: a randomized preliminary study

J. Neuroeng. Rehab.

Reducing fall risk with combined motor and cognitive training in elderly fallers

Brain Sci.

Evaluation of RESPOND, a patient-centred program to prevent falls in older people presenting to the emergency department with a fall: a randomised controlled trial

PLoS Med.

Measuring balance in the elderly: preliminary development of an instrument

Physiother. Can.

Effects of a falls prevention exercise programme on health-related quality of life in older home care recipients: a randomised controlled trial

Age Ageing

Fall detectors: do they work or reduce the fear of falling?

Housing, Care & Support

Cost-effectiveness of telemedicine in remote orthopedic consultations: randomized controlled trial

J. Med. Internet Res.

Effects of different exercise interventions on risk of falls, gait ability, and balance in physically frail older adults: a systematic review

Rejuvenation Res.

The Effect of Information Communication Technology Interventions on Reducing Social Isolation in the Elderly: A Systematic Review

J. Med. Internet Res.

Effectiveness of cognitive behaviour therapy-based multicomponent interventions on fear of falling among community-dwelling older adults: A systematic review and meta-analysis

J. Adv. Nurs.

Integration of balance and strength training into daily life activity to reduce rate of falls in older people (the LiFE study): randomised parallel trial

The BMJ

A mobile application for improving functional performance and health education in older adults: a pilot study

J. Ageing Sci.

Older adults' motivating factors and barriers to exercise to prevent falls

Scandinavian J. Occupational Ther.

A single postdischarge telephone call by an occupational therapist does not reduce the risk of falling in women after hip fracture: a randomized controlled trial

Eu. J. Phys. Rehab. Med.

Multicomponent physical exercise with simultaneous cognitive training to enhance dual-task walking of older adults: a secondary analysis of a 6-month randomized controlled trial with 1-year follow-up

Clin. Interven. Aging

EQ-5D-5L User Guide

GRADEpro GDTGRADEpro Guideline Development Tool

Fall prediction using behavioural modelling from sensor data in smart homes

Arti. Intel. Rev.

Cognitive training sustainably improves executive functioning in middle-aged industry workers assessed by task switching: a randomized controlled ERP study

Front. Human Neurosci.

Systematic review and meta-analysis: when one study is just not enough

Clin. J. Am. Soc. Nephrol.

Interventions for preventing falls in older people living in the community

Cochrane Database of Syst. Rev.

The importance of trunk muscle strength for balance, functional performance, and fall prevention in seniors: a systematic review

Sports Med.

Literature search for research planning and identification of research problem

Indian J. Anaesthesia

ICT-based system to predict and prevent falls (iStoppFalls): results from an international multicenter randomized controlled trial

Eu. Rev. Aging and Phys. Activity

A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission

The J. Gerontol.

Changes in HRQoL after 12 months of exercise linked to primary care are associated with fitness effects in older adults

Eur. J. Public Health

Effects of traditional physical training and visual computer feedback training in frail elderly patients

Eu. J. Phys. Rehab. Med.