An introduction to exercise-based interventions for improving balance and preventing falls among community dwelling older adults

An introduction to exercise-based interventions for improving balance and preventing falls among community dwelling older adults

A guide for first year physical therapy students

by Caitlin Gallagher, SPT

How my capstone project came to be…

There were several driving forces behind the development of my capstone project. In the first year of the program I identified a desire among my fellow DPT students to have greater exposure to clinical interventions prior to beginning the first clinical experience at the end of the first year. I knew that I would need to refine and specify the scope of my capstone project, however I decided early on that I wanted to share intervention-based information with first year students in preparation for their first clinical rotation.

During my second year of PT school, I developed a strong interest in working with older adults, especially in the context of active aging. I found myself repeatedly coming back to the mantra that aging is not synonymous with decline. In the spring of my second year I was lucky to have a wonderful clinical experience at a continuing care retirement community where I had ample opportunity to work with older adults. During that clinical rotation I really enjoyed treating patients who had balance impairments and I was intrigued by the many ways physical therapists can intervene to improve balance and prevent falls among older adults. I became particularly interested in understanding how well balance practice translates into functional gains. I found myself challenging my patients with cognitive tasks during their balance and gait activities to simulate real-world demands, and I became curious about the effectiveness of dual task balance interventions in the older population. These experiences helped me to form the clinical question for my Critically Appraised Topic (CAT) in Evidence-Based Practice II in the fall of the third year.

Clinical Question: For a community dwelling older adult (60 yrs or older) with an identified increased risk of falls, is dual-task balance training as effective or more effective at reducing falls risk, as compared to single task balance training?

For those of you interested in the topic, I have made my CAT available.

Over the last year I have also had a growing interest in teaching, and I would like to be involved in the education of physical therapy students as my career develops. The final capstone project presented a wonderful opportunity for me to develop an interest in teaching whilst providing first year physical therapy students with a stronger background in physical therapy interventions. Specifically, I felt that interventions related to fall prevention and older adults would be particularly relevant given the aging population. A survey completed by 49 current second and third year students confirmed a need for guidance related to interventions for balance and fall prevention among older adults.

Survey results

51% reported they saw older individuals/individuals at risk of falls “very often” during their first clinical

35% reported they saw older individuals/individuals at risk of falls “sometimes” during their first clinical

14% reported seeing older individuals/individuals at risk of falls either “rarely” or “never” during their first clinical

94% of the students surveyed felt that a brief, simple introduction to balance interventions would have been helpful to prepare for the first clinical rotation

These survey results suggested that an introduction to balance interventions would be well received by first year students. The dual task focus of my CAT was too detailed to be appropriate for first year students, however it served as a great starting point for developing an educational module related to exercise based interventions for improving balance and preventing falls among older adults.

The Project

The educational module that I developed for my capstone project includes a Voicethread presentation, a summary handout, and a short series of discussion board posts. The Voicethread includes a brief review of physiologic changes related to aging and falls risk factors, an overview of the evidence behind exercise based interventions for improving balance and preventing falls, and considerations for the long term planning of exercise-based fall prevention. At the end of the Voicethread there is a short case scenario that demonstrates application of the topics. The summary handout is meant to be a quick reference for the major topics covered in the Voicethread. The discussion board posts are designed to allow students to practice selecting appropriate interventions based on case scenarios.   The module was integrated into the course: Motor Development and Human Movement Across the Lifespan (PHYT 701). Students are able to access the materials online and complete the module over the course of a couple of weeks. The timing of the module coincides with the course content related to aging, and the final discussion post requires students to apply the material from the module to the Adult and Older Adult Movement Lab.

Evaluation and self-reflection

In an effort to make my educational module more user-friendly, I reviewed “Keys to designing effective presentations” by Margaret Plack.  I have included a short description of my application of presentation guidelines and strategies for this educational module.

Students were asked to complete a post module survey, to assist in revising the module for future use.  The results of the survey and feedback from the students is described in the Evaluation document.

Overall, it seems as though the module was well received, however, if I am given the opportunity to implement it again, I would make several changes based on the feedback I have received from students. First, I would love to have part of this module be delivered in an in-person format, however that was not a feasible option at this time. I think a live presentation and case scenario discussion would alleviate some of the criticisms surrounding the Voicethread, and it be an opportunity to have more interaction with the students. If a Voicethread were used in the future, I would record it again, at a slightly faster pace, editing out any redundant comments and possibly inserting video clips/links of various exercise progressions or formats (tai chi, etc). For the discussion posts, I would change the final “older adult lab post” into a group post or I might work with the course instructor to have a question included in the lab write-up, so that student’s could complete it more easily and in a collaborative manner.   Also, I think it would be helpful to have multiple cases on the initial and response discussion posts, so that students can apply the concepts in different ways without feeling like it is redundant busy work (everyone answering about the same case).   Also, many of the students worked with very active, healthy older adults in the older adult lab, so additional cases may be beneficial to apply the concepts in more “realistic patients”.

My capstone project has been a wonderful learning experience for me. I have a newfound appreciation for the effort that is required to create a useful and comprehensive teaching module. I have appreciated the opportunity to utilize teaching tools such as Voicethread and Sakai discussion board postings. Additionally, I have gained greater appreciation for how to develop instructional materials in a way that effectively reaches the target audience. This has also been an opportunity for me to receive constructive criticism and to evaluate how to better meet the needs of students. I hope that this is just the first of many teaching experiences for me!

Acknowledgements

I would like to say a big thank you to my committee members Andy Blackburn and Carol Giuliani for sharing their expertise in working with older adults, and for helping me to develop a project that was clinically relevant and appropriate for first year students. Also, thank you to my advisor Karen McCulloch who helped me create a cogent plan for implementing my project. I would also like to thank Melissa Scales for allowing me to integrate this project into her course this spring (PHYT 701)- I appreciate that you were flexible and willing to make sure this module fit in well with the older adult content of the course.   Finally, thank you to the UNC DPT students in the Class of 2017 for allowing me to share my capstone project with you!