Visually Impaired OLder people's Exercise programme for falls prevenTion (VIOLET): a feasibility study

N. Adams, D. Skelton, C. Bailey, D. Howel, D. Coe, R. Lampitt, J. Wilkinson, T. Fouweather, L.D. De Jong, S. Gawler, V. Deary, J. Gray, H. Waterman, S.W. Parry

Research output: Book/ReportCommissioned report

Abstract

Background
The visually impaired have a higher risk of falling and are likely to avoid activity.

Objectives
To adapt the existing Falls Management Exercise (FaME) programme, which is delivered in the community, for visually impaired older people (VIOP) and to investigate the feasibility of conducting a definitive randomised controlled trial of this adapted intervention.

Design
Phase I – consultation with stakeholders to adapt the existing programme. Two focus groups were conducted, each with 10 VIOP across the study sites. Phase II – two-centre randomised pilot trial and economic evaluation of the adapted programme for VIOP versus usual care. Phases III and IV – qualitative interviews with VIOP and Postural Stability Instructors regarding their views and experiences of the research process, undertaking the intervention and its acceptability.

Intervention
This was adapted from the group-based FaME programme. A 1-hour exercise programme ran weekly over 12 weeks at the study sites (Newcastle upon Tyne and Glasgow) and was delivered by third-sector organisations. Participants were advised to also exercise at home for 2 hours per week. Those randomised to the usual activities group received no intervention.

Outcome measures
These were completed at baseline, week 12 and week 24. The primary potential outcome measure used was the Short Form Falls Efficacy Scale – International. Secondary outcome assessment measures were activity avoidance, current activity, balance/falls risk, physical activity, loneliness, anxiety and depression, work and social adjustment, quality of life and economic costs. Participants’ compliance was assessed by reviewing attendance records and self-reported compliance with the home exercises. Instructors’ compliance with the course content (fidelity) was assessed by a researcher attending a sample of exercise sessions. Adverse events were collected in a weekly telephone call for all participants in both the intervention and control arm.

Findings
An adapted exercise programme was devised with stakeholders. In the pilot trial, 82 participants drawn from community-living VIOP were screened, 68 met the inclusion criteria and 64 were randomised, with 33 allocated to the intervention and 31 to the usual activities arm. A total of 94% of participants provided data at week 12 and 92% at week 24. Adherence to the study was high. The intervention was found to be both safe and acceptable to participants, with 76% attending nine or more classes. Median time for home exercise was 50 minutes per week. There was little or no evidence that fear of falling, exercise, attitudinal or quality-of-life outcomes differed between trial arms at follow-up. Thematic analysis of the interviews with VIOP participants identified facilitators of and barriers to exercise, including perceived relevance to health, well-being and lifestyle, social interaction, self-perception and practical assistance. Instructors identified issues regarding level of challenge and assistance from a second person.

Limitations
The small sample size and low falls risk of the study sample are study limitations.

Conclusion
Although adaptation, recruitment and delivery were successful, the findings (particularly from qualitative research with instructors and participants) indicated that VIOP with low to moderate falls risk could be integrated into mainstream programmes with some adaptations. A future definitive trial should consider graduated exercises appropriate to ability and falls risk within mainstream provision. Other outcome measures may additionally be considered.
Original languageEnglish
Commissioning bodyNational Institute for Health Research
Number of pages178
Volume7
Edition4
ISBN (Electronic)2050-439X
DOIs
Publication statusPublished - 6 Feb 2019

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Feasibility Studies
Outcome Assessment (Health Care)
Accidental Falls
Quality of Life
Interviews
Social Adjustment
Loneliness
Aptitude
Qualitative Research
Interpersonal Relations
Focus Groups
Telephone
Self Concept
Sample Size
Compliance
Fear
Cost-Benefit Analysis
Life Style
Referral and Consultation
Anxiety

Keywords

  • visual impairment
  • falls management exercise
  • falls prevention
  • feasibility study
  • RCT

Cite this

Adams, N. ; Skelton, D. ; Bailey, C. ; Howel, D. ; Coe, D. ; Lampitt, R. ; Wilkinson, J. ; Fouweather, T. ; De Jong, L.D. ; Gawler, S. ; Deary, V. ; Gray, J. ; Waterman, H. ; Parry, S.W. / Visually Impaired OLder people's Exercise programme for falls prevenTion (VIOLET): a feasibility study. 4 ed. 2019. 178 p.
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title = "Visually Impaired OLder people's Exercise programme for falls prevenTion (VIOLET): a feasibility study",
abstract = "BackgroundThe visually impaired have a higher risk of falling and are likely to avoid activity.ObjectivesTo adapt the existing Falls Management Exercise (FaME) programme, which is delivered in the community, for visually impaired older people (VIOP) and to investigate the feasibility of conducting a definitive randomised controlled trial of this adapted intervention.DesignPhase I – consultation with stakeholders to adapt the existing programme. Two focus groups were conducted, each with 10 VIOP across the study sites. Phase II – two-centre randomised pilot trial and economic evaluation of the adapted programme for VIOP versus usual care. Phases III and IV – qualitative interviews with VIOP and Postural Stability Instructors regarding their views and experiences of the research process, undertaking the intervention and its acceptability.InterventionThis was adapted from the group-based FaME programme. A 1-hour exercise programme ran weekly over 12 weeks at the study sites (Newcastle upon Tyne and Glasgow) and was delivered by third-sector organisations. Participants were advised to also exercise at home for 2 hours per week. Those randomised to the usual activities group received no intervention.Outcome measuresThese were completed at baseline, week 12 and week 24. The primary potential outcome measure used was the Short Form Falls Efficacy Scale – International. Secondary outcome assessment measures were activity avoidance, current activity, balance/falls risk, physical activity, loneliness, anxiety and depression, work and social adjustment, quality of life and economic costs. Participants’ compliance was assessed by reviewing attendance records and self-reported compliance with the home exercises. Instructors’ compliance with the course content (fidelity) was assessed by a researcher attending a sample of exercise sessions. Adverse events were collected in a weekly telephone call for all participants in both the intervention and control arm.FindingsAn adapted exercise programme was devised with stakeholders. In the pilot trial, 82 participants drawn from community-living VIOP were screened, 68 met the inclusion criteria and 64 were randomised, with 33 allocated to the intervention and 31 to the usual activities arm. A total of 94{\%} of participants provided data at week 12 and 92{\%} at week 24. Adherence to the study was high. The intervention was found to be both safe and acceptable to participants, with 76{\%} attending nine or more classes. Median time for home exercise was 50 minutes per week. There was little or no evidence that fear of falling, exercise, attitudinal or quality-of-life outcomes differed between trial arms at follow-up. Thematic analysis of the interviews with VIOP participants identified facilitators of and barriers to exercise, including perceived relevance to health, well-being and lifestyle, social interaction, self-perception and practical assistance. Instructors identified issues regarding level of challenge and assistance from a second person.LimitationsThe small sample size and low falls risk of the study sample are study limitations.ConclusionAlthough adaptation, recruitment and delivery were successful, the findings (particularly from qualitative research with instructors and participants) indicated that VIOP with low to moderate falls risk could be integrated into mainstream programmes with some adaptations. A future definitive trial should consider graduated exercises appropriate to ability and falls risk within mainstream provision. Other outcome measures may additionally be considered.",
keywords = "visual impairment, falls management exercise, falls prevention, feasibility study, RCT",
author = "N. Adams and D. Skelton and C. Bailey and D. Howel and D. Coe and R. Lampitt and J. Wilkinson and T. Fouweather and {De Jong}, L.D. and S. Gawler and V. Deary and J. Gray and H. Waterman and S.W. Parry",
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Adams, N, Skelton, D, Bailey, C, Howel, D, Coe, D, Lampitt, R, Wilkinson, J, Fouweather, T, De Jong, LD, Gawler, S, Deary, V, Gray, J, Waterman, H & Parry, SW 2019, Visually Impaired OLder people's Exercise programme for falls prevenTion (VIOLET): a feasibility study. vol. 7, 4 edn. https://doi.org/10.3310/phr07040

Visually Impaired OLder people's Exercise programme for falls prevenTion (VIOLET): a feasibility study. / Adams, N.; Skelton, D.; Bailey, C.; Howel, D.; Coe, D.; Lampitt, R.; Wilkinson, J.; Fouweather, T.; De Jong, L.D.; Gawler, S.; Deary, V.; Gray, J.; Waterman, H.; Parry, S.W.

4 ed. 2019. 178 p.

Research output: Book/ReportCommissioned report

TY - BOOK

T1 - Visually Impaired OLder people's Exercise programme for falls prevenTion (VIOLET): a feasibility study

AU - Adams, N.

AU - Skelton, D.

AU - Bailey, C.

AU - Howel, D.

AU - Coe, D.

AU - Lampitt, R.

AU - Wilkinson, J.

AU - Fouweather, T.

AU - De Jong, L.D.

AU - Gawler, S.

AU - Deary, V.

AU - Gray, J.

AU - Waterman, H.

AU - Parry, S.W.

PY - 2019/2/6

Y1 - 2019/2/6

N2 - BackgroundThe visually impaired have a higher risk of falling and are likely to avoid activity.ObjectivesTo adapt the existing Falls Management Exercise (FaME) programme, which is delivered in the community, for visually impaired older people (VIOP) and to investigate the feasibility of conducting a definitive randomised controlled trial of this adapted intervention.DesignPhase I – consultation with stakeholders to adapt the existing programme. Two focus groups were conducted, each with 10 VIOP across the study sites. Phase II – two-centre randomised pilot trial and economic evaluation of the adapted programme for VIOP versus usual care. Phases III and IV – qualitative interviews with VIOP and Postural Stability Instructors regarding their views and experiences of the research process, undertaking the intervention and its acceptability.InterventionThis was adapted from the group-based FaME programme. A 1-hour exercise programme ran weekly over 12 weeks at the study sites (Newcastle upon Tyne and Glasgow) and was delivered by third-sector organisations. Participants were advised to also exercise at home for 2 hours per week. Those randomised to the usual activities group received no intervention.Outcome measuresThese were completed at baseline, week 12 and week 24. The primary potential outcome measure used was the Short Form Falls Efficacy Scale – International. Secondary outcome assessment measures were activity avoidance, current activity, balance/falls risk, physical activity, loneliness, anxiety and depression, work and social adjustment, quality of life and economic costs. Participants’ compliance was assessed by reviewing attendance records and self-reported compliance with the home exercises. Instructors’ compliance with the course content (fidelity) was assessed by a researcher attending a sample of exercise sessions. Adverse events were collected in a weekly telephone call for all participants in both the intervention and control arm.FindingsAn adapted exercise programme was devised with stakeholders. In the pilot trial, 82 participants drawn from community-living VIOP were screened, 68 met the inclusion criteria and 64 were randomised, with 33 allocated to the intervention and 31 to the usual activities arm. A total of 94% of participants provided data at week 12 and 92% at week 24. Adherence to the study was high. The intervention was found to be both safe and acceptable to participants, with 76% attending nine or more classes. Median time for home exercise was 50 minutes per week. There was little or no evidence that fear of falling, exercise, attitudinal or quality-of-life outcomes differed between trial arms at follow-up. Thematic analysis of the interviews with VIOP participants identified facilitators of and barriers to exercise, including perceived relevance to health, well-being and lifestyle, social interaction, self-perception and practical assistance. Instructors identified issues regarding level of challenge and assistance from a second person.LimitationsThe small sample size and low falls risk of the study sample are study limitations.ConclusionAlthough adaptation, recruitment and delivery were successful, the findings (particularly from qualitative research with instructors and participants) indicated that VIOP with low to moderate falls risk could be integrated into mainstream programmes with some adaptations. A future definitive trial should consider graduated exercises appropriate to ability and falls risk within mainstream provision. Other outcome measures may additionally be considered.

AB - BackgroundThe visually impaired have a higher risk of falling and are likely to avoid activity.ObjectivesTo adapt the existing Falls Management Exercise (FaME) programme, which is delivered in the community, for visually impaired older people (VIOP) and to investigate the feasibility of conducting a definitive randomised controlled trial of this adapted intervention.DesignPhase I – consultation with stakeholders to adapt the existing programme. Two focus groups were conducted, each with 10 VIOP across the study sites. Phase II – two-centre randomised pilot trial and economic evaluation of the adapted programme for VIOP versus usual care. Phases III and IV – qualitative interviews with VIOP and Postural Stability Instructors regarding their views and experiences of the research process, undertaking the intervention and its acceptability.InterventionThis was adapted from the group-based FaME programme. A 1-hour exercise programme ran weekly over 12 weeks at the study sites (Newcastle upon Tyne and Glasgow) and was delivered by third-sector organisations. Participants were advised to also exercise at home for 2 hours per week. Those randomised to the usual activities group received no intervention.Outcome measuresThese were completed at baseline, week 12 and week 24. The primary potential outcome measure used was the Short Form Falls Efficacy Scale – International. Secondary outcome assessment measures were activity avoidance, current activity, balance/falls risk, physical activity, loneliness, anxiety and depression, work and social adjustment, quality of life and economic costs. Participants’ compliance was assessed by reviewing attendance records and self-reported compliance with the home exercises. Instructors’ compliance with the course content (fidelity) was assessed by a researcher attending a sample of exercise sessions. Adverse events were collected in a weekly telephone call for all participants in both the intervention and control arm.FindingsAn adapted exercise programme was devised with stakeholders. In the pilot trial, 82 participants drawn from community-living VIOP were screened, 68 met the inclusion criteria and 64 were randomised, with 33 allocated to the intervention and 31 to the usual activities arm. A total of 94% of participants provided data at week 12 and 92% at week 24. Adherence to the study was high. The intervention was found to be both safe and acceptable to participants, with 76% attending nine or more classes. Median time for home exercise was 50 minutes per week. There was little or no evidence that fear of falling, exercise, attitudinal or quality-of-life outcomes differed between trial arms at follow-up. Thematic analysis of the interviews with VIOP participants identified facilitators of and barriers to exercise, including perceived relevance to health, well-being and lifestyle, social interaction, self-perception and practical assistance. Instructors identified issues regarding level of challenge and assistance from a second person.LimitationsThe small sample size and low falls risk of the study sample are study limitations.ConclusionAlthough adaptation, recruitment and delivery were successful, the findings (particularly from qualitative research with instructors and participants) indicated that VIOP with low to moderate falls risk could be integrated into mainstream programmes with some adaptations. A future definitive trial should consider graduated exercises appropriate to ability and falls risk within mainstream provision. Other outcome measures may additionally be considered.

KW - visual impairment

KW - falls management exercise

KW - falls prevention

KW - feasibility study

KW - RCT

U2 - 10.3310/phr07040

DO - 10.3310/phr07040

M3 - Commissioned report

SN - 2050-4381

VL - 7

BT - Visually Impaired OLder people's Exercise programme for falls prevenTion (VIOLET): a feasibility study

ER -