October 2019

Bilateral Custom AFOs Reduce Fear of Falling, Up Physical Activity

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By Robert Sberna

For older adults who have fears about falling, the daily use of custom-made ankle-foot orthoses (AFOs) with walking shoes is effective in improving balance and reducing fear of falls, according to a recent study published in the journal Gerontology.

In the elderly population, falls are a particularly serious problem. According to the US Centers for Disease Control and Prevention, about 3 million older patients are treated in emergency rooms for fall injuries each year. As the leading cause of injury-related deaths for older adults, falls by the elderly cost the U.S. healthcare system about $50 billion annually.

Ankle-foot orthoses (AFOs) are commonly prescribed for pathological conditions affecting joint stability, positioning, pressure distribution, and neuromuscular insufficiencies. Past studies have shown that wearing bilateral custom-made AFOs can immediately improve the postural stability of older adults during balance assessments performed in a laboratory environment. However, the benefits of daily use of custom-made AFOs were not evaluated.

In the 6-month trial reported here, conducted at the Baylor College of Medicine by the Interdisciplinary Consortium on Advanced Motion Performance (iCAMP) group, researchers studied 44 older adults who had a self-reported concern about falling or were at risk for falling (confirmed by either a fall in the past 6 months or a score of 13 seconds or more in the Timed Up and Go [TUG] test).

The iCAMP research team aimed to evaluate whether the daily use of  custom-made AFOs plus walking shoes could lead to improvement in balance (reduction in postural sway) as compared to walking shoes alone. Researchers hypothesized that enhancing balance could reduce fear of falling and increase the level of physical activity. The study participants were randomly divided into two separate groups: A control group (mean age 75) provided with fitted walking shoes; and an intervention group (mean age 73) provided with fitted walking shoes and bilateral AFOs with custom-made footplates (Moore Balance Brace™).

To determine baseline measurements, TUG and Alternate-Step tests were conducted to assess mobility performance and lateral stability. In addition, the participants’ fear of falling was measured using the Fall Efficacy Scale–International (FES–I). Balance and gait performance were assessed using validated wearable sensor platforms.

Balance and gait were reassessed at intervals of 3, 6 and 12 months. Physical activity and FES-I were reassessed at 6 and 12 months. However, the publication focused only on changes in balance, FES-I, and physical activity between the baseline and the 6-month follow-up.

Results show that daily use of the custom-made AFO and walking shoes significantly decreased upright postural sway in the IG; on average, sway was reduced by 54.9% from baseline to the 6-month reassessment.

The IG also showed a significant reduction in the fear of falling, with a nonsignificant but noticeable positive trend in physical activity, as compared to baseline measurements. The authors suggested the increase in physical activity may be explained by the reduced fear of falling during activities of daily living. Additionally, 79% of the IG participants perceived the AFOs plus walking shoes to be useful and 93% of the participants perceived the AFOs plus walking shoes to be easy to use.

Robert Sberna is a freelance writer in Northeast Ohio.

Source: Wang C, Goel R, Rahemi H, Zhang Q, Lepow B, Najafi B. Effectiveness of daily use of bilateral custom-made ankle-foot orthoses on balance, fear of falling, and physical activity in older adults: a randomized controlled trial. Gerontology. 2019; 65(3):299–307.

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