Feasibility and Acceptability of HOLOBalance Compared to Standard Care in Older Adults at Risk for Falls

Aging Clinical Trial

— HOLOBALANCE  

Official title:

A Phase 2 Study to Investigate the Feasibility and Acceptability of the HOLOBalance System Compared to Standard Care in Older Adults at Risk for Falls: a Multi-site Study

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT04053829
• Other study ID #: 76957
• Status: Recruiting
• Phase: N/A
• Start date: September 2020
• Est. completion date: April 2021

Study information

• Verified date: August 2020
• Source: King's College London
• Contact: Matthew Liston, PhD
• Phone: +442078486316
• Email: matthew.liston[@]kcl.ac.uk
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This study will utilise an assessor blinded, randomised controlled design to investigate the acceptability and feasibility of providing a novel tele-rehabilitation balance training system (HOLOBalance) for community dwelling older adults at risk for falls. Older adults (age 65-80) who meet the inclusion criteria (e.g. independently living, no neurological conditions) will be recruited from falls services and from the wider community (via AgeUK) and will be randomly allocated to receive either a prescribed exercise programme delivered by: 1) the HOLOBalance tele-rehabilitation system or 2) an exercise booklet (The OTAGO Home Exercise Programme). Participants will be required to perform a series of prescribed exercises each day (duration of up to 30 minutes per day) for the entirety of the 8-week exercise programme. These exercises will be provided via the HOLOBalance tele-rehabilitation system (intervention arm) or by written instructions (control arm).

Primary objectives for this study are to assess recruitment rate, compliance with exercise programmes (exercise diaries) and drop-out rates within the intervention group and a control group undertaking standard practice, home based balance rehabilitation (the OTAGO Home Exercise Programme) to explore whether HOLOBalance is acceptable to participants. Furthermore, acceptability to older adults will also be investigated via exit interviews performed within the HOLOBalance tele-rehabilitation intervention arm.

Feasibility will be assessed by documenting adverse events (and SAE's), adverse device effects (and SADE's), deviations from protocol and feedback from treating clinicians. Implementation issues such as technology break down, service delivery and usability issues will also be documented. Secondary outcomes to explore trends for effectiveness will investigate performance of both groups at baseline and after the 8 week intervention across a range of outcome measures associated with balance function and falls risk, cognitive function, Physical activity and social participation, and subjective report of mobility and balance.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 120
• Est. completion date: April 2021
• Est. primary completion date: April 2021
• Accepts healthy volunteers: No
• Gender: All
• Age group: 65 Years to 80 Years

Eligibility

Inclusion Criteria:

• Independent community-dwelling participants able to walk 500 meters independently or with a stick

• No significant visual impairment

• Able to understand and to consent to the research

• A score of >22 on the MoCA, i.e. adults with no or mild cognitive impairment;

• At risk of falls (i.e. FGA less than 22/30), have significant fear of falling (FESI short form >10) or having experienced a fall/s in the last 12 months

• Willing to participate and to comply with the proposed training and testing regime.

• Available space of 1x2 metres at home and sufficient home broadband to allow the system to operate as designed

Exclusion Criteria:

• Orthostatic hypotension or uncontrolled hypertension

• Have depression i.e. a score of >10 at the Geriatric depression scale

• Have cognitive impairment as indicated by the MoCA score(score <22)

• Other neurological problem (stroke, Parkinson's, peripheral neuropathy)

• Acute musculo-skeletal injury that prevents participation in a structured exercise programme (e.g. lower limb fracture)

• No internet connection at home

• Has participated in a clinical drug trial in the past 6 months

• Currently receiving falls and/or cognitive rehabilitation.

• Has an implanted medical device or cardiac pacemaker

Related Conditions & MeSH terms

• Accidental Falls
• Aging
• Vestibular Diseases
• Vestibular Disorder

Intervention

Device:
• HOLOBalance
The HOLOBalance tele-rehabilitation system will be used to deliver an evidence based, multi-sensory balance rehabilitation programme to participants, and will deliver a series of exercises prescribed by an expert balance physiotherapist following an initial balance assessment. The HOLOBalance system will use a head mounted augmented reality display to deliver exercises and games to participants and will record task performance via a combination of body worn sensors and a depth camera. The HOLOBalance tele-rehabilitation system will provide feedback to the supervising clinical team regarding task performance, participant usage and user feedback. The system will have daily presence in the users' home with users expected to complete their prescribed rehabilitation on a daily basis, which mirrors the prescribed exercise routines often provided by balance physiotherapists.

Other:
• OTAGO Home Exercise Programme
The OTAGO is a systematic, progressive strength and balance training programme and is supported by a comprehensive workbook that provides written and pictorial instructions for each exercise. It is well-established and widely used in clinical practice in the UK, and has been shown to reduce falls rate in older adults by 35-40%. It is well tolerated in older adults in community settings with good adherence rates.The OTAGO has also been used as the standard intervention in previous investigations of MSR interventions in older adults. To match intervention and control interventions, participants in the OTAGO group will be asked to complete the OTAGO programme every day for the duration of the 8 week programme.

Locations

Country	Name	City	State
United Kingdom	King's College London	London

Sponsors (7)

Lead Sponsor	Collaborator
King's College London	Horizon 2020 - European Commission, Roessingh Research and Development, University College, London, University Hospital Freiburg, University of Athens, University of Ioannina

Country where clinical trial is conducted

United Kingdom, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Acceptability Assessment 1: Recruitment Rate	Assessment of recruitment rate of study (% of eligible participants enrolled)	Through study completion (12 months)
Primary	Acceptability Assessment 2: Programme Compliance	Comparison of compliance with exercise programmes (% of sessions completed) within the intervention group and a control group undertaking standard practice, home based balance rehabilitation (the OTAGO Home Exercise Programme).	Through study completion (12 months)
Primary	Acceptability Assessment 3: Drop out rate	Comparison of drop-out rates (%) between the intervention group and a control group undertaking standard practice, home based balance rehabilitation (the OTAGO Home Exercise Programme).	Through study completion (12 months)
Primary	Acceptability 4: Qualitative interview	Acceptability of HOLOBalance to older adults will be investigated via exit interviews performed within the tele-rehabilitation intervention arm.	Collected at end of each participants participation in the study (After 8 weeks)
Primary	Feasibility of providing HOLOBalance 1: Monitoring of Adverse and Serious Adverse Events	Feasibility will be assessed by documenting adverse events (and SAE's) and adverse device effects (and SADE's).	Through study completion (12 months)
Primary	Feasibility of providing HOLOBalance 2: Monitoring for deviations from study protocol	Assessment of any deviations from protocol reported logged in the site files using the deviation from protocol form.	Through study completion (12 months)
Secondary	Balance Function Assessment	Functional Gait Assessment. This is a 10-item test that assesses performance on complex gait tasks (e.g. walking with head turns or stopping and turning). Each item is rated on a 4 point scale (0-3) with higher scores indicating better task performance.	Baseline (Week 0) and Follow up (Week 9)
Secondary	Balance Function Assessment	Mini-BESTest. This is a 14-item test that assesses dynamic balance components including anticipatory postural adjustments, reactive postural control, sensory orientation and dynamic gait. The 14 items are scored on a 3 point scale (0-2), with a maximum score of 28 points awarded. Higher scores indicate better task performance.	Baseline (Week 0) and Follow up (Week 9)
Secondary	Cognitive Function Assessment	Montreal Cognitive Assessment. This test includes sections on visuospatial/executive function (alternating trail-making, cube copy, clock drawing), naming (lion, rhinoceros, camel), attention (forward and backward digit span, tapping to the letter A, subtracting 7s from 100), language (sentence repetition, letter fluency), abstraction (similarities between train and bicycle, watch and ruler), memory (delayed verbal recall of 5 words) and orientation to time and place (6 questions)	Baseline (Week 0) and Follow up (Week 9)
Secondary	Cognitive Function Assessment	Cambridge Neuropsychological Test Automated Battery (CANTAB). The test battery includes: (i) Motor screening task to assess a participant's general ability to understand and complete tasks and highlights if any sensorimotor or hearing impairments will have an impact on test performance, (ii) Paired Associated Learning assesses visual associative learning and memory, (iii) Spatial Working Memory to assess one's ability to retain and use visuospatial input, (iv) Reaction Time tests a person's mental and motor response speed, (v) Rapid Visual Information Processing assesses the ability to maintain visual attention and continuous performance on a task and (vi) Delayed Matching to Sample tests visual recognition memory and short term visual memory.	Baseline (Week 0) and Follow up (Week 9)
Secondary	Subjective Questionnaire	Rapid Assessment of Physical Activity (RAPA). This is a 9-item, self-administered questionnaire developed to provide an easily administered and interpreted means of assessing levels of physical activity among adults older than 50 years. RAPA evaluates a wide range of physical activity level, from sedentary to vigorous activity, as well as strength and flexibility training	Baseline (Week 0) and Follow up (Week 9)
Secondary	Subjective Questionnaire	WHO Disability Assessment Schedule 2.0. This is an assessment which provides a global measure of disability. It covers the following domains of functioning: Cognition - understanding & communicating; Mobility- moving & getting around; Self-care- hygiene, dressing, eating & staying alone; Getting along- interacting with other people; Life activities- domestic responsibilities, leisure, work & school; Participation- joining in community activities.	Baseline (Week 0) and Follow up (Week 9)
Secondary	Subjective Questionnaire	Activities-Specific Balance Confidence Scale (ABC). This questionnaire assesses patients perceived confidence for performing 16-activities of daily living without losing balance. Scores =67/100% indicate increased falls risk.	Baseline (Week 0) and Follow up (Week 9)
Secondary	Subjective Questionnaire	Falls Self-Efficacy Scale International. This is a short, easy to administer tool measuring an individual's level of concern regarding falling during social and physical activities inside and outside the home, whether or not the person actually does the activity. Level of concern is measured on a four-point Likert scale (1=not at all to 4=very). It has excellent internal validity and test-retest reliability. Scores of >23 for the long form and >10 for the short form have been suggested as cut points for indicating high concern about falling	Baseline (Week 0) and Follow up (Week 9)
Secondary	Subjective Questionnaire	Behavioral Regulation in Exercise Questionnaire (BREQ-3). This is a 24 item questionnaire to assess motivation to exercise. Participants rate whether statements apply to themselves (or not) using a 5 point likertLikert scale ranging from 0 (Not true for me) to 4 (Very true for me)	Baseline (Week 0) and Follow up (Week 9)
Secondary	Subjective Questionnaire	EQ-5D-5L. This is a standardized, valid and reliable simple, generic measure of health status for clinical and economic appraisal. The EQ-5D-5L has 5 dimensions (mobility, selfcare, usual activities, pain/discomfort, anxiety/depression) and includes the EQ visual Analogue scale (EQ VAS). The respondent is asked to rate their health status on these five dimensions from 1 to 5 respectively as no problems, slight problems, moderate problems, severe problems, and extreme problems. The EQ VAS records the respondent's self-rated health on a 20 cm vertical, visual analogue scale with endpoints labeledlabelled 'the best health you can imagine' and 'the worst health you can imagine'. The respondent is asked to mark an X on the scale to indicate "how your health is TODAY".	Baseline (Week 0) and Follow up (Week 9)
Secondary	Subjective Questionnaire	Environmental Mobility Scale. This is a self-report scale assessing the effect of the physical environment on community mobility. Twenty-four features of the physical environment are identified. For each feature, an encounter question (How often do you?) is paired with an avoidance question (How often do you avoid?). Subjects report on frequency of encounter and avoidance behaviour using a five-point ordinal scale (never, rarely, sometimes, often, always). The test-retest reliability of the questionnaire is good.	Baseline (Week 0) and Follow up (Week 9)

External Links

•   HOLOBalance study website