title: Investigating the effectiveness of postural muscle electrostimulation and static posturography feedback exercises in elders with balance disorder.
abstract: BACKGROUND
  Deterioration associated with aging in the erect posture and balance to change the location of the center increased the rate of fall in older age is one of the reasons. Loss of muscle strength is one of the major factors affecting the posture. In this prospective, randomized and controlled study, it was aimed to investigate the effectiveness of strengthening postural muscles through electrostimulation or by applying biofeedback exercises with static posturography in patients aged 60 years and over with balance disorder.
  
  
  METHODS
  Patients aged between 60-80 years, who applied to Istanbul Faculty of Medicine Physical Medicine and Rehabilitation Department outpatient clinic and had been diagnosed with balance disorder using the Timed Up and Go (TUG) test, were included. 250 patients were screened, from them 67 patients were enrolled and 57 of them completed the study. Patients were randomized to three groups. The patients in Tetrax® group (TG) group (n:18) participated in a 15-minute exercise with Tetrax® which consisted of 15 minutes exercise session 3 times weekly for 4 weeks. The patients in EG group (n:19) received an electrostimulation program of postural muscles of 40 minutes per session 3 times weekly for 4 weeks. Patients in the control group (n:20) did 6-week balance exercises which were performed by other groups as well. 48 out of 57 patients attended the 6th-month control. As determinants of balance status Timed Up and Go Test (TUG), Berg Balance Scale (BBS) and Fall Index measured by Tetrax® were calculated at baseline, 1-month and 6-month follw up assesments. The patient's quality of life was assesed by Turkish version of World Health Organisation Quality of Life Questionnaire in Older Adults (WHOQOL-OLD.TR) at baseline and 6-month follow up assesments.
  
  
  RESULTS
  TUG values in both EG and TG decreased significantly between baseline assesment and 1-month (mean differences for TG: -4,00 ± 1,309 and EG -2,588 ± 1,839 p= 0,002 for the each of groups) and baseline assesment and 6-month (mean differences for TG: -2,933± 1,223 and EG -2,058 ± 1,477 p= 0,003 for the each of groups). A significant increase was determined in BBS values between baseline and 1-month (mean differences for TG: 4.000 ± 2,360 and EG: 3,529 ± 2,672 p= 0,031 for the each of groups). Fall Index (FI) measured by Tetrax® decreased between baseline assesment and 1-month (p= 0,185), and 6-month (p= 0,086) respectively, also between 1-month and 6-month follow up assesments (p= 0,627), but all of them were not significant changes. In all three groups the quality of life (p= 0,951) improved. Exercises conducted with Tetrax® were more effective than electrostimulation of postural muscles in increasing TUG values and decreasing BBS values.
  
  
  CONCLUSIONS
  Even though applying electrostimulation to postural muscles affected patients positively compared to pre-treatment, exercises performed with Tetrax® were more effective than the electrostimulation protocol to postural muscles in reducing balance disorder and this well-being continued even in the 6th month.
authors.affiliation: Physiotherapy and Rehabilitation Department, Health Sciences Faculty, Bahçesehir University, Istanbul, Turkey.
authors.forename: Kerem
authors.initials: K
authors.lastname: Alptekin
authors.affiliation: Department of Physical Medicine and Rehabilitation, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey.
authors.forename: Ayse
authors.initials: A
authors.lastname: Karan
authors.affiliation: Department of Physical Medicine and Rehabilitation, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey.
authors.forename: Demirhan
authors.initials: D
authors.lastname: Dıracoglu
authors.affiliation: Physiotherapy and Rehabilitation Department, Health Sciences Faculty, Medipol University, Istanbul, Turkey.
authors.forename: Aysel
authors.initials: A
authors.lastname: Yildiz
authors.affiliation: Department of Physical Medicine and Rehabilitation, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey.
authors.forename: Akin
authors.initials: A
authors.lastname: Baskent
authors.affiliation: Department of Physical Medicine and Rehabilitation, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey.
authors.forename: Nurten
authors.initials: N
authors.lastname: Eskiyurt
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control; D000328:Adult; D000368:Aged; D001676:Biofeedback, Psychology; D004599:Electric Stimulation Therapy; D005080:Exercise Test; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength / Q000502:physiology*; D018482:Muscle, Skeletal / Q000502:physiology; D004856:Postural Balance / Q000502:physiology*; D011446:Prospective Studies; D011788:Quality of Life
keywords: Balance disturbance; balance exercises; electrostimulation of postural muscles; quality of life; static posturography