title: The efficacy of treadmill training with and without projected visual context for improving walking ability and reducing fall incidence and fear of falling in older adults with fall-related hip fracture: a randomized controlled trial.
abstract: The ability to adjust walking to environmental context is often reduced in older adults and, partly as result of this, falls are common in this population. A treadmill with visual context projected on its belt (e.g., obstacles and targets) allows for practicing step adjustments relative to that context, while concurrently exploiting the great amount of walking practice associated with conventional treadmill training. The present study was conducted to compare the efficacy of adaptability treadmill training, conventional treadmill training and usual physical therapy in improving walking ability and reducing fear of falling and fall incidence in older adults during rehabilitation from a fall-related hip fracture.
  
  
  
  In this parallel-group, open randomized controlled trial, seventy older adults with a recent fall-related hip fracture (83.3 ± 6.7 years, mean ± standard deviation) were recruited from inpatient rehabilitation care and block randomized to six weeks inpatient adaptability treadmill training (n = 24), conventional treadmill training (n = 23) or usual physical therapy (n = 23). Group allocation was only blind for assessors. Measures related to walking ability were assessed as the primary outcome before and after the intervention and at 4-week and 12-month follow-up. Secondary outcomes included general health, fear of falling, fall rate and proportion of fallers.
  
  
  
  Measures of general walking ability, general health and fear of falling improved significantly over time. Significant differences among the three intervention groups were only found for the Functional Ambulation Category and the dual-task effect on walking speed, which were in favor of respectively conventional treadmill training and adaptability treadmill training.
  
  
  
  Overall, adaptability treadmill training, conventional treadmill training and usual physical therapy resulted in similar effects on walking ability, fear of falling and fall incidence in older adults rehabilitating from a fall-related hip fracture. Additional post hoc subgroup analyses, with stratification for pre-fracture tolerated walking distance and executive function, revealed several intervention effects in favor of adaptability and conventional treadmill training, indicating superiority over usual physical therapy for certain subgroups. Future well-powered studies are necessary to univocally identify the characteristics of individuals who will benefit most from a particular intervention.
  
  
  
  The Netherlands Trial Register ( NTR3222 , 3 January 2012).
authors.affiliation: Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, MOVE Research Institute Amsterdam, Van der Boechorststraat 9, Amsterdam, 1081 BT, The Netherlands. m.van.ooijen-kerste@vu.nl.|Amsterdam Rehabilitation Research Center | Reade, Overtoom 283, Amsterdam, 1054 HW, The Netherlands. m.van.ooijen-kerste@vu.nl.
authors.forename: Mariëlle W
authors.initials: MW
authors.lastname: van Ooijen
authors.affiliation: Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, MOVE Research Institute Amsterdam, Van der Boechorststraat 9, Amsterdam, 1081 BT, The Netherlands.
authors.forename: Melvyn
authors.initials: M
authors.lastname: Roerdink
authors.affiliation: PW Janssen, Zorggroep Solis, Hermelijn 2, Deventer, 7423 EJ, The Netherlands.
authors.forename: Marga
authors.initials: M
authors.lastname: Trekop
authors.affiliation: Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, MOVE Research Institute Amsterdam, Van der Boechorststraat 9, Amsterdam, 1081 BT, The Netherlands.|Amsterdam Rehabilitation Research Center | Reade, Overtoom 283, Amsterdam, 1054 HW, The Netherlands.
authors.forename: Thomas W J
authors.initials: TW
authors.lastname: Janssen
authors.affiliation: Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, MOVE Research Institute Amsterdam, Van der Boechorststraat 9, Amsterdam, 1081 BT, The Netherlands.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Beek
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D015444:Exercise / Q000502:physiology / Q000523:psychology; D005080:Exercise Test / Q000379:methods; D005239:Fear; D005260:Female; D005684:Gait / Q000502:physiology; D006620:Hip Fractures / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D015994:Incidence; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D010043:Outcome and Process Assessment, Health Care; D026741:Physical Therapy Modalities / Q000523:psychology / Q000706:statistics & numerical data; D004856:Postural Balance / Q000502:physiology; D016138:Walking / Q000502:physiology / Q000523:psychology
keywords: Exercise; Falls; Hip fracture; Intervention studies; Older adults; Treadmill; Walking adaptability