Long-term retention of patient-reported outcomes after a 12-week attentional focus balance training program

UNCG Author/Contributor (non-UNCG co-authors, if there are any, appear on document)
Taniya Monet Wilson (Creator)
The University of North Carolina at Greensboro (UNCG )
Web Site: http://library.uncg.edu/
Christopher Rhea

Abstract: Older adults are at a higher risk of falls due to physiological and psychological factors associated with natural aging. Relative to balance, a recent meta-analysis showed that an external focus of attention results in enhanced learning of balance tasks compared to an internal focus. However, only a couple studies have incorporated attentional focus as part of their multi-session balance training program. This observation set the foundation for the NIH funded clinical trial at UNCG titled “Merging attentional focus and balance training to reduce fall risk in older adults”. The clinical trial was a balance intervention program that assessed motor ability and patient reported outcomes throughout 12-weeks of training (2 sessions per week), and for 8 weeks following the training program to test for retention. The potential extended retention (>6 months) of patient-reported outcomes is outside the scope of the clinical trial, but it is the focus of this thesis. It was hypothesized that elevations in the patient reported outcomes observed at the last assessment timepoint (week 20 and differentiated by attentional focus group) would remain elevated relative at their extended retention timepoint. Participants who completed the clinical trial (N=54) were asked to re-enroll in this study, of which a total of 33 participants (82.39 (6.25) years; 164.91 (9.72) cm; 63.84 (17.32) kg; M=7, F=26) elected to participate. This included those who were originally assigned to the external focus group (n=19; 87.88 (6.15) years; 164.91 (7.74) cm; 61.92 (17.99) kg; M=3, F=16) or to the internal focus group (n=14; 82.62 (6.61) years; 163.99 (11.81) cm; 64.02 (17.23) kg; M=4, F=10). All participants enrolled in this study completed the same patient-reported outcomes as assessed during the original 20-week clinical trial [(Activities-Specific Balance Confidence Scale short version (ABC-6), Short Form 36 (SF-36), and the Tampa Scale for Kinesiophobia (TSK)] so that extended retention can be examined. The new data and data from the final timepoint in the clinical trial (week 20) were combined to examine the extent to which patient-reported outcomes were retained over an extended period of time (>6 months). We used a repeated measures ANCOVA for each metric of interest, with timepoint (week 20 vs. extended retention) as the within subjects variable and training group assignment (external focus vs. internal focus) as the between-subjects variable. The covariate of time since completing the study (in weeks) was included in the model. Cohen’s d was also calculated between groups at week 20 and again at the extended retention timepoint to compare group-related effect size differences. The ABC-6 and TSK showed no group × time interaction, nor a group or time main effect (all p>.05). For the SF-36, seven of the eight dimensions had non-significant interaction or main effects. Only physical role exhibited an interaction, F(1,28)=5.301, p=.029, np2<.159, which was driven by unusual, by valid, responses from the external focus group reporting an increase in physical limitations in the extended retention test. For the effect size data, a medium effect between groups was reported at the 20-week and extended retention timepoints for the ABC-6 and the SF-36 physical functioning dimension, suggesting that some group-level differences that existed after the clinical trial persisted at the extended retention timepoint. Collectively, these data show that some patient-reported outcomes can be retained long after an attentionally focused balance training intervention.

Additional Information

Language: English
Date: 2021
Attentional focus, Balance, Balance training, Long-term retention, Patient reported outcomes, Retention
Falls (Accidents) in old age $x Prevention
Attention $x Physiological aspects
Equilibrium (Physiology)

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