Department of Physical Therapy Student Theses, Dissertations and Capstones

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD) in Physical Therapy

Copyright Statement

All rights reserved. This publication is intended for use solely by faculty, students, and staff of Nova Southeastern University. No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, now known or later developed, including but not limited to photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author or the publisher.

Department

College of Health Care Sciences - Physical Therapy Department

First Advisor

Alicia Fernandez-Fernandez

Second Advisor

Leah Nof

Third Advisor

Olaide Oluwole-Sangoseni

Publication Date / Copyright Date

2019

Publisher

Nova Southeastern University

Abstract

Background and Purpose: To investigate the effect of an individualized exercise program versus a generic group-based exercise program on balance, gait, and functional performance of older adults categorized as having mild balance dysfunction and living in residential care facilities. Methods: Single blind randomized control design. One hundred-twenty residents fulfilled screening criteria for mild balance dysfunction based on the BioSwayTM balance and the Multi-Directional Reach Test (MDRT) primary outcome measures. Secondary assessment was completed using the Modified Physical Performance Test (PPT), hand-held dynamometer (lower-limb muscle strength testing), and gait speed analysis. Sixty subjects received individualized treatment from physical therapists (8 weeks). Another sixty subjects received generic group-based exercises (8 weeks). All outcome measures were collected at baseline and post-intervention (ninth week); and BioSwayTM and PPT measures at follow-up (thirteenth week) for the individualized group. Results: Individualized group (n=60) showed significant improvement compared to the group-based group (n=60) on the two BioSwayTM scores (limits of stability, p < .001; and postural stability, p = .016), the MDRT scores (forward reach, p < .001; backward reach, p = .007; right lateral reach, p < .001; and left lateral reach p < .001), the strength scores (hip flexors, p = .010; knee extensors, p = .002; hip abductors, p = .009; and ankle dorsiflexors, p = .025), the PPT outcomes (p < .001), and the gait scores (p = .012). Effect sizes ranged from small to large, with the largest sizes for limits of stability and MDRT. There were no significant differences between groups for the mCTSIB (p = .538). However, 96.7% of subjects in the individualized group scored within one SD of the reference mean, relative to 75% in the group-based group. At follow-up, the individualized group showed significant differences over time with medium to large effect sizes on the PPT (p < .001), limits of stability (p < .001), postural stability (p < .001), and mCTSIB (p = .005) measures. Post-hoc analysis revealed retention of gains for all measures at follow-up, except the mCTSIB. Conclusion: The individualized group showed significant improvements in the areas of balance, strength, mobility, and functional outcomes.

Disciplines

Physical Therapy

Keywords

Social sciences, Health and environmental sciences, Balance, Group-based exercises, Individual-based exercises, Older adults, Randomized controlled trials, Residential care facilities

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