Program to improve balance/strength has a positive outcome on falls experienced by people with ID

Jennifer Crockett
Glasgow Learning Disability Services, Scotland, UK

People with intellectual disabilities (ID) are a high-risk population for falls. People with ID experience similar or higher rates of falls compared to the elderly in the general population. However, even at younger ages falls are the most common cause of injury in this population. Falls services are offered to the older population but at present are not available to younger people.

What did you do in your research?
People with ID might need a Falls Pathway Service (FPS) to address their specific needs. A physiotherapy led FPS was devised. This service offers a full assessment including onward referral for equipment, environment, health and medication checks, and interventions that include a 12-week individual exercise program to address balance and strength issues.

The devised FPS included approximately 50 clients (from the UK) with ID (ages 28-81; mean age, 58 years) who were reported to have experienced one or more falls. All clients were given a comprehensive assessment including gait, strength, balance which determined their falls risk (Tinetti balance and gait instrument). If able, the client was prescribed a 12-week individual exercise program to follow with some initial training and instruction. Of the 50 participants, 35 (70%) were involved in the exercise program of which 27 (54%) completed it. The program included education leaflets on how to avoid trips and slips and information on how to deal with a fall. A Falls chart was also kept to detail the circumstances around the fall. Test measures were taken in week 1 in the FPS and repeated after week 12, following the completion of the exercise program. Results were compared with additional questions around fear of falling and ability to manage a fall. Finally, post-exercise intervention, the physiotherapist as well as family caregivers were asked for their opinion around whether the client had benefitted from the exercise intervention.

What did you find out?
Not all clients were able to complete the 12-week exercise program. Reasons for this included lack of support to participate in the exercises, ability to understand the exercise program, and motivation to continue with the exercises. Of those clients who did complete the 12-week exercise program (27/35), there was improvement in their Falls risk test scores and/or their balance or strength tests. The physiotherapist along with family caregivers were also asked to determine if, in their opinion, the client had improved following completion of the program. The results identified that both physiotherapists and the client/caregivers agreed that, overall, the client had improved.

What are the take-home messages?
Following an individual exercise program to improve balance and strength has a positive outcome on the number and type of falls experienced by people with ID. It is recommended that people with ID have a comprehensive assessment to identify and address their falls risk. Additionally, these individuals may benefit from exercise, equipment prescription, health and medication checks, and environmental assessments in order to reduce their risk of falls.

To learn more about these findings contact Jennifer Crockett.

Full Journal Article
Crockett, J., Finlayson, J., Skelton, D. A., & Miller, G. (2015). Promoting exercise as part of a physiotherapy-led falls pathway service for adults with intellectual disabilities: A service evaluation. Journal of Applied Research in Intellectual Disabilities, 28(3), 257–264.