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Digital Fall Prevention for Older Adults Feasibility of a Self-Managed Exercise Application and Development of a Smartphone Self-Test for Balance and Leg Strength

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Digital Fall Prevention for Older Adults Feasibility of a Self-Managed Exercise Application and Development of a Smartphone Self-Test for Balance and Leg Strength Digital fall prevention for older adults Feasibility of a self-managed exercise application and development of a smartphone self-test for balance and leg strength Linda Månsson Department of Community Medicine and Rehabilitation, Section of Physiotherapy Department of Radiation Sciences, Radiation Physics and Biomedical Engineering Umeå University, Sweden Umeå 2021 Responsible publisher under Swedish law: the Dean of the Medical Faculty This work is protected by the Swedish Copyright Legislation (Act 1960:729) Dissertation for PhD in Medicine Copyright © Linda Månsson, 2021 ISBN: 978-91-7855-449-2 (print) ISBN: 978-91-7855-450-8 (pdf) ISSN: 0346-6612 New Series Number: 2113 Front cover illustration: Rose Cooper, Valencia, www.rosecooper.com Electronic version available at: http://umu.diva-portal.org/ Printed by: Cityprint i Norr AB Umeå, Sweden 2021 Learn continually—there's always "one more thing" to learn! Steve Jobs Table of Contents Abstract ........................................................................................ iii Enkel sammanfattning på svenska ................................................... v Abbreviations ..............................................................................viii Definitions ..................................................................................... ix Original papers ............................................................................... x Preface .........................................................................................xii Introduction ................................................................................... 1 The ageing population and falls........................................................................................1 Falls in older adults ................................................................................................... 2 Balance the opposite to falls ...................................................................................... 4 Exercise as fall prevention ............................................................................................... 5 Adherence to fall prevention interventions .............................................................. 6 Self-management of exercise to prevent falls .......................................................... 7 Digital technology, eHealth, and falls in older adults ..................................................... 9 Fall prevention with digital technology ................................................................. 10 Smartphones and sensor measurements ............................................................... 12 Balance function self-assessment with smartphone.............................................. 13 User experience to facilitate eHealth .......................................................................15 Rationale ...................................................................................... 17 Aims ............................................................................................. 19 Materials and Methods ................................................................. 20 Study design ................................................................................................................... 21 Safe Step feasibility study (Papers I & II) .............................................................. 21 MyBalance project (Papers III & IV) ...................................................................... 24 Co-creation study for the self-test application development (Paper III) ............. 25 Concurrent validity study (Paper IV)..................................................................... 26 Setting ............................................................................................................................. 27 Participants .................................................................................................................... 27 Safe Step feasibility study (Paper I & II) ................................................................ 28 MyBalance co-creation study (Paper III) .............................................................. 28 MyBalance validity study (Paper IV) ..................................................................... 29 Data collection ................................................................................................................ 29 Safe Step feasibility study (Paper I & II) ................................................................ 29 Co-creation study for the self-test application development (Paper III) ............. 32 Concurrent validity study (Paper IV)..................................................................... 33 Data analyses .................................................................................................................. 36 Quantitative methods for data analysis (Papers I-II & IV) .................................. 36 Qualitative methods for data analysis (Paper III) ................................................ 38 Ethical considerations .................................................................................................... 40 i Results .......................................................................................... 41 The Safe Step feasibility study (Papers I & II) .............................................................. 41 Description of the participants ............................................................................... 41 Attrition to the study................................................................................................ 41 Adherence to the exercise intervention ................................................................... 42 Feasibility of performance-based and self-reported outcome measures ............ 44 4-month survey ........................................................................................................ 46 12-month survey ...................................................................................................... 46 Co-creation application design with older adults (Paper III) ...................................... 48 Result of the qualitative content analysis .............................................................. 48 Application development ..........................................................................................51 Concurrent validity testing of the MyBalance prototype (Paper IV) ........................... 52 Participants’ characteristics ................................................................................... 52 Sensor measurement and clinical instrument correlation analyses .................... 54 Discussion .................................................................................... 56 Adherence to exercise programmes .............................................................................. 56 Feasibility of outcome measures ................................................................................... 58 User experience and involvement ................................................................................. 60 Self-assessment with digital technology ....................................................................... 62 Methodological reflections............................................................................................. 64 Participants .............................................................................................................. 64 Data collection and data analysis .......................................................................... 66 Ethical reflections........................................................................................................... 69 Overall reflection ............................................................................................................ 70 Implications for fall prevention and physiotherapy ..................................................... 70 Future research .............................................................................................................. 72 Conclusions .................................................................................. 73 Acknowledgements ....................................................................... 75 References .................................................................................... 77 Appendix ..................................................................................... 89 ii Abstract As the numbers of older adults grow, fall prevention is vital to reduce health care needs due to falls and to increase quality of life. Balance and strength exercises have been found to be effective in fall prevention, however, long-term adherence is often poor. The growth of digital technology in society has generated opportunities for fall prevention with eHealth. The aim of this thesis was to evaluate the feasibility and use of a new digital fall prevention exercise programme, and to develop and investigate a smartphone self-test application for balance and leg strength. Three different studies included community-dwelling older adults ≥ 70 years, who were able to rise from a chair and stand without support. A feasibility study evaluated a new digital exercise programme (DP) compared to a paper booklet exercise programme (PB) for self-managed fall prevention in a four-month controlled participant preference trial (n = 67) (Paper I & II). Self-reported data on adherence, falls efficacy, and functional ability were collected
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