Search

Enquadramento: As quedas em idosos acima dos 65 anos, provocadas por alterações aos sistemas de movimento, podem resultar em reduções drásticas da funcionalidade e independência. Torna-se fundamental a ação dos Fisioterapeutas na sua prevenção. Objetivos: Interpretar os programas e tipos de intervenção na prevenção de quedas em idosos, especificamente produzidos por Fisioterapeutas. Métodos: Registo PROSPERO com ID: CRD42021229343. Os estudos identificados, foram recolhidos nas bases de dados: PubMed, PEDro, Ovid e Web of Science. Pesquisa limitada a 10 anos e análise da qualidade utilizando a escala de PEDro, incluindo-se aqueles com 6 ou mais valores. Incluídos apenas ensaios clínicos randomizados que avaliassem os efeitos de programas de exercício na redução do número de quedas em idosos. Programas orientados a idosos com idade igual ou superior a 65 anos. Excluíram-se indivíduos com condições de saúde associadas. Resultados: 23 registos selecionados para análise. Observaram-se efeitos na redução de quedas em 73,9% dos estudos e 43,5% mostraram resultados significativos dos programas implementados comparando com os grupos de controlo. As componentes de adaptabilidade e força foram as mais utilizadas e os programas multicomponentes foram os que indicaram maior grau de eficácia. Conclusões: demonstra-se forte evidência na eficácia de redução de quedas em idosos quando aplicados programas de exercício multicomponentes. Programas com maior eficácia têm frequência semanal de 1 a 2 vezes e por períodos de até 6 meses, com foco nas componentes de adaptabilidade, força, resistência e flexibilidade. Considerou-se útil e fácil de utilizar a categorização da teoria contínua do movimento para descrever e interpretar as intervenções., {"references":["Allen, D. D. (2007). Proposing 6 dimensions within the construct of movement in the movement continuum theory. Physical Therapy, 87(7), 888–898. https://doi.org/10.2522/ptj.20060182","Arkkukangas, M., Johnson, S. T., Hellström, K., Anens, E., Tonkonogi, M., & Larsson, U. (2020). Fall prevention exercises with or without behavior change support for community-dwelling older adults: a two-year follow-up of a randomized controlled trial. Journal of Aging and Physical Activity, 28(1), 34–41.","Arkkukangas, M., Johnson, S. T., Hellström, K., Söderlund, A., Eriksson, S., & Johansson, A.-C. (2015). A feasibility study of a randomised controlled trial comparing fall prevention using exercise with or without the support of motivational interviewing. Preventive Medicine Reports, 2, 134–140. https://doi.org/10.1016/j.pmedr.2015.01.007","Arkkukangas, M., Söderlund, A., Eriksson, S., & Johansson, A.-C. (2019). Fall prevention exercises with or without behavior change support for community-dwelling older adults: a two-year follow-up of a randomized controlled trial. Journal of Geriatric Physical Therapy (2001), 42(1), 9–17. https://doi.org/10.1519/JPT.0000000000000129","Aromataris, E., & Munn, Z. (2020). JBI Manual for Evidence Synthesis. In JBI. https://synthesismanual.jbi.global","Campbell, A. J., & Robertson, M. C. (2003). Otago exercise programme to prevent falls in older adults: A home-based, individually tailored strength and balance retraining programme. In Otago Medical School, University of Otago. https://hfam.ca/wp-content/uploads/2020/04/Otago-Exercise-Program.pdf","Clemson, L., Singh, M. F., Bundy, A., Cumming, R. G., Weissel, E., Munro, J., Manollaras, K., & Black, D. (2010). LiFE Pilot Study: a randomised trial of balance and strength training embedded in daily life activity to reduce falls in older adults. Australian Occupational Therapy Journal, 57(1), 42–50.","Conroy, S., Kendrick, D., Harwood, R., Gladman, J., Coupland, C., Sach, T., Drummond, A., Youde, J., Edmans, J., & Masud, T. (2010). A multicentre randomised controlled trial of day hospital-based falls prevention programme for a screened population of community-dwelling older people at high risk of falls. Age and Ageing, 39(6), 704–710. https://doi.org/10.1093/ageing/afq096","Crocker, T., Forster, A., Young, J., Brown, L., Ozer, S., Smith, J., Green, J., Hardy, J., Burns, E., Glidewell, E., & Greenwood, D. C. (2013). Physical rehabilitation for older people in long-term care. Cochrane Database of Systematic Reviews, 2013(2), CD004294. https://doi.org/10.1002/14651858.CD004294.pub3","Day, L., Hill, K. D., Stathakis, V. Z., Flicker, L., Segal, L., Cicuttini, F. M., & Jolley, D. (2015). Impact of Tai Chi on falls among preclinically disabled older people. A randomized controlled trial. Journal of the American Medical Directors Association, 16(5), 420–426. https://doi.org/10.1016/j.jamda.2015.01.089","Delbaere, K., Valenzuela, T., Lord, S. R., Clemson, L., Zijlstra, G. A. R., Close, J. C. T., Lung, T., Woodbury, A., Chow, J., McInerney, G., Miles, L., Toson, B., Briggs, N., & van Schooten, K. S. (2021). E-health StandingTall balance exercise for fall prevention in older people: results of a two year randomised controlled trial. BMJ (Clinical Research Ed.), 373, n740. https://doi.org/10.1136/bmj.n740","Elkins, M. R., Herbert, R. D., Moseley, A. M., Sherrington, C., & Maher, C. (2010). Rating the quality of trials in systematic reviews of physical therapy interventions. Cardiopulmonary Physical Therapy Journal, 21(3), 20–26. https://doi.org/10.1097/01823246-201021030-00005","Finlayson, M. L., & Peterson, E. W. (2010). Falls, aging, and disability. Physical Medicine and Rehabilitation Clinics of North America, 21(2), 357–373. https://doi.org/10.1016/j.pmr.2009.12.003","Gillespie, L. D., Robertson, M. C., Gillespie, W. J., Sherrington, C., Gates, S., Clemson, L. M., & Lamb, S. E. (2012). Interventions for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews, 2012(9), CD007146. https://doi.org/10.1002/14651858.CD007146.pub3","Hopewell, S., Adedire, O., Copsey, B. J., Boniface, G. J., Sherrington, C., Clemson, L., Close, J. C. T., & Lamb, S. E. (2018). Multifactorial and multiple component interventions for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews, 2018(7), CD012221. https://doi.org/10.1002/14651858.CD012221.pub2","Hwang, H.-F., Chen, S.-J., Lee-Hsieh, J., Chien, D.-K., Chen, C.-Y., & Lin, M.-R. (2016). Effects of home-based Tai Chi and lower extremity training and self-practice on falls and functional outcomes in older fallers from the emergency department. A randomized controlled trial. Journal of the American Geriatrics Society, 64(3), 518–525. https://doi.org/10.1111/jgs.13952","Ishigaki, E. Y., Ramos, L. G., Carvalho, E. S., & Lunardi, A. C. (2014). Effectiveness of muscle strengthening and description of protocols for preventing falls in the elderly: A systematic review. Brazilian Journal of Physical Therapy, 18(2), 111–118. https://doi.org/10.1590/S1413-35552012005000148","Kendrick, D., Kumar, A., Carpenter, H., Zijlstra, G. A. R., Skelton, D. A., Cook, J. R., Stevens, Z., Belcher, C. M., Haworth, D., Gawler, S. J., Gage, H., Masud, T., Bowling, A., Pearl, M., Morris, R. W., Iliffe, S., & Delbaere, K. (2014). Exercise for reducing fear of falling in older people living in the community. Cochrane Database of Systematic Reviews, 2014(11), CD009848. https://doi.org/10.1002/14651858.CD009848.pub2","Kovács, E., Prókai, L., Mészáros, L., & Gondos, T. (2013). Adapted physical activity is beneficial on balance, functional mobility, quality of life and fall risk in community-dwelling older women: a randomized single-blinded controlled trial. European Journal of Physical and Rehabilitation Medicine, 49(3), 301–310.","LaStayo, P., Marcus, R., Dibble, L., Wong, B., & Pepper, G. (2017). Eccentric versus traditional resistance exercise for older adult fallers in the community: a randomized trial within a multi-component fall reduction program. BMC Geriatrics, 17(1), 149. https://doi.org/10.1186/s12877-017-0539-8","Lee, H.-C., Chang, K.-C., Tsauo, J.-Y., Hung, J.-W., Huang, Y.-C., & Lin, S.-I. (2013). Effects of a multifactorial fall prevention program on fall incidence and physical function in community-dwelling older adults with risk of falls. Archives of Physical Medicine and Rehabilitation, 94(4), 606–615, 615.e1. https://doi.org/10.1016/j.apmr.2012.11.037","Lee, H.-C., Chang, K.-C., Tsauo, J.-Y., Hung, J.-W., Huang, Y.-C., Lin, S.-I., & Fall Prevention Initiatives in Taiwan (FPIT) Investigators. (2013). Effects of a multifactorial fall prevention program on fall incidence and physical function in community-dwelling older adults with risk of falls. Archives of Physical Medicine and Rehabilitation, 94(4), 606–615, 615.e1. https://doi.org/10.1016/j.apmr.2012.11.037","Li, Z., Wang, X.-X., Liang, Y.-Y., Chen, S.-Y., Sheng, J., & Ma, S.-J. (2018). Effects of the visual-feedback-based force platform training with functional electric stimulation on the balance and prevention of falls in older adults: a randomized controlled trial. PeerJ, 6, e4244. https://doi.org/10.7717/peerj.4244","Liu-Ambrose, T., Davis, J. C., Best, J. R., Dian, L., Madden, K., Cook, W., Hsu, C. L., & Khan, K. M. (2019). Effect of a home-based exercise program on subsequent falls among community-dwelling high-risk older adults after a fall: a randomized clinical trial. JAMA, 321(21), 2092–2100. https://doi.org/10.1001/jama.2019.5795","Lurie, J. D., Zagaria, A. B., Ellis, L., Pidgeon, D., Gill-Body, K. M., Burke, C., Armbrust, K., Cass, S., Spratt, K. F., & McDonough, C. M. (2020). Surface perturbation training to prevent falls in older adults: A highly pragmatic, randomized controlled trial. Physical Therapy, 100(7), 1153–1162. https://doi.org/10.1093/ptj/pzaa023","Ma, A. W., Wang, H.-K., Chen, D.-R., Chen, Y.-M., Chak, Y. T. C., Chan, J. W. Y., Yam, T. T. T., Cheng, Y. T. Y., Ganesan, B., & Fong, S. S. M. (2019). Chinese martial art training failed to improve balance or inhibit falls in older adults. Perceptual and Motor Skills, 126(3), 389–409. https://doi.org/10.1177/0031512518824945","Neyens, J. C., van Haastregt, J. C., Dijcks, B. P., Martens, M., van den Heuvel, W. J., de Witte, L. P., & Schols, J. M. (2011). Effectiveness and Implementation Aspects of Interventions for Preventing Falls in Elderly People in Long-Term Care Facilities: A Systematic Review of RCTs. Journal of the American Medical Directors Association, 12(6), 410–425. https://doi.org/10.1016/j.jamda.2010.07.018","Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., … Moher, D. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. The BMJ, 372(71). https://doi.org/10.1136/bmj.n71","Palvanen, M., Kannus, P., Piirtola, M., Niemi, S., Parkkari, J., & Järvinen, M. (2014). Effectiveness of the Chaos Falls Clinic in preventing falls and injuries of home-dwelling older adults: a randomised controlled trial. Injury, 45(1), 265–271. https://doi.org/10.1016/j.injury.2013.03.010","Sherrington, C., Fairhall, N. J., Wallbank, G. K., Tiedemann, A., Michaleff, Z. A., Howard, K., Clemson, L., Hopewell, S., & Lamb, S. E. (2019). Exercise for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews, 1(1), CD012424. https://doi.org/10.1002/14651858.CD012424.pub2","Sherrington, C., Lord, S. R., Vogler, C. M., Close, J. C. T., Howard, K., Dean, C. M., Heller, G. Z., Clemson, L., O'Rourke, S. D., Ramsay, E., Barraclough, E., Herbert, R. D., & Cumming, R. G. (2014). A post-hospital home exercise program improved mobility but increased falls in older people: a randomised controlled trial. PloS One, 9(9), e104412. https://doi.org/10.1371/journal.pone.0104412","Skjaerven, L. H., Kristoffersen, K., & Gard, G. (2008). An eye for movement quality: A phenomenological study of movement quality reflecting a group of physiotherapists' understanding of the phenomenon. Physiotherapy Theory and Practice, 24(1), 13–27. https://doi.org/10.1080/01460860701378042","Stel, V. S., Smit, J. H., Pluijm, S. M. F., & Lips, P. (2004). Consequences of falling in older men and women and risk factors for health service use and functional decline. Age and Ageing, 33(1), 58–65. https://doi.org/10.1093/ageing/afh028","Suttanon, P., Piriyaprasarth, P., Krootnark, K., & Aranyavalai, T. (2018). Effectiveness of falls prevention intervention programme in community-dwelling older people in Thailand: randomized controlled trial. Hong Kong Physiotherapy Journal, 38(1), 1–11.","Taylor, D., Leigh Hale, P. S., Waters, D. L., Binns, E. E., McCracken, H., McPherson, K., & Wolf, S. L. (2012). Effectiveness of Tai Chi as a community-based falls prevention intervention: a randomized controlled trial. Journal of the American Geriatrics Society, 60(5), 841–848.","Taylor, J., Walsh, S., Kwok, W., Pinheiro, M. B., de Oliveira, J. S., Hassett, L., Bauman, A., Bull, F., Tiedemann, A., & Sherrington, C. (2021). A scoping review of physical activity interventions for older adults. International Journal of Behavioral Nutrition and Physical Activity, 18(1), 82. https://doi.org/10.1186/s12966-021-01140-9","Uusi-Rasi, K., Patil, R., Karinkanta, S., Kannus, P., Tokola, K., Lamberg-Allardt, C., & Sievänen, H. (2015). Exercise and vitamin D in fall prevention among older women: a randomized clinical trial. JAMA Internal Medicine, 175(5), 703–711. https://doi.org/10.1001/jamainternmed.2015.0225","Voight, M. L., & Hoogenboom, B. J. (2017). What is the movement system and why is it important? International Journal of Sports Physical Therapy, 12(1), 1–2.","Wetherell, J. L., Bower, E. S., Johnson, K., Chang, D. G., Ward, S. R., & Petkus, A. J. (2018). Integrated exposure therapy and exercise reduces fear of falling and avoidance in older adults: a randomized pilot study. American Journal of Geriatric Psychiatry, 26(8), 849–859. https://doi.org/10.1016/j.jagp.2018.04.001","WHO. (2007). WHO Global Report on Falls Prevention in Older Age. In Community Health.","Yamada, M., Aoyama, T., Arai, H., Nagai, K., Tanaka, B., Uemura, K., Mori, S., & Ichihashi, N. (2012). Complex obstacle negotiation exercise can prevent falls in community-dwelling elderly Japanese aged 75 years and older. Geriatrics & Gerontology International, 12(3), 461–467. https://doi.org/10.1111/j.1447-0594.2011.00794.x","Yamada, M., Higuchi, T., Nishiguchi, S., Yoshimura, K., Kajiwara, Y., & Aoyama, T. (2013). Multitarget stepping program in combination with a standardized multicomponent exercise program can prevent falls in community-dwelling older adults: a randomized, controlled trial. Journal of the American Geriatrics Society, 61(10), 1669–1675. https://doi.org/10.1111/jgs.12453","Yamada, M., Tanaka, B., Nagai, K., Aoyama, T., & Ichihashi, N. (2010). Trail-walking exercise and fall risk factors in community-dwelling older adults: Preliminary results of a randomized controlled trial. JAGS, 58(10), 1946–1951. https://doi.org/10.1111/j.1532-5415.2010.03059.x"]}