Visually Impaired OLder people’s Exercise programme for falls prevenTion (VIOLET): a feasibility study

Adams, Nicola, Skelton, Dawn, Bailey, Cathy, Howel, Denise, Coe, Dorothy, Lampitt, Rosy, Wilkinson, Jennifer, Fouweather, Tony, de Jong, Lex, Gawler, Sheena, Deary, Vincent, Gray, Joanne, Waterman, Heather and Parry, Steve (2019) Visually Impaired OLder people’s Exercise programme for falls prevenTion (VIOLET): a feasibility study. Public Health Research, 7 (4). pp. 1-148. ISSN 2050-4381

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Abstract

This study aims to conduct a mixed methods feasibility study to inform the design and conduct of a future definitive RCT of an adapted exercise programme to prevent falls by reducing fear of falling among older people with visual impairment (OPVI). The research questions are: can an existing exercise programme be adapted for OPVI and successfully delivered in the community; is it feasible to conduct an RCT of this intervention and what are the features of a future definitive trial? We propose to: (i) Adapt an existing exercise programme with the full involvement of OPVI and practitioners; (ii) Run a feasibility study in 2 sites to test our proposed measures, trial processes and recruitment; explore acceptability of the intervention; fidelity of and compliance with the intervention. Two stakeholder panels will be established including OPVI aged 60 and over from Newcastle Society for Blind People (NSBP) and Visibility in Glasgow, practitioners and researchers. They will work together to adapt the FaME programme, which is known to be effective in reducing falls in frequent fallers, so that the methods are acceptable for OPVI, whilst retaining the effective components of the exercise. The panels will meet 4 times to adapt the intervention and contribute to decisions on outcome measures and data collection. During this time we will identify OPVI wishing to act as expert stakeholders in the subsequent WPs. OPVI aged 60+ will be recruited from low vision clinics and voluntary organisations and randomised into the intervention or comparator arm. Those in the comparator arm will receive no intervention, but will be offered it after final data collection. The core components of the adapted exercise programme aim to strengthen leg muscles and retrain balance. However, the detail of the methods and timing will be decided by the stakeholder panel. The programme is likely to run once a week over 12 weeks, with each session lasting up to one hour. The final form of delivery will be one of the outcomes of the PPI work in WP1. Participants will be provided with instructions and equipment to do the exercises at home if they wish. The intervention will be delivered by exercise instructors engaged by Health Works, Newcastle and Visibility, Glasgow, in venues agreed with participants. The final primary outcome of the future RCT will be decided by the responsiveness to change, participant burden and participant feedback from this study. The likely candidate primary outcome is fear of falling (Short FES-I scale). The main secondary outcomes will be: activity avoidance; balance/falls risk; number of falls; quality of life; loneliness; depression; adherence to exercise programme; self-reported home exercising. An estimate of cost effectiveness and cost utility of the intervention will be undertaken. In-depth interviews with a sample of OPVI will be conducted to explore their reasons for taking part/not taking part; factors that facilitate/hinder them from participating in exercise groups; their experiences of the recruitment and randomisation process and views on the outcome measures; their experience of the adapted intervention. The interviews will highlight site specific issues to consider for the definitive RCT. Structured interviews will be undertaken with commissioners and practitioners to explore their perspectives on the application of the intervention.

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