Author Names
Vaillant, J., Rouland, A., Martigne, P., Braujou, R., Nissen, M., Caillat-Miousse, J., Vuillerme, N., Nougier, V., Juvin, R.
Reviewer Name
Kylie Dahlberg, SPT
Reviewer Affiliation(s)
Duke University School of Medicine, Doctor of Physical Therapy Division
Paper Abstract
The aim of this study was to evaluate the effects of a session of plantar massage and joint mobilization of the feet and ankles on clinical balance performance in elderly people. A randomized, placebo-controlled, cross-over trial was used to examine the immediate effects of manual massage and mobilization of the feet and ankles. Twenty-eight subjects, aged from 65 to 95 years (78.8 8.5 years – mean SD) were recruited from community nursing homes. Main outcome measures were the performances in three tests: One Leg Balance (OLB) test, Timed Up and Go (TUG) test and Lateral Reach (LR) test. Results demonstrated a significant improvement after massage and mobilization compared with placebo for the OLB test (1.1 1.7 s versus 0.4 1.2 s, p < 0.01) and the TUG test (0.9 2.6 s versus 0.2 1.2 s, p < 0.05). Conversely, performances in the LR test did not improve significantly. These results emphasize the positive impact of a single session of manual therapy applied to the feet and ankles on balance in elderly subjects.
NIH Risk of Bias Tool
Quality Assessment of Controlled Intervention Studies
- Was the study described as randomized, a randomized trial, a randomized clinical trial, or an RCT
- Yes
- Was the method of randomization adequate (i.e., use of randomly generated assignment)?
- Yes
- Was the treatment allocation concealed (so that assignments could not be predicted)?
- Yes
- Were study participants and providers blinded to treatment group assignment?
- Yes
- Were the people assessing the outcomes blinded to the participants’ group assignments?
- Yes
- Were the groups similar at baseline on important characteristics that could affect outcomes (e.g., demographics, risk factors, co-morbid conditions)?
- Yes
- Was the overall drop-out rate from the study at endpoint 20% or lower of the number allocated to treatment?
- Yes
- Was the differential drop-out rate (between treatment groups) at endpoint 15 percentage points or lower?
- Yes
- Was there high adherence to the intervention protocols for each treatment group?
- Yes
- Were other interventions avoided or similar in the groups (e.g., similar background treatments)?
- Yes
- Were outcomes assessed using valid and reliable measures, implemented consistently across all study participants?
- Yes
- Did the authors report that the sample size was sufficiently large to be able to detect a difference in the main outcome between groups with at least 80% power?
- No
- Were outcomes reported or subgroups analyzed prespecified (i.e., identified before analyses were conducted)?
- Yes
- Were all randomized participants analyzed in the group to which they were originally assigned, i.e., did they use an intention-to-treat analysis?
- Yes
Key Finding #1
After massage and mobilization, there were significant improvements in the One Leg Balance test (OLB) and the Timed Up and Go test (TUG) compared with the placebo.
Key Finding #2
The improvements found in this study could be due to the improvement of somatosensory information, which plays a role in postural control and balance.
Key Finding #3
The results found in this study emphasize that there is a positive impact on balance in elderly populations when a single session of manual therapy is applied to the feet and ankles.
Key Finding #4
After massage and mobilization, there were no significant improvements in the lateral reach test compared with the placebo group.
Please provide your summary of the paper
The purpose of this study was to evaluate the effects of massage and mobilization on balance performance in elderly adults. This is an important study because older adults are at a higher risk of falls due to the natural aging process. This natural aging process can lead to reduced joint flexibility and reduced afferent sensory information. Having an adequate range of motion in the ankle is also shown to be important for gait and balance. The participants in this study were volunteers from community nursing homes who met the inclusion criteria. The three functional balance performance tests used in this study were the One Leg Balance test (OLB), the Timed Up and Go (TUG), and the Lateral Reach (LR). The tests were performed in that order for every participant. Both the massage and mobilization interventions were applied for a total of 20 minutes for each participant not in the placebo group. The aim of these interventions was to target the somatosensory system, which plays an important role in balance. This study found that there was a statistically significant improvement in balance performance for both the OLB and the TUG test, where the LR test showed no statistical improvements. Researchers hypothesize that improvements in the somatosensory system from the interventions could explain the results found in this study. One limitation of this study was that it assessed balance performance immediately after the intervention and it is hard to tell how long the effects of that intervention will last.
Please provide your clinical interpretation of this paper. Include how this study may impact clinical practice and how the results can be implemented.
This study can impact clinical practice because the results show that massage and mobilization on the ankle do have a positive impact on balance performance, specifically the Timed Up and Go and the One Leg Balance test. This information is helpful for clinicians because it shows that massage and mobilization can make a difference in balance, which could lead to a decrease in falls in elderly adults. This study also used a test, treat, retest method, which is what is used in the clinical practice. Researchers tested balance, treated with massage and mobilization, and then retested to see if there were any improvements, which there were. This study emphasizes that just 20 minutes of massage and mobilization can make a positive impact on older adults balance, therefore decreasing their risk of falls.
