Effects of a multicomponent physical exercise programme on perceived health-related quality of life and on depressive symptoms in older adults living in long-term nursing homes

ObjectivesThis study aimed to investigate the impact of a multicomponent exercise programme on perceived health-related quality of life (HRQoL) and depressive symptomatology in older people living in a long-term nursing home (LTNH).MethodsA quasi-experimental study was conducted. Forty-one older people were conveniently selected from the largest LTNH in the Basque Country. The participants were assigned to either an intervention group (n = 21) or a control group (n = 20). The intervention group participated in 50-min moderate intensity multicomponent physical exercise sessions (strength and balance, three sessions a week for 3 months). The control group participants continued their usual activities in the LTNH. Assessments were completed at baseline and reassessed after the 12-week intervention by the same nurse researchers who filled out the questionnaires: the 36-item Short Form Survey (SF-36) and the Geriatric Depression Scale (GDS).ResultsThirty-eight participants completed the study (19 participants in each group). In the SF-36 parameters, physical functioning increase in the intervention group tends with a mean increase of 11.06 units (a 17.2% increase over the pre). In the role-emotional, the increase in the intervention group is with a mean increase of 5.27 units (a 29.1% increase over the pre) (P < 0.05). In social functioning, the increase in the control group is significant with a mean increase of 13.16 units (a 15.4% increase over the pre) (P < 0.05). There are no significant changes in the rest of the parameters, there are no differences between groups in the evolutionary pattern either.ConclusionsAs for the effects of the multicomponent exercise programme on HRQoL and depressive symptomatology, no statistically significant effects were obtained in the outcome data among older adults living in LTNHs. An increase in the sample size could confirm the trends obtained. The results may help inform the design of future studies.     

Use of puppets to teach resourcefulness skills to women who self-injure: An exploratory study

BackgroundSelf-injurious behavior (SIB), when frequent and repetitive, can lead to risk behaviors resulting in accidental or intentional suicide. Psychoeducation about resourcefulness can be critical to interrupt the cycle of self-injury. Therapeutic puppetry provides a safe and secure vehicle for expressing feelings without fear of retaliation.ObjectivesDetermine the outcome of a resourcefulness psychoeducation program, utilizing hand puppets as a teaching tool, on the measure of resourcefulness for adult women who self-injure.MethodsA psychoeducation program, utilizing hand puppets as a teaching tool, was offered to women during psychiatric hospitalization. Participants completed the Resourcefulness Scale (RS) pre and post intervention. A program evaluation to determine the effectiveness of hand puppets was completed. Acceptability and feasibility of the program was evaluated.ResultsSixteen participants completed the program. Results showed a statistically insignificant increase in scores. The program evaluation revealed agreement that resourcefulness learning was accomplished. Participants reported that hand puppets were helpful in practicing resourcefulness skills. Majority of participants recommended continuation of the program.     

Sensitivity of the modified Angoff standard‐setting method to variations in item content

Background: The faculty development community has been challenged to more rigorously assess program impact and move beyond traditional outcomes of knowledge tests and self ratings. Purpose: The purpose was to (a) assess our ability to measure supervisors' feedback skills as demonstrated in a clinical setting and (b) compare the results with traditional outcome measures of faculty development interventions. Methods: A pre–post study design was used. Resident and expert ratings of supervisors' demonstrated feedback skills were compared with traditional outcomes, including a knowledge test and participant self-evaluation. Results: Pre–post knowledge increased significantly (pre = 61%, post = 85%; p < .001) as did participant's self-evaluation scores (pre = 4.13, post = 4.79; p < .001). Participants' self-evaluations were moderately to poorly correlated with resident (pre r = .20, post r = .08) and expert ratings (pre r = .43, post r = ?.52). Residents and experts would need to evaluate 110 and 200 participants, respectively, to reach significance. Conclusions: It is possible to measure feedback skills in a clinical setting. Although traditional outcome measures show a significant effect, demonstrating change in teaching behaviors used in practice will require larger scale studies than typically undertaken currently.     

Mock trials and web-based education using malpractice cases: A randomised controlled trial

BackgroundWeb-based education using malpractice cases is increasingly used as an effective program to improve nurses' patient safety competency, and education on legal obligations is vital for nursing students.AimTo evaluate the effectiveness of web-based education using mock trials of medical malpractice cases in improving nursing students' legal obligations, patient safety competency, and critical thinking.MethodsForty-three senior nursing students were randomly assigned to be exposed to blended learning of mock trials (4 weeks) and web-based education (4 weeks) in experimental group (n = 23), and web-based education (4 weeks) alone in control group (n = 20). Pre-test (before randomisation) and post-test (after intervention) data were collected at a university in Korea between October and December 2019.ResultsThere were statistically significant differences in patient safety competencies (t = 3.59, P = 0.001), including skills (t = 2.89, P = 0.006) and knowledge (t = 2.60, P = 0.013), as well as a significant difference in critical thinking disposition (t = 3.09, P = 0.004) between the two groups in the pre−post changes. The two groups had no difference in knowledge and cognition of legal obligation.ConclusionBlended learning of mock trials and web-based education can enhance nursing students' patient safety competency. In particular, mock trials are an active participatory learning method that helps nursing students develop critical thinking skills to ensure patient safety competency compared to web-based education alone. Incorporating mock trial education using medical malpractice cases into the curriculum could enhance nursing students' patient safety competency and critical thinking disposition.     

Impact of two different pulmonary rehabilitation methods in children with down syndrome

PurposeTo investigate and compare the effect of proprioceptive neuromuscular facilitation of respiratory muscles with that of inspiratory muscle training as a preventive measure on respiratory muscle strength, chest expansion, spirometry, and functional capacity in children with Down syndrome.MethodsForty-five Down syndrome participants with an age ranged from 10 to 13 years were enrolled. There were distributed into three groups. The study group A (n = 15) underwent proprioceptive neuromuscular facilitation of respiratory muscles while study group B (n = 15) underwent inspiratory muscle training. Third group C (n = 15) was a control group. The three groups received aerobic exercises using the bicycle ergometer for 20 min, 5 times/week for 12 successive weeks. The treatment program for both study groups was conducted for 20–30 min, 5 times/week for 12 successive weeks. Measurements of respiratory muscle strength (MIP, MEP), chest expansion, spirometry test (VC, FEV1, PEFR, MVV) and 6 min walk test were measured pre and post treatment.ResultsThe post treatment mean values of all investigated variables were significantly increased in both study groups with higher effect to group underwent proprioceptive neuromuscular facilitation of respiratory muscles.ConclusionBoth proprioceptive neuromuscular facilitation of respiratory muscles and inspiratory muscle training are effective in children with Down syndrome on improving respiratory muscle strength, chest expansion, spirometry and functional capacity with superior effect of proprioceptive neuromuscular facilitation.     

Efficacy of a progressive resistance exercise program to increase toe flexor strength in older people

BackgroundReduced toe flexor strength is an independent predictor of falls in older people. However it is unknown whether strengthening programs can restore toe flexor strength in older individuals. The aim of this study was to investigate whether a progressive resistance training program, focused specifically on the foot muscles, could improve toe flexor strength in community-dwelling older people.MethodsAfter baseline testing, 85 men and women (age range 60–90 years) were randomized to either a supervised, progressive resistance training (n = 43) or a home-based exercise (n = 42) group for 12 weeks. A further 32 participants were recruited for a control group. The primary outcome measures were hallux and lesser toe flexor strength pre- and post-intervention. Secondary outcome measures were exercise compliance, components of the Foot Health Status Questionnaire and single-leg balance time.FindingsAverage class attendance was 89% with 68 participants from the two intervention groups (80%) completing the follow-up assessments. Participants in the supervised, progressive resistance training group significantly increased their toe strength (up to 36%; P < 0.02), whereas there was no change in toe strength in either the home-based or control groups. This increased toe strength was accompanied by a significant improvement in perceived general foot health and single-leg balance time compared to the other groups (P < 0.05).InterpretationProgressive resistance exercises are a viable intervention to increase toe flexor strength in older adults. A clinical trial is now required to determine whether this intervention can reduce the number of falls suffered by older adults.     

The effects of an 8-week knitting program on osteoarthritis symptoms in elderly women: A pilot randomized controlled trial

BackgroundExercise therapy is effective in reducing symptoms and disability associated with hand osteoarthritis (HOA) but often has low adherence. An intervention consisting in a meaningful occupation, such as knitting, may improve adherence to treatment. This pilot randomized controlled trial (RCT) studied the adherence and clinical effectiveness of a knitting program in older females suffering from HOA to evaluate the acceptability of this intervention and assess the feasibility of a larger-scale RCT.MethodsSingle-blind, two-arm pilot RCT with a parallel group design with 37 participants (18 control, 19 intervention). Control participants were given an educational pamphlet and assigned to a waiting list. The knitting program (8-week duration) had two components: bi-weekly 20-min group knitting sessions and daily 20-min home knitting session on the 5 remaining weekdays. Measures included knitting adherence (implementation outcomes) as well as stiffness, pain, functional status, hand physical activity level, patient's global impression of change, health-related quality of life, self-efficacy, and grip strength (clinical outcomes measured throughout the 8-week program and 4 weeks after the intervention).ResultsOur protocol is feasible and the intervention was acceptable and enjoyable for participants, who showed high adherence. No difference was observed between the two groups for any of the clinical outcome measures (all p > .05).ConclusionKnitting is a safe and accessible activity for older women with HOA. However, our 8-week knitting program did not result in improvements in any of our outcome measures. Knitting for a longer period and/or with higher frequency may yield better outcomes.     

The implementation of a reflex locomotion program according to Vojta produces short-term automatic postural control changes in patients with multiple sclerosis

BackgroundImbalance is common in people with multiple sclerosis.ObjectiveTo examine the effectiveness of a Vojta locomotion reflex program as short-term automatic postural control in patients with Multiple sclerosis.MethodsQuasi-experimental controlled trial with a pretest-post-test design. Participants: People with Multiple Sclerosis (N = 21) able to walk 100 m but unable to maintain 30-s tandem stance with arms alongside the body.Interventionin two consecutive weeks two interventions were conducted: Vojta group(A) and standard therapy group(B). Primary outcome were: Berg Balance scale (BBS), Tandem test, 10 m Walk in the 1st session (pre and post) then at the end of the study 2 weeks later.ResultsIntervention A had significant results in contrast to intervention B in BBS when referred to equilibrium variables (p = 0.026) and Tandem test (p = 0.01). In the 10 m Walk test a significant improvement was seen in both interventions, p = 0.00 in group A, p = 0.038 in group B. In addition, an association was found between the variable Core activation and the main equilibrium variable (BBS) in the intervention A.ConclusionsThe results suggest that Vojta therapy has a short-term effect improved balance in everyday skills according to BBS and the other tests (walking) in people with MS compared to a standard therapeutic procedure. www.ClinicalTrial.gov.Registration numberNCT03887507.     

Feasibility and preliminary efficacy of a hypopressive exercise program on postmenopausal cancer survivors: A pilot study

BackgroundCancer-related fatigue (CRF) is a common symptom during and after cancer treatment that negatively affects the patient's quality of life. Exercise is one of the most effective non-pharmacological treatments for CRF. Multimodal exercise therapy programs that include hypopressive exercises, relaxation and myofascial release may be beneficial for CRF. The aim of this pilot study was to evaluate the feasibility and efficacy of a multimodal program on CRF and lower limb functional strength in postmenopausal women diagnosed with cancer.Methods7 postmenopausal women (age = 55.28 years; BMI = 26.05 kg/m2) who had a cancer diagnosis participated in a supervised and progressive 55-min class once per week for 12-weeks. CRF was measured using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Cancer Related Fatigue 12 and lower limb strength was assessed with the sit and stand test.ResultsNo adverse events were reported during the training period and all participants completed the exercise protocol. There was a significant increase (p = 0.01) in lower limb functional strength (pre: 19.60 (SD = 2.19) vs post: 24.60(SD = 2.19)) with an effect size of d = 2.28 and a decrease in CRF (p = 0.245) (pre: 29.36 ± 24.42; post: 17.85 ± 14.23) with a trivial effect size (d < 0.5).ConclusionsThese preliminary findings indicate that a supervised once per week multimodal program that includes hypopressive exercises for postmenopausal cancer survivors increased lower limb functional strength without exacerbating their CRF. These findings support further randomized trials of hypopressive training programs on patients with cancer.     

The effect of animal-assisted therapy on nursing student anxiety: A randomized control study

Background and objectiveNursing student stress has a major impact on academic performance and testing anxiety is one prominent source. This study evaluated the influence of dogs in decreasing student anxiety at a nursing program prior to a medication dosage calculation exam.MethodThis study uses a convenience sample randomly assigned to a control and intervention group with a pre-pre, pre, post and post-post-test using the Spielberger State-Trait Anxiety Inventory. The intervention group experienced a therapy dog intervention prior to the medication dosage calculation exam.ResultsUsing a repeated measures one-way MANOVA, there was a statistically significance difference between intervention and control groups Wilk’s ∧ = 0.761, F(8, 79) = 3.103, p < 0.01.ConclusionA brief interaction with therapy dogs prior to a medication calculation exam decreased anxiety in a convenience sample of nursing students. This study adds empirical knowledge to the field of animal-assisted therapy and nursing student anxiety-coping methods.     

Effects of a multifaceted neurological assessment educational program in nursing students: A randomized crossover study

AimThis study aimed to verify the effects of a multifaceted neurological assessment educational program on neurological assessment-related knowledge, skills, communication ability and self-efficacy in nursing students.BackgroundNurses should be equipped with optimal neurological assessment competency to ensure quality care for patients with neurological symptoms.DesignThis study involved a waitlist control group with a randomized crossover design.MethodsFourth-year nursing students were randomly assigned to an intervention group (n = 28) or a waitlist control group (n = 27). Pre- and post-intervention differences in neurological assessment knowledge, skills, communication ability and self-efficacy between the intervention and the waitlist control group were analyzed using generalized estimated equations.ResultsThe nursing students in the intervention group showed significantly improved knowledge, skills, communication ability and self-efficacy scores compared with those in the waitlist control group. Scores related to knowledge, skills and communication ability were maintained and self-efficacy scores had further increased at 2 weeks after the educational program in the intervention group.ConclusionsOur multifaceted neurological assessment educational program is useful for improving nursing students' knowledge, skills, communication ability and self-efficacy.     

Effects of core stability training program on trunk muscle endurance in deaf children: A preliminary study

IntroductionSport participation is an important for deaf children as participants experience physical, psychological and social benefits; however, the beneficial effect of core stability training on core muscle endurance is unclear. The present study aimed to examine the effects of an 8-week core stability exercise training program on endurance of trunk muscles in deaf children.MethodsTwenty male deaf students (age, 16.5 ± 0.65 y; body mass, 62.08 ± 5.39 kg; BMI, 22.33 ± 2.24 kg/m²) volunteered to participate in this study and were randomly assigned to experimental (EXP, n = 10) and control (CON, n = 10) groups. The subjects in the EXP group performed 3 times a week for 8 weeks period of core stability training program and tested trunk muscle endurance including prone bridge, supine bridge and flexor endurance tests at pre and post 8 weeks intervention.ResultsThe CON group did not show any significant change after training period (p > 0.05). The EXP group showed significantly changes in core stability muscle endurance tests following the 8-week core stability training program (p < 0.05). In addition, the EXP group indicated statistically significant changes than the CON group in truck muscle endurance (p < 0.05).ConclusionsThe results indicated that core stability training program improved trunk muscle endurance. Therefore, this training approach can be recommended in deaf rehabilitation programs to improve trunk muscle endurance.     

The effect of a peer education program on combating violence against women: A randomized controlled study

BackgroundStudent nurses in Turkey need to be exposed to appropriate undergraduate training if they are to acquire the required knowledge, attitudes and skills that will help them to fight the issue of violence against women (VAW).ObjectivesThe aim of this research study was to assess the effect of a peer education program about combating VAW on the knowledge, attitudes and skills of nursing students.DesignThe study was designed as a randomized controlled trial.SettingsThe participants in the intervention group received peer education on combating VAW.Participants136 nursing students (intervention group: n = 63, control group: n = 73) were included in the study.ResultsParticipants in both the intervention and control groups were assessed at pre-training and at two months post-training. Pre-training and post-training knowledge and attitudes were significantly different in the intervention group (p < 0.001). Moreover, the intervention group displayed a statistically significant difference in their ability to explain the correct interventions in a case study about VAW (p < 0.001).ConclusionsOur results indicate that peer education should be used as a part of undergraduate nursing education on VAW.     

A training intervention to enhance self-management support competencies among nurses: A non-randomized trial with mixed-methods evaluation

AimTo evaluate the process and outcomes of INTENSS, a training intervention grounded in Self-Determination Theory to enhance nurses’ competencies for self-management support.DesignNon-randomized intervention study with mixed-methods evaluation approach (2019–2020).MethodsThe multifaceted training was implemented in six groups. Cluster-assignment to study arm 1 or arm 2. Arm 1 received a basic training module and arm 2 the basic module with additional video-interaction guidance. Focus groups were held to detect what was helpful in competency enhancement. Intervention effectiveness was determined on trainees’ attitude, motivation, self-efficacy and skills for self-management support (multiple time-points by self-reports and observations).ResultsTrainees (N = 50) indicated the video-interaction guidance, the connectivity within the training group, the constructive feedback from trainers as well as from peers, as helpful for the acquisition of self-management support skills. At 2-month post-training, participants slightly improved in their competencies for the assess (p = .03), agree (p = .02), arrange (p < .01) phase and partnership skills (p < .01). Between the study arms, video-trained participants significantly reduced their use of controlling approaches (p = .03). Observations indicated that trainees mostly used an autonomy-supportive approach, seldom we observed the use of competence supportive, controlling or chaotic approaches. The interviews gave indications that obligatory training in this field needs to be questioned.ConclusionThe outcome evaluation of the INTENNS training indicated most improvement in nurses’ skills for collaborative goal setting and partnership with patients. The mixed-methods evaluation emerges transferable principles to implement the training amongst nurses and, by extension, other healthcare professions. A training intervention involving patient experts can add value to further pave the way towards a true partnership between patients and healthcare professionals.ImpactA training intervention taking into account the complexity of supporting patients towards self-management is available. Important elements for growth are: connectivity within training group, a safe learning climate where ‘failure’ is allowed and video-interaction guidance. Obligatory training participation can be questioned.     

A mindful eating intervention: A theory-guided randomized anti-obesity feasibility study with adolescent Latino females

While pediatric anti-obesity lifestyle interventions have received considerable attention, few show sustained impact on body mass index (BMI). Using the Information-Motivation-Behavioral Skills Theory as a framework, we examined the effects of a satiety-focused mindful eating intervention (MEI) on BMI, weight and mindful awareness.MethodDesign and Setting: Utilizing a two-group, repeated measures design, 37 adolescent females with a BMI >90th percentile, recruited from a public high school in a Latino community in the Southwestern United States, were randomized 2:1, one third to the group receiving a 6-week MEI and two thirds to the comparison group (CG) receiving the usual care (nutrition and exercise information). Intervention: During six weekly 90-min after school MEI group sessions, the behavioral skills of slow intentional eating were practiced with foci on satiety cues and triggers to overeat. Outcomes: Feasibility and acceptability were measured as participant retention (goal ≥55%) and evaluative comments from those in the MEI group, respectively. BMI and mindful awareness were measured on site at baseline, immediately post intervention, and at 4-week follow-up (week 10).ResultsFifty-seven and 65% of those in the MEI and CG were retained throughout the study, respectively. MEI participants showed significantly lowered BMI compared with CG participants, whose weight increased (p < 0.001). At six weeks, the MEI group BMI decreased by 1.1 kg/m² (BMI continued to decline to 1.4 kg/m² by week 10); while CG BMI increased by 0.7 kg/m² (consistent with BMI >90th percentile standard growth projections).ConclusionsInitial and sustained decline of BMI in the MEI group supports further study of this theory-guided approach, and the value of practicing satiety-focused mindful eating behavioral skills to facilitate health behavior change.     

An overview of the Families Improving Together (FIT) for weight loss randomized controlled trial in African American families

BackgroundThe Families Improving Together (FIT) randomized controlled trial tests the efficacy of integrating cultural tailoring, positive parenting, and motivational strategies into a comprehensive curriculum for weight loss in African American adolescents. The overall goal of the FIT trial is to test the effects of an integrated intervention curriculum and the added effects of a tailored web-based intervention on reducing z-BMI in overweight African American adolescents.Design and settingThe FIT trial is a randomized group cohort design the will involve 520 African American families with an overweight adolescent between the ages of 11–16 years. The trial tests the efficacy of an 8-week face-to-face group randomized program comparing M + FWL (Motivational Plus Family Weight Loss) to a comprehensive health education program (CHE) and re-randomizes participants to either an 8-week on-line tailored intervention or control on-line program resulting in a 2 (M + FWL vs. CHE group) × 2 (on-line intervention vs. control on-line program) factorial design to test the effects of the intervention on reducing z-BMI at post-treatment and at 6-month follow-up.InterventionThe interventions for this trial are based on a theoretical framework that is novel and integrates elements from cultural tailoring, Family Systems Theory, Self-Determination Theory and Social Cognitive Theory. The intervention targets positive parenting skills (parenting style, monitoring, communication); cultural values; teaching parents to increase youth motivation by encouraging youth to have input and choice (autonomy-support); and provides a framework for building skills and self-efficacy through developing weight loss action plans that target goal setting, monitoring, and positive feedback.     

Randomised controlled trial of a tailored information pack for patients undergoing surgery and treatment for rectal cancer

PurposeTo evaluate the effects of a tailored information package for rectal cancer patients on satisfaction with information, anxiety and depression and readjustment.MethodThe study used a randomised control trial method. Seventy six patients undergoing surgery and treatment for rectal cancer were randomly assigned to an intervention (n = 43) or control group (n = 33). The intervention group received an information pack tailored according to their treatment plan and preferred information. The control group received the information currently given to these patients. Satisfaction with information was measured using the Patient Satisfaction with Cancer Treatment Education (PSCaTE) scale, anxiety and depression were measured using the Hospital Anxiety and Depression Scale (HADS) and readjustment was measured using the Reintegration to Normal Living Index, at three time points.ResultsThere was a statistically significant difference between the intervention and control group on pre and post intervention scores with patients in the intervention group expressing a higher level of satisfaction with information than those in the control group at Times 2 and 3 (p = 0.00 for both). The intervention group also had a significantly lower anxiety score than the control group at Time 3 (p = 0.03). There was no difference between depression and readjustment scores in the two groups.ConclusionThe results support the hypothesis that a tailored information pack for patients with rectal cancer will positively affect satisfaction with information. These results will enhance the knowledge base surrounding the provision of tailored information to specific patient groups.     

Family,community and clinic collaboration to treat overweight and obese children: Stanford GOALS—A randomized controlled trial of a three-year,multi-component,multi-level,multi-setting intervention

ObjectiveTo test the effects of a three-year, community-based, multi-component, multi-level, multi-setting (MMM) approach for treating overweight and obese children.DesignTwo-arm, parallel group, randomized controlled trial with measures at baseline, 12, 24, and 36 months after randomization.ParticipantsSeven through eleven year old, overweight and obese children (BMI ≥ 85th percentile) and their parents/caregivers recruited from community locations in low-income, primarily Latino neighborhoods in Northern California.InterventionsFamilies are randomized to the MMM intervention versus a community health education active-placebo comparison intervention. Interventions last for three years for each participant. The MMM intervention includes a community-based after school team sports program designed specifically for overweight and obese children, a home-based family intervention to reduce screen time, alter the home food/eating environment, and promote self-regulatory skills for eating and activity behavior change, and a primary care behavioral counseling intervention linked to the community and home interventions. The active-placebo comparison intervention includes semi-annual health education home visits, monthly health education newsletters for children and for parents/guardians, and a series of community-based health education events for families.Main outcome measureBody mass index trajectory over the three-year study. Secondary outcome measures include waist circumference, triceps skinfold thickness, accelerometer-measured physical activity, 24-hour dietary recalls, screen time and other sedentary behaviors, blood pressure, fasting lipids, glucose, insulin, hemoglobin A1c, C-reactive protein, alanine aminotransferase, and psychosocial measures.ConclusionsThe Stanford GOALS trial is testing the efficacy of a novel community-based multi-component, multi-level, multi-setting treatment for childhood overweight and obesity in low-income, Latino families.     

Intrinsic foot muscle strengthening exercises with electromyographic biofeedback achieve increased toe flexor strength in older adults: A pilot randomized controlled trial

BackgroundToe flexor strength is important for preventing older adults from falling. Although intrinsic foot muscles are the main determinants of toe flexor strength, exercises for strengthening these muscles are difficult for older adults. This study therefore aimed to determine whether the use of electromyographic biofeedback helps older adults to perform intrinsic foot muscle strengthening exercises.MethodsThis randomized controlled trial had two parallel arms. Participants were randomly allocated to the control group or the electromyographic biofeedback group. Control participants performed two progressive intrinsic foot muscle strengthening exercises twice a week for 6 weeks. Participants in the other group performed these exercises assisted by electromyographic biofeedback. Primary outcome measures were changes in toe flexor strength and the timed up-and-go and functional reach tests (the latter two being balance tests).FindingsAltogether, 23 older adults were randomized to the control group (n = 12) or the electromyographic biofeedback group (n = 11). After the 6-week intervention, toe flexor strength on the dominant side increased in both groups (P < 0.017). However, toe flexor strength on the nondominant side increased only in the electromyographic biofeedback group (P < 0.017), with a large effect size of 1.5. There were no changes in the two balance tests. Three of the control group and two of the electromyographic biofeedback group were lost to follow- up.InterpretationOur results indicate that, the use of electromyographic biofeedback can enhance the effect of intrinsic foot muscle strengthening exercises on the nondominant side in older adults.Clinical trial registration number: UMIN000036521.