Dataset Information

Integrated Exposure Therapy and Exercise Reduces Fear of Falling and Avoidance in Older Adults: A Randomized Pilot Study.

ABSTRACT: OBJECTIVES:To evaluate the safety and acceptability of a novel 8-week intervention integrating exercise, exposure therapy, cognitive restructuring, and a home safety evaluation, conducted by a physical therapist, in reducing fear of falling and activity avoidance. To collect preliminary evidence of efficacy. DESIGN:Randomized pilot study comparing the intervention to time- and attention-equivalent fall prevention education. SETTING:Participants' homes. PARTICIPANTS:42 older adults with disproportionate fear of falling (high fear, low to moderate objective fall risk). MEASUREMENTS:Falls Efficacy Scale-International, modified Activity Card Sort, satisfaction, falls. RESULTS:Relative to education, the intervention reduced fear of falling (d?=?1.23) and activity avoidance (d?=?1.02) at 8 weeks, but effects eroded over a 6-month follow-up period. The intervention did not increase falls, and participants rated the exercise, exposure therapy, and non-specific elements as most helpful. CONCLUSIONS:An integration of exercise and exposure therapy may help older adults with disproportionate fear of falling, but modifications to the intervention or its duration may be needed to maintain participants' gains.

SUBMITTER: Wetherell JL

PROVIDER: S-EPMC6086757 | biostudies-literature | 2018 Aug

REPOSITORIES: biostudies-literature

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Integrated Exposure Therapy and Exercise Reduces Fear of Falling and Avoidance in Older Adults: A Randomized Pilot Study.

Wetherell Julie Loebach JL Bower Emily S ES Johnson Kristen K Chang Douglas G DG Ward Samuel R SR Petkus Andrew J AJ

The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry 20180412 8

<h4>Objectives</h4>To evaluate the safety and acceptability of a novel 8-week intervention integrating exercise, exposure therapy, cognitive restructuring, and a home safety evaluation, conducted by a physical therapist, in reducing fear of falling and activity avoidance. To collect preliminary evidence of efficacy.<h4>Design</h4>Randomized pilot study comparing the intervention to time- and attention-equivalent fall prevention education.<h4>Setting</h4>Participants' homes.<h4>Participants</h4>4 ...[more]

PMID: 29754811

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Project description:BackgroundAs a common psychological problem among older adults, fear of falling was found to have a wide range prevalence in different studies. However, the global prevalence of it was unknown and a lack of the large sample confirmed its risk factors.ObjectivesTo report the global prevalence of fear of falling and to explore its risk factors among older adults for further developing precise interventions to systematically manage FOF.DesignA systematic review and meta-analysis was conducted by PRISMA guidelines.MethodsSearches were conducted in PubMed, Web of Science, EMBASE, the Cochrane Library and the manual search in August 20, 2022, updated to September 2, 2023. Observational studies published in English were included and two researchers independently screened and extracted the data. Fixed or random effects mode was used to estimate the pooled prevalence of and risk factors for fear of falling. Heterogeneity resources were analyzed by subgroup and sensitivity analysis. Publication bias was assessed through funnel plots, Egger's test and Begg's test.ResultsA total of the 153 studies with 200,033 participants from 38 countries worldwide were identified. The global prevalence of fear of falling was 49.60%, ranging from 6.96-90.34%. Subgroup analysis found the estimates pooled prevalence of it was higher in developing countries (53.40%) than in developed countries (46.7%), and higher in patients (52.20%) than in community residents (48.40%). In addition, twenty-eight risk factors were found a significant associations with fear of falling, mainly including demographic characteristics, physical function, chronic diseases and mental problems.ConclusionThe global prevalence of FOF was high, especially in developing countries and in patients. Demographic characteristics, Physical function, chronic diseases and mental problems were a significant association with FOF. Policy-makers, health care providers and government officials should comprehensively evaluate these risk factors and formulate precise intervention measures to reduce FOF.Trial registrationThe study was registered in the International Database of Prospectively Registered Systematic Reviews (PROSPERO): CRD42022358031.

Project description:INTRODUCTION:Activity restriction due to fear of falling is a common problem after a stroke. It can lead to deteriorated physical condition, restricted social participation and deprived quality of life. The Survey of Activities and Fear of Falling in the Elderly (SAFE) was developed to assess these difficulties, and its utility has been demonstrated among the older adults and older people with Parkinson's disease. This study aimed to expand those demonstrations to community-dwelling chronic stroke survivors using a Chinese translation of the instrument. METHODS:One hundred and eight elderly individuals with a history of stroke completed the Chinese version of the SAFE (SAFE-C). The internal consistency of their responses was assessed using Cronbach's alpha. Twenty of the same subjects were reassessed after a 1-week interval to assess the instrument's test-retest reliability. Structure validity was examined by exploratory factor analysis. Pearson correlation was used to establish the instrument's convergent validity with respect to the results from the Chinese version of the Activities-specific Balance Confidence Scale (ABC-C) and the Chinese version of the Lawton Instrumental Activities of Daily Living scale (IADL-C). RESULTS:The items of the SAFE-C demonstrated excellent internal consistency with a Cronbach's alphas of 0.90. The SAFE-C also had excellent test-retest reliability with an overall intra-class correlaton coefficient of 0.91. A 1-factor structure termed "fear avoidance circumstances" was identified and it was shown to be consistent with the original measure developed among community-living older people. The correlations between the SAFE-C and the ABC-C (r = -0.68) and the IADL-C (r = -0.57) confirmed the convergent validity. CONCLUSIONS:Fear avoidance behavior is a homogeneous construct applicable to people with stroke-specific impairments alike. The SAFE-C is a reliable and valid instrument for measuring the level of fear avoidance behavior among community-dwelling stroke survivors. Stroke survivors with good functional mobility revealed a low level of fear and avoidance as measured by the SAFE-C.

Dataset Information

Integrated Exposure Therapy and Exercise Reduces Fear of Falling and Avoidance in Older Adults: A Randomized Pilot Study.

Publications

Integrated Exposure Therapy and Exercise Reduces Fear of Falling and Avoidance in Older Adults: A Randomized Pilot Study.

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