Cross-Cultural Adaptation, Validity and Reliability of the Arabic Version of the Falls Efficacy Scale-International (FES-I)

Cross-cultural adaptation, reliability, and validity study of the Turkish version of the "Spinal Cord Injury-Falls Concern Scale"

PURPOSE

This study aims to conduct a Turkish validity and reliability study of the Spinal Cord Injury-Falls Concern Scale (SCI-FCS).

METHODS

The study involved 134 volunteer patients with spinal cord injury. Various validity analyses, including content validity analysis, Confirmatory Factor Analysis (CFA), Pearson product-moment correlation coefficient, and Cronbach's alpha value based on a single application for reliability, were employed. The Falls Efficacy Scale-International (FES-I) was used for criterion validity.

RESULTS

All the standardized regression coefficients for the single factor measurement model established with 16 items in the scale are above 0.84. The CFA model, also with a single factor and 16 items, yields the following fit indices: Root-Mean-Square Error of Approximation value of 0.15, Standardized Root Mean Residual Squares value of 0.06, Chi-square value of 2.20, and Comparative Fit Index and Non-Normed Fit Index values of 0.98. The scores they received from the SCI-FCS and the scores they received from the FES-I scale have a statistically significant positive correlation (p < 0.01). The test-retest reliability coefficient value is 0.81, and the Cronbach Alpha value is 0.97.

CONCLUSION

The Turkish version of the SCI-FCS is a valid and reliable tool for determining fall concerns for patients with spinal cord injury.

Moving the needle on implementing fall prevention programs in Saudi Arabia: assessing knowledge and perceptions of fall risk among community-dwelling older women

BACKGROUND

Saudi Arabia, like many nations globally, is experiencing a demographic shift towards an aging population. With this demographic shift, falls and the fear of falling (FOF) emerge as serious public health concerns among community-dwelling older adults. Addressing misconceptions and enhancing awareness regarding fall risks among older adults holds significant importance, offering insights for informing targeted interventions and enhancing well-being. This study aimed to examine knowledge and perceptions of fall risk among community-dwelling older women in Saudi Arabia.

METHODS

A cross-sectional study was conducted with 150 Saudi older women, with a mean age (SD) of 63.98 (4.90) years. Participants completed questionnaires assessing fall history, fall knowledge, fall perception, the Falls Efficacy Scale-International (FES-I), Timed Up and Go (TUG), and the Barthel Index. Fall knowledge and perception were assessed using previously constructed statements translated into Arabic and carried out in interviewer-administered forms.

RESULTS

Nearly half of the participants reported experiencing at least one fall in the previous 12 months. Despite good knowledge of falls, some gaps were identified, particularly regarding the awareness of social isolation as a consequence of falls. Participants demonstrated positive perceptions towards fall prevention programs but also highlighted misconceptions regarding aging and falls. FOF was prevalent, with higher levels identified among participants without a history of falls.

CONCLUSION

Multidimensional strategies are needed to address falls and FOF among community-dwelling older women in Saudi Arabia. Leveraging existing knowledge and perceptions towards fall prevention and implementing evidence-based interventions can reduce the burden of falls and enhance health outcomes in older adults. Future research should focus on diverse samples and evaluate the feasibility of implementing fall prevention interventions within Saudi Arabia's healthcare systems.

Multiple Long-Term Conditions and Disability are Independently Associated with Higher Risk of Fall Among Community Adults: a Cross-Sectional Study

Background

Previous studies have suggested an association between falls and the presence of Multiple Long-Term Conditions (MLTC) or disabilities. However, there is limited understanding of how these factors independently or collectively contribute to the risk of falls and fear of falling among community-dwelling adults.

Objective

This study examined the independent association between MLTC and the presence of disability with the risk of falls among community adults.

Methods

A cross-sectional study included 324 adults (age ≥ 50). Demographic and clinical data included age, sex, body mass index (BMI), MLTC (≥ two chronic diseases) risk of fall (ie, history of fall in the previous 12-months, number of falls, and recurrent falls). The Barthel Index and Falls Efficacy Scale-International (FES-I) were used to assess disability and fear of fall, respectively.

Results

MLTC (Odds Ratio (OR) 2.50, 95% Confidence Interval (CI) [1.26, 4.95], p=0.009), and disability (OR 1.71, 95% CI [1.04, 2.79], p = 0.034) were independently associated with history of falls. MLTC (Incidence Rate Ratio (IRR) 2.87, 95% CI [1.93, 4.29], p < 0.001) and disability (IRR 1.86 95% CI [1.46, 2.36], p < 0.001) were independently associated with an increased number of falls. MLTC (OR 4.50, 95% CI [1.78, 11.36], p = 0.001) and disability (OR 2.82, 95% CI [1.58, 5.05], p < 0.001) were independently associated with recurrent falls. MLTC (B = 6.45, p < 0.001) and disability (B = 3.05, p = 0.025) were independently associated with increased fear of falling.

Conclusion

This study indicated that both MLTC and disability are independently associated with falls, number of falls and fear of falling in this population.

Reliability and validity of the Arabic version of the modified falls efficacy scale

PURPOSE

The purpose of this study was to adapt Modified Falls Efficacy Scale (MFES) into Arabic and determine the reliability and validity of the instrument.

MATERIALS AND METHODS

The study was conducted in two phases: (i) translation and adaptation by the systematic approach of the 'forward-back' translation method and (ii) psychometric testing of the Arabic version of the Modified Falls Efficacy Scale among 207 community-dwelling older adults (≥ 60 years).

RESULTS

The Arabic version of the Modified Falls Efficacy Scale demonstrated excellent internal consistency (Cronbach's alpha = 0.98) and test-retest reliability scores (ICC = 0.96, 95% CI; 0.95-0.97). And also showed strong correlations with both the Falls Efficacy International (r = -0.82) and the activities-specific Balance Confidence Scale (r = 0.87). Sampling adequacy for factor analysis was proven by a Kaiser-Meyer-Olkin value of 0.962. Goodness-of-fit (GFI) statistics for the model were in the acceptable range (Chi-Square/Degree of Freedom (CMIN/DF) = 2.59, Goodness-of-fit index (GFI) = 0.9, Comparative Fit Index (CFI) = 0.97, Root Mean Square Error of Approximation (RMSEA) = 0.79).

CONCLUSION

The Arabic version of the Modified Falls Efficacy Scale has demonstrated excellent psychometric qualities to measure the level of fear of falling.

Cognitive status and sleep quality can explain the fear of falling and fall history in people with Parkinson's disease

Fear of falling (FOF) is highly prevalent in people with Parkinson's disease (PwPD) and contributes to high fall risk. Studies reporting on the relationship between falls, FOF, and non-motor factors such as cognitive function and sleep quality in Parkinson's disease are limited. This study aimed to investigate (1) the relationship of cognitive function and sleep quality with FOF, and history of falls in PwPD; (2) differences in cognitive function and sleep quality between Parkinson's disease fallers and non-fallers; and (3) a cut-off score for cognitive function and sleep quality to discriminate Parkinson's disease fallers from non-fallers. Fifty PwPD were assessed for FOF [Falls Efficacy Scale-International (FES-I)], cognition [Montréal Cognitive Assessment (MOCA)], sleep quality [Pittsburgh Sleep Quality Index (PSQI)], and falls history. The MOCA is significantly associated with FES-I scores ( R2  = 0.429, P  < 0.0001). Both MOCA ( P  = 0.012) and PSQI ( P  = 0.027) were associated with falls history even after adjusting for confounding factors (age, sex, L-dopa use, Parkinson's disease severity). Both MOCA and PSQI scores were able to distinguish fallers from non-fallers with cut-off scores of 15.5 and 7.5, respectively. Although our findings revealed that both cognitive function and sleep quality are important factors influencing falls and FOF in PwPD, it remains to be determined if addressing cognitive impairments and poor sleep quality may favorably impact balance before integrating such screenings into fall prevention programs.

Cross-cultural Adaptation and Validation of the Arabic version of Stroke Self-Efficacy Questionnaire for Patients with Stroke

BACKGROUND

Self-efficacy has an important impact on rehabilitation outcomes in stroke. The Stroke Self-Efficacy Questionnaire assesses performance in daily functional activities and self-management following a stroke.

PURPOSE

To translate and cross-culturally adapt the Stroke Self-Efficacy Questionnaire (SSEQ) into the Arabic language and to assess its psychometric properties among patients with stroke.

METHODS

SSEQ was translated into Modern Arabic and then translated back into English. An expert review panel produced a pre-final version of SSEQ-AR, which was followed by a pilot test with a sample of 15 patients with stroke. The psychometric properties of the final version of the SSEQ-AR were evaluated in 135 patients with stroke.

DATA ANALYSIS

Cronbach's alpha and ICC were calculated to describe the internal consistency and test-retest reliability, respectively. Short-Form Survey (SF-12) physical and mental subscales and Fall Efficacy Scale International were used to determine the construct validity.

RESULTS

The total score of the SSEQ-AR and subscales showed a strong to very strong (ICC2,1 0.89-0.92), and acceptable internal consistency for two subscales (Cronbach's alpha = 0.81 to 0.94) and total (Cronbach's alpha = 0.93). The SSEQ-AR subscales showed a good correlation with physical component subscales of SF-12 (r = 0.64-0.72) and excellent correlation with FES-I in total (r = 0.82) and with subscales (r = 0.75-0.79).

CONCLUSION

This study shows that SSEQ-AR is a reliable and valid instrument that assesses the level of self-efficacy for patients with stroke in Arabic-speaking countries.

Predictors of Dizziness and Hearing Disorders in People with Long COVID

Background and Objectives: Individuals report persistent symptoms after becoming infected by SARS-CoV-2 (COVID-19) that last for >4 weeks (long-COVID syndrome). Dizziness and hearing loss have been reported among long-COVID symptoms. However, little is known about the potential predictors of dizziness and hearing loss in individuals with long COVID. This study aimed to explore the presence and correlates of dizziness and hearing loss in a sample of people with long-COVID syndrome. Materials and Methods: Individuals aged 18 years and older who were infected with COVID-19 at least 8 weeks prior to the start of the study were included if they were not diagnosed with dizziness or hearing loss before getting COVID-19. Demographics and COVID-19-related information were collected. Participants completed the Dizziness Handicap Inventory (DHI), Activities-Specific Balance Confidence (ABC) scale, Falls Efficacy Scale International (FES-I), Modified Fatigue Impact Scale (MFIS), and Medical Outcomes Study Short Form 12 (SF-12). Finally, hearing was assessed using pure-tone audiometry (PTA) in a subsample. Results: Two hundred and nine individuals (66% female) with a mean (SD) age of 27 (9) participated in the study. Perceived dizziness and hearing loss were reported in 26 and 15.3% of the sample, respectively. Logistic regression was conducted to identify potential predictors of dizziness and hearing loss separately. After controlling for age and severity of dizziness, female sex and high fatigue severity were associated with an increased likelihood of reporting dizziness (R2 = 31%). The severity of dizziness and neurological symptoms during the acute stage of COVID-19 were associated with an increased likelihood of reporting hearing loss (R2 = 10.4%) after controlling for age. Conclusions: Dizziness and hearing loss present in long COVID and can be disabling. Females with high levels of fatigue should be questioned about persistent dizziness. Hearing loss should be considered in individuals with neurological symptoms and severe dizziness as a consequence of long COVID.

The Five Times Sit-to-Stand Test is associated with both history of falls and fear of falling among community adults aged 50 years and older

BACKGROUND

Limited evidence has examined the association between balance and mobility measures with risk of fall.

AIM

To determine the prevalence and balance measures associated with falls and fear of falling among community adults aged 50 years and older.

METHODS

This cross-sectional study included community-dwelling adults aged ≥ 50 years, living in Saudi Arabia. The participants were asked to report any history of falls in the past 12 months and fear of falling using the Falls Efficacy Scale (FES-I). Balance/mobility measures included the Timed Up and Go (TUG) test, Functional Reach Test (FRT), 10-m walk test (10-MWT), 6-min walk test (6-MWT), and Five Times Sit-to-Stand Test (5XSST).

RESULTS

Two hundred and six participants, including 96 women, were included. The prevalence of falls was 12.6%, and the 5XSST was the only balance measure significantly associated with falls (OR 1.17, 95% CI [1.03, 1.33], p = 0.019) with a cutoff score of 13.93 s or more, a sensitivity of 0.73, and a specificity of 0.58. An increase in 5XSST time was associated with an increase in FES-I score, while a decrease in other balance measures (10-MWT, TUG, FRT, and 6-MWT) was associated with an increase in FES-I scores.

CONCLUSION

Adults living in Saudi Arabia had a low prevalence of falls. The 5XSST was the only significant balance/mobility measure that distinguished fallers from non-fallers.

Factors contributing to falls in people with multiple sclerosis: The exploration of the moderation and mediation effects

BACKGROUND

The prevalence of multiple sclerosis (MS) has significantly increased in recent decades. People with MS have a high risk of falling; these falls may lead to serious injuries, affecting their quality of life PURPOSE: The aim of this study is to assess the factors affecting falls in people with MS and map out the most significant ones. This study also aims to determine whether fatigue has a moderation effect and balance has a mediation effect on falls in people with MS METHODS: In total, 103 people with MS with a mean age of 32.09 ± 7.17 were enrolled. All subjects were assessed for multiple variables including balance using the Berg Balance Scale (BBS), speed of gait using the Timed Up and Go (TUG) test, fear of falling using the Falls Efficacy Scale-International (FES-I), level of fatigue using the Modified Fatigue Impact Scale (MFIS), and lower limb muscle strength using a handheld digital dynamometer RESULTS: Simple binary logistic regression analysis showed significant results for BBS (OR: 10.88; 95% CI: 4.24-27.96; p < 0.0001), TUG (OR: 1.18; 95% CI: 1.09-1.28; p < 0.0001), FES-I (OR: 1.06; 95% CI: 1.02-1.10; p = 0.001), and MFIS (OR: 1.04; 95% CI: 1.02-1.07; p < 0.0001) as factors affecting falls. According to multivariate analysis, balance (OR: 3.924; 95% CI: 1.307-11.780, p = 0.015), speed of gait (OR: 1.122; 95% CI: 1.023-1.231; p = 0.015), and fatigue (OR: 1.029; 95% CI: 1.002-1.058; p = 0.038) were the strongest predicting factors of falls. Hayes's PROCESS analysis showed that fatigue had a significant moderation effect on the relationship between gait speed and falls (MFIS; β; 0.10; p < 0.0001; 95% CI: 0.07-0.14) and balance had a mediation effect on the relationship between gait speed and falls (BBS; indirect effect; 0.08; 95% CI: 0.02-0.13) CONCLUSIONS: People with MS with impaired balance, slower gait speeds, higher levels of fatigue, and a fear of falling were at a high risk of falling. The relationship between gait speed and falls can be mediated by impaired balance and moderated by the level of fatigue. Our data suggest that targeting balance and fatigue while developing rehabilitation interventions could decrease the incidence of falls among people with MS.

Objective assessment of mobility among adults with diabetes and end-stage renal disease using walking aid: A cross-sectional cohort study

BACKGROUND

This cross-sectional study aimed to compare physical activity levels, plantar sensation, and fear of falling between individuals with diabetes undergoing hemodialysis, with or without walking aids.

METHODS

Sixty-four participants were recruited, with 37 not using walking aids (age = 65.8 ± 0.7 years, 46% female) and 27 using walking aids (age = 69.2 ± 1.2 years, 63% female). Physical activity was measured using validated pendant sensors over two consecutive days. Concern for falling and plantar numbness were assessed using the Falls Efficacy Scale-International and vibration perception threshold test, respectively.

FINDINGS

Participants using walking aids exhibited a greater fear of falling (84% vs. 38%, p < 0.01) and fewer walking bouts (p < 0.01, d = 0.67) and stand-to-walk transitions (p < 0.01, d = 0.72) compared to those not using walking aids. The number of walking bouts was negatively correlated with concern for falling scores (ρ = -0.35, p = 0.034) and vibration perception threshold (R = -0.411, p = 0.012) among individuals not using walking aids. However, these correlations were not significant among those using the walking aid. There was no significant group difference in active behavior (walking + standing %) and sedentary behavior (sitting + lying %).

INTERPRETATION

Those undergoing hemodialysis often lead sedentary lives, with mobility affected by fear of falling and plantar numbness. Using walking aids can help, but it doesn't guarantee more walking. A combined psychosocial and physical therapy approach is key for managing fall concerns and improving mobility.

A systematic review and meta-analysis of the measurement properties of concerns-about-falling instruments in older people and people at increased risk of falls

BACKGROUND

The 16-item Falls Efficacy Scale International (FES-I) is widely used to assess concerns-about-falling. Variants include 7-item Short FES-I, 30-item Iconographical Falls Efficacy Scale (Icon FES) and 10-item short Icon FES. No comprehensive systematic review and meta-analysis has been conducted to synthesise evidence regarding the measurement properties of these tools.

OBJECTIVES

To conduct a systematic review and meta-analysis of the measurement properties of four FES-I variants.

METHODS

MEDLINE, Embase, CINAHL Plus, PsycINFO and Web of Science were searched systematically and articles were assessed for eligibility independently. The methodological quality of eligible studies was assessed using COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) Risk of Bias checklist. The quality of measurement properties was assessed using COSMIN criteria for good measurement properties. Where possible, meta-analysis was conducted; otherwise, narrative synthesis was performed. Overall certainty of evidence was rated using a modified Grading of Recommendations, Assessment, Development and Evaluation system approach.

RESULTS

The review included 58 studies investigating measurement properties of the four instruments. There was high-quality evidence to support internal consistency, reliability and construct validity of all instruments. Moderate- to high-certainty evidence suggests one-factor structure of FES-I with two underlying dimensions, one-factor structure of Short FES-I and two-factor structure of Icon FES. There was high-certainty evidence to support the responsiveness of FES-I, with further research needed for the other instruments.

CONCLUSION

There is evidence for excellent measurement properties of all four instruments. We recommend the use of these tools with healthy older people and people at a greater risk of falls due to conditions that might affect mobility and balance.

Number of medications and polypharmacy are associated with risk of fall in Saudi community-dwelling adults

Background

This study primarily aimed to examine the association between the number of medications and polypharmacy with fall history and fear of falling among Saudi community-dwelling adults aged 50 years and older. A secondary objective was to determine the cutoff score of the number of medications associated with a history of falls within this population.

Methods

This cross-sectional study included community-dwelling adults aged ≥ 50 years living in Saudi Arabia. The participants were asked to report any history of falls in the past 12 months; the Falls Efficacy Scale (FES-I) was used to measure the fear of falling. The number of medications was obtained by interviewing the participants and was recorded as a number. Polypharmacy was defined as the use of ≥ 4 medications. Binary logistic regression and linear regression analyses were performed. Receiver operator characteristics and area under the curve were used to determine the cut-off scores for the number of medications that distinguished fallers from non-fallers.

Results

A total of 206 participants (96 women) were included. The prevalence of falls was 12.6 %. Number of medications was associated with a history of falls (OR 1.55, 95 % CI [1.16, 2.07], p = 0.003) after adjustments for age, sex, body mass index, education, employment status, marital status, and number of chronic conditions. Polypharmacy was associated with a history of falls (OR 9.06, 95 % CI [2.56, 32.04], p = 0.012) after adjusting for covariates. Neither the number of medications nor polypharmacy was associated with fear of falling, as measured by FES-I. The number of medications with a cutoff of ≥ 2 or more medications was associated with a history of fall with a sensitivity of 69.23 % and specificity of 66.67 %.

Conclusion

This study found that the number of medications and polypharmacy were associated with a history of falls among community-dwelling adults aged ≥ 50 years. A cutoff score was identified of 2 or more medications that distinguished fallers from non-fallers in this population. This cut-off score was below the polypharmacy threshold.

Cross-cultural adaptation of the Taiwan Chinese version of the Falls Efficacy Scale-International for community-dwelling elderly individuals

Background

The Falls Efficacy Scale-International (FES-I) is a commonly used questionnaire to evaluate concerns about falling. We adapted a Taiwan Chinese version (FES-ITC) and evaluated its reliability and validity in community-dwelling elderly individuals. The discriminative validity was tested in relation to several known risk factors for fear of falling (FOF).

Methods

The questionnaire was adapted through translation, back-translation, and expert review processes. A convenience sample of 135 community-dwelling elderly individuals (at least 60 years old) completed the adapted questionnaire, and 31 of them had a retest within 7–10 days. Cronbach’s α and an intraclass correlation coefficient (ICC) were used to evaluate the internal consistency and test–retest reliability. Principal component factor analysis was performed to assess the factor-construct validity. The discriminative validity was tested in relation to demographic features, fall-related history and performances on three functional tests: timed up and go, four-stage balance and 30-s chair stand tests. Effect sizes were computed. Correlation coefficients between physical functional performance and FES-ITC scores were computed. Receiver operating characteristic curves were used to determine the cutoff point for the score to differentiate high and low concern of falling.

Results

The FES-ITC questionnaire had high internal consistency (Cronbach’s α = 0.94) and excellent test–retest reliability (ICC = 0.94). Principal component factor analysis yielded a two-factor model, with several items requiring high demand on postural control loading on factor 2. FES-ITC scores discriminated individuals with different ages, reporting FOF, reporting falls in the past year and using walking aids. However, FES-ITC scores did not differ between the participants who were at risk of falling and those who were not at risk based on functional test performance and there was no correlation found between them.

Conclusion

The FES-ITC was highly reliable and had adequate construct and discriminative validity. The lack of correlation between FES-ITC scores and functional test performance implied the presence of FOF even in individuals with good functional performance. Further follow up studies are warranted to verify the predictive validity of the FES-ITC.

Predictors of fear of falling among community-dwelling older adults: Cross-sectional study from Palestine

Introduction

Fear of falling has serious implications for health and is an important threat to autonomy. The purpose of this cross-sectional study was to investigate risk factors for fear of falling among Palestinian older adults in Hebron district.

Methods

A cross-sectional study was conducted among Palestinians > 60 years living in Hebron, West Bank. The Falls Efficacy Scale-International was used to predict falls among Palestinian older adults. Moreover, socio-demographic data, medical history, lifestyle habits, body composition, nutritional status, cognitive status (using the Montreal cognitive assessment tool), and functional status (using activities of daily living and instrumental activities of daily living scale), the presence of depressive symptoms (using geriatric depression scale), and physical fitness performance (using senior fitness test) were collected through an interview-based questionnaire. Data were analyzed using univariate and multivariate approach.

Results

A total of 200 participants were included in the study; 137 (68.5%) females and 63 (31.5%) males. Mean age was 70.5 ± 5.7 years, ranged from 65 to 98 years old. Fear of falling was significantly higher among older adults with advanced aged, living in villages or camps, low educational level, and being married (p < 0.05). Functional status (ADL and IADL), physical fitness status (timed up and go), and depression symptoms were significantly related to fear of falling (p < 0.05).

Conclusion

High concern of falling is significantly associated with advanced age, low education level, being married, and living in villages or camps. ADLs were among the factors that had a significant relationship with increased fear of falling. Predictors of fear of falling among Palestinian older adults were IADL scores, body fat percentage, rapid gait speed, timed up and go test. Future studies could investigate further correlates of fear of falling among older adults.

Effects of Neuromuscular Electrical Stimulation on Plantarflexors Spasticity, Gait Performance, and Self-Reported Health Outcomes in People With Chronic Stroke: A Study Protocol for a Double-Blinded Randomized Clinical Trial

Introduction: Rehabilitation approaches have been used for people with stroke to decrease spasticity and improve functions, but little is known about the effect of neuromuscular electrical stimulation (NMES) in this population. Therefore, the primary purpose of this study was to establish a protocol for a double-blinded randomized clinical trial to examine using NMES on plantarflexors spasticity, dorsiflexor muscle strength, physical functions, and self-reported health outcomes in people with chronic stroke in Saudi Arabia. Material and Methods: This randomized clinical trial with two arms and double-blinded registered in ClinicalTrials (NCT04673045) will enroll 44 participants with chronic stroke and randomized them into either the experimental group (EG), including electrical stimulation (ES) with conventional therapy or the control sham group (NMES_sham) including placebo electrical stimulation with conventional therapy. The frequency will be set at 80 Hz for 30 min. The intervention will be three times a week for 4 weeks for both groups. Data collection for pre- and post-intervention outcomes will include measurements for the primary outcomes including paretic limb (plantarflexor spasticity, ankle range of motion, and dorsiflexor muscles strength), and gait speed using 10-m walk test (10-MWT). The secondary outcomes including mobility function using Timed Up and Go (TUG), walking endurance using 6 Minutes Walk Test (6-MWT), activity of daily living using the Arabic version of Barthel Index (BI), and self-reported health measures such as quality of life using the Medical Outcomes Survey (Short Form 36, SF-36), physical activity using Rapid Assessment of Physical Activity (RAPA), depression symptoms using Patient Health Questionnaire-9 (PHQ-9), fatigue level using Fatigue Severity Scale (FSS), and risk of fall using Fall Efficacy Scale International (FES-I). An independent t-test will be utilized to examine the effect of the intervention on the outcome measures. Results: The recruitment has started and is ongoing. Conclusions: Using 4 weeks of NMES will provide information about its effect in improving plantarflexor spasticity, dorsiflexor muscles strength, gait speed, mobility functions, and other self-reported health outcomes in people with chronic stroke when compared to NMES_sham.

A New Tool for Safety Evaluation and a Combination of Measures for Efficacy Assessment of Cotransplanting Human Allogenic Neuronal Stem Cells and Mesenchymal Stem Cells for the Treatment of Parkinson Disease: Protocol for an Interventional Study

Background

Parkinson disease (PD) is a neurodegenerative disorder associated with a broad spectrum of motor and nonmotor symptoms. Any proposed cure needs to address the many aspects of the disease. Stem cell therapy may have potential in this regard as indicated in recent preclinical and clinical studies.

Objective

This protocol aims to examine the safety and therapeutic benefit of human Wharton jelly-derived mesenchymal stem cells (WJ-MScs) and their derivatives, neuronal stem cells (NSCs) in PD.

Methods

This clinical trial is a double-arm, single-blinded, phase I-II interventional study. Participants have been allocated to 1 of 2 groups: one receiving allogeneic WJ-MSCs alone, the other receiving NSCs and WJ-MScs. Participants are being followed-up and assessed over a period of 6 months. To assess safety, an incidence of treatment-emergent adverse events (TEAEs) tool tailored for PD is being used immediately and up to 6 months after treatment. For efficacy assessment, a number of factors are being used, including the gold standard severity test and the Unified Parkinson Disease Rating Scale. In addition, the following standardized assessments for different common symptoms in PD are being included: motor (both subjectively and objectively assessed with wearable sensors), sensory, quality of life and psychological well-being, cognition, and sleep quality. Furthermore, immune-modulatory cytokines and neuronal damage versus regeneration markers in PD, including the neuronal protein linked to PD, α-synuclein, are being monitored.

Results

Ten patients have been enrolled in this study and thus participant recruitment has been completed. The study status is active and beyond the recruiting stage. Study chart implementation, data collection, and analysis are ongoing.

Conclusions

The combination of NSCs and MSCs in PD may be useful for harnessing the best of the immunomodulation and neural repair characteristics of these cell types. The tailored comprehensive and scaled TEAEs and the variety of evaluation tools used enables a comprehensive assessment of this cellular therapy treatment protocol. A consideration of this expanded tool set is important in the design of future clinical studies for PD.

Trial Registration

ClinicalTrials.gov NCT03684122; https://clinicaltrials.gov/ct2/show/NCT03684122

International Registered Report Identifier (IRRID)

DERR1-10.2196/29695

Understanding the influence of pain and fatigue on physical performance, fear of falling and falls in people with Parkinson's disease: a pilot study

Objective: Pain and fatigue are highly prevalent debilitating symptoms in Parkinson's disease (PD), however, their relationship with physical performance, fear of falling (FOF) and falls is not clear. We aim in this pilot study to investigate the relationship of pain and fatigue with physical performance, FOF and falls in people with Parkinson's disease (PwPD). Materials & methods: 53 PD patients were assessed for fall history, physical performance, FOF, pain and fatigue. Results: Pain and fatigue are significantly associated with physical performance and FOF (p ≤ 0.002). Pain and fatigue were different between fallers and non-fallers (p < 0.5), but only fatigue could distinguish fallers from non-fallers (area under the receiver operating characteristics curve = 0.81; p < 0.0001). Conclusion: This pilot study indicated that FOF in PwPD is significantly associated with pain and fatigue. Furthermore, fatigue level is related to fall history. By addressing pain and fatigue, we may ameliorate the deterioration of FOF and falls in PwPD.

Cross-Cultural Adaptation of Indonesian Version of Activities-Specific Balance Confidence Scale for Elderly in Surabaya

Falling is a major health problem and is also a major cause of morbidity and mortality in the elderly. The more serious consequences of falling on the elderly are the increased risk of injury and fear of falling. Activities-Specific Balance Confidence (ABC) scale is one of the assessment instruments for fear of falling. This instrument is used to assess balance confidence in various ambulation activities. The purpose of this study was to carry out the process of adaptation of the cross cultural ABC English questionnaire to ABC Indonesian. This study was a cross sectional study with participants of five elderly members of the Posyandu Lansia who were in accordance with the inclusion and exclusion criteria. The output is the correlation between the score of ABC English with ABC Indonesian and the score of ABC Indonesian with ABC English Back Translation which are tested at different times. All the question score in the ABC English questionnaire correlated with ABC Indonesian, as well as the Indonesian Language ABC correlated with ABC English back translation, have a significant correlation (r> 0.3). The conclusion of this study is that the ABC English has a close meaning with the ABC Indonesian and the ABC Indonesian has a close meaning with the ABC English back translation. The validity and reliability of the Indonesian version of ABC questionnaire is needed to obtain a valid and reliable questionnaire.

Challenges Facing Family Caregivers of Children With Disabilities During COVID-19 Pandemic in Palestine

BACKGROUND

COVID-19 has caused great changes in all aspects of life which affected all people especially vulnerable groups such as children with disabilities (CWD) and their families.

OBJECTIVE

This study aimed to examine the challenges facing caregivers of CWD during the pandemic, and to explore these challenges from various physical, social, psychological, and financial aspects.

METHODS

A cross-sectional design was conducted in Palestine, a total of 130 caregivers of CWD completed a survey consisting of demographic and clinical characteristics questionnaire and the short version of the burden scale for family caregivers (BSFC-s) between March and May 2021.

RESULTS

Most of the caregivers were mothers (76.9%), the mean age of the children was (6.09 ± 3.43 years). The majority (88.5%) of the caregivers felt physically exhausted, about (75.4%) had decreased living standards, and (86.2%) indicated that caregiving is taking their strength. A high burden score was recorded, the mean BSFC-s score was 20.17 ± 5.57. Significant differences in BSFC-s scores were recorded based on the type of disability, and child's ability to take care of oneself, P < .05. The total scores of the BSFC-s were positively correlated with the physical, social, psychological, and financial challenges facing the caregivers (P < .001).

CONCLUSIONS

COVID-19 has caused increased burdens on the caregivers of CWD and a negative impact on the child's mobility accompanying a lack of access to health and rehabilitation services. Vital factors are to be considered in developing strategic health and rehabilitative plans for promoting better care for caregivers and their CWD during lockdown restrictions time.

The effect of stem cell therapy and comprehensive physical therapy in motor and non-motor symptoms in patients with multiple sclerosis: A comparative study

INTRODUCTION

People with multiple sclerosis (PwMS) experience a wide range of disabilities which negatively impact their quality of life (QOL). Several interventions have been used in PwMS such as medication, physical therapy exercises and stem cell therapy to improve their QOL. However, there is a limited evidence on the benefits of combining interventions. The purpose of this study is to explore the effect of combining physical therapy exercises (PTE) and Wharton Jelly mesenchymal stem cell (WJ-MSCs) injections on motor and non-motor symptoms versus each intervention alone in PwMS.

METHODS

Sixty PwMS will be allocated to either PTE, WJ-MSCs, or a combined group, followed up for 12 months and examined using a comprehensive battery of measures. Participants in the PTE group will receive 2 sessions per week of a supervised exercise program for 6 months followed by a home exercise program for another 6 months. The WJ-MSCs group will receive 3 WJ-MSCs injections in the first 6 months then they will be encouraged to follow an active life style. The third group will receive both interventions.

DISCUSSION

This study will aid in a better understanding of the combined effect of physical therapy and mesenchymal stem cell therapy. The results from this proposed study may reduce disability, improve QOL in PwMS, and consequently, reduce the cost associated with the life-time care of these individuals worldwide.

TRIAL REGISTRATION NUMBER

NCT03326505.

Evaluation of Fear of Falling in Patients with Primary Open-Angle Glaucoma and the Importance of Inferior Visual Field Damage

Purpose

To evaluate fear of falling using the Fall Efficacy Scale-International (FES-I) in glaucoma patients and investigate its association with glaucomatous visual field loss.

Methods

This study included 273 patients (160 men and 113 women, average age 64.2 years) with primary open-angle glaucoma. Participants were requested to answer the FES-I questionnaire, translated into Japanese, in a face-to-face interview. The relationship between total FES-I score and the following variables was analyzed using multivariable linear regression: age, sex, better and worse best corrected visual acuity, total deviation (TD) in four visual field areas, body mass index (BMI), minutes walked per day, history of diabetes mellitus, history of systemic hypertension, number of previous falls.

Results

Univariate analysis suggested that total FES-I score increased with age and in woman, whereas other variables were not significantly associated with total FES-I score. However, age (coefficient, 0.23; standard error [SE], 0.04; P < 0.001), sex (coefficient, 1.79 for women; SE, 0.84; P = 0.034), mean TD in the inferior central area (coefficient, 0.92; SE, 0.22; P <0.001), and mean TD in the inferior peripheral area (coefficient, –0.86; SE, 0.21; P < 0.001) were included in the optimal model for total FES-I score.

Conclusions

Inferior peripheral visual field damage and preserved inferior central visual field sensitivity were associated with increased fear of falling assessed with FES-I in glaucoma.

Evaluating the psychometric properties of the iconographical falls efficacy scale (ICON-FES)

OBJECTIVE

This study aims to analyze the construct and content validity of the Iconographical Falls Efficacy Scale (Icon-FES) in order to measure the fear of falling in community-dwelling older adults.

METHODS

The Icon-FES was applied to 333 older adults. An exploratory factor analysis was performed to assess internal consistency. Item response theory (IRT) and confirmatory factor analysis (CFA) were used to evaluate the consistency of the questionnaire and whether it corresponded satisfactorily to the construct "concern about falling." Concurrent validity with the Falls Efficacy Scale-International (FES-I) and convergent validity with the Senior Fitness Test (SFT) were also assessed. Receiving operator characteristic (ROC) curves were used to determine the sensitivity and specificity.

RESULTS

The structural model of the 30-item and 10-item Icon-FES showed some theoretical fragility. The final model of the new short version of the Icon-FES consisted of 13 items, yielding a theoretically satisfactory structural model. Validity analyses indicated that the 13-item Icon-FES had a moderate relationship with the SFT, a strong relationship with the FES-I, and good sensitivity and specificity for a history of falls.

CONCLUSION

The 13-item Icon-FES has excellent psychometric properties for measuring fear of falling in community-dwelling older adults. It can be recommended as a screening tool for fear of falling for both research and clinical purposes.

The Turkish version of the Modified Falls Efficacy Scale: reliability and validity from the viewpoint of balance

Background/aim

The factors associated with fall-related self-efficacy should be addressed, especially in the elderly. The Modified Falls Efficacy Scale (MFES) is a simple instrument with good scaling properties and reliability. The aim of the present study was to determine the reliability and the validity of the Turkish version of the MFES from the viewpoint of balance.

Materials and methods

In this study, 164 participants aged >65 years were included. The use of walking aids and assistive devices, history and frequency of falls in the previous year, living environment, and exercise habits were noted. Balance and risk of falling were assessed with the Berg Balance Scale (BBS). A forward-backward translation procedure was used for the Turkish version of the MFES.

Results

None of the 14 items in the MFES were modified. The Turkish version of the MFES has excellent internal consistency (Cronbach’s alpha, 0.978) and reliability (interclass correlation coefficient, 0.928–0.982), and its construct validity was supported by its ability to distinguish between the groups with respect to fall-risk factors and balance. According to the BBS scores, the high-fall-risk group had lower MFES scores than the moderate- and low-fall-risk groups (χ2 = 34.153, P = 0.001).

Conclusion

The Turkish version of the MFES is a sensitive instrument for evaluation of fall-related confidence while carrying out indoor/outdoor activities. It also predicts falls, reduced physical activity, balance and mobility problems, and restricted social participation and daily living activities.

Psychometric Properties of the Czech Version of the Falls Efficacy Scale-International in Patients with Early-Stage Dementia

Introduction

A fear of falling marks an important psychological factor connected with a reduction in the life space of people with dementia. The Czech version of the Falls Efficacy Scale-International (FES-I) has not been validated in patients with early-stage dementia.

Methods

The tests were administered to 282 patients with early-stage dementia. The test battery included the following: the FES-I, the Short Physical Performance Battery, the Geriatric Depression Scale, the Bristol Activity Daily Living Scale, and the Quality of Life-Alzheimer's Disease Scale. Internal reliability (Cronbach's α and intraclass correlation [ICC]), Pearson's and Spearman's correlations, exploratory factor analysis, and a t test for independent samples were used for statistical analyses.

Results

The Czech version of the FES-I had excellent internal and test-retest reliability (Cronbach's α = 0.98, ICC = 0.90; 95′ CI 0.82–0.94). Factor analysis suggested 2 relevant factors. A significantly higher FES-I score was associated with patients with early-stage dementia who were older (p = 0.003) or female (p = 0.001), lived alone (p = 0.0001), spent >8 h a day alone (p = 0.032), used mobility aids (p < 0.0001), or had severe hearing (p = 0.004) or vision impairment (p < 0.0001) or a lower education (r = −0.16, p = 0.007).

Conclusion

The Czech version of the FES-I had very good reliability and validity and may be useful in future cross-cultural comparisons in research among patients with early-stage dementia.

The development and pilot evaluation of virtual reality balance scenarios in people with multiple sclerosis (MS): A feasibility study

BACKGROUND

Balance deficits are considered a risk factor for falls in MS patients. Therefore, developing innovative approaches such as virtual reality (VR) to improve balance in MS is required.

OBJECTIVES

The aims of this study were to develop and evaluate feasibility and acceptability of VR scenarios that target balance in MS using a pilot trial.

METHODS

Participants were randomly allocated to either a VR training (i.e. intervention group) (n = 20) or a control group (n = 20). Intervention group received VR training for 6 weeks. Control group received home-based traditional balance exercises without the VR. Participants were assessed at baseline and follow-up on Berg Balance Scale (BBS), Timed Up and Go (TUG), the 10 Meter Walk Test (10-MWT), the 3 Minute Walk Distance (3-MWD), the Modified Fatigue Impact Scale (MFIS) Fall Efficacy Scale- International (FES-I) and the Short Form 36 (SF-36).

RESULTS

Six VR scenarios weer developed. Sixteen participants in the intervention and 16 in the control group completed the study. Significant differences between the two groups were observed at on BBS, MFIS and several outcomes of the SF-36 survey (P < 0.05). Participants reported overall level of satisfaction with the developed VR scenarios.

CONCLUSIONS

Findings demonstrated the feasibility and acceptability of a VR-based program in MS individuals. Our findings support the implementation of a larger trial of longer-term VR program.

Cross-cultural adaptation and psychometric properties of the Falls Efficacy Scale - International in Filipino community-dwelling older adults

Purpose: The Falls Efficacy Scale - International is universally used in assessing the level of concern about falling in older adults. The objectives of this study were to conduct a cross-cultural adaptation and to establish psychometric properties of Falls Efficacy Scale - International in Filipino (FES-I F).Methods: The standardized 10-step translation protocol of the Prevention of Falls Network Europe was followed. Community-dwelling older adults aged 60 or above (N = 211) from Manila, Philippines were recruited. The internal consistency and test-retest reliability of the translated tool was assessed. Convergent validity was compared with fall-related factors. The receiver operating characteristics were used to determine the cutoff score.Results: The FES-I F has high internal consistency (α = 0.91) and good test-retest reliability (intraclass correlation coefficient = 0.86). Overall scores were significantly higher among those with subjective report of fear of falling (p < 0.001), lower timed up and go test scores (p = 0.014), slower gait speed (p = 0.003), and lower perceived well-being scores (p = 0.003) indicating acceptable convergent validity. The cutoff score of FES-I F was 22 points.Conclusions: The FES-I F has high internal reliability and acceptable validity, and can be a practical tool to measure the concern about falling in Filipino older adults. Future research is necessary to establish its utilization as an outcome measure in intervention studies.Implications for rehabilitationThe psychometric properties of the Filipino version of the Falls Efficacy Scale - International were good when assessed in older adults living in the community.The cutoff score to demarcate those with fear of falling from those without is 22 points.Falls Efficacy Scale - International in Filipino is recommended for the assessment of fear of falling for research and clinical purposes.

Cross-cultural validation of the Falls Efficacy Scale-International to assess concerns about falls among Hungarian community-living older people

PURPOSE

The Falls Efficacy Scale-International (FES-I) is a reliable and valid tool for assessing concerns about falling. Our aims were to translate, culturally adapt, and evaluate the main psychometric characteristics (internal consistency, reproducibility, and convergent construct validity) of the Hungarian version of the FES-I on a sample of community-living older adults.

METHODS

After translating and culturally adapting the original scale, 165 community-living older adults (aged 60 years or over) participated in the measurements and filled in the questionnaire. After two weeks, a subsample of 64 persons filled in the FES-I again to determine the test-retest reliability.

RESULTS

The test-retest analysis showed excellent reliability: Intraclass Correlation Coefficient was 0.831. The FES-I Hungarian consisted of two factors that showed good internal consistency: Cronbach's alpha 0.95 (Factor 1), 0.89 (Factor 2), and 0.93 (whole scale). The FES-I was able to discriminate the participants based on gender and fall history. It showed a significant correlation with the Timed Up and Go test (r = 0.740) and the general health perception (r = -0.713).

CONCLUSIONS

Translation and cultural adaptation of the original scale were successful. The Hungarian version proved to be a reliable, valid tool confirming that it can be used in future clinical and scientific work with Hungarian older people. Implications for rehabilitation Excessive concerns about falls may lead to avoidance of activities, decreasing functional abilities, increasing of risk of a future fall, ultimately premature nursing home admission. The Falls Efficacy Scale-International is a widespread tool for assessing concerns about falls. The Hungarian version of Falls Efficacy Scale-International has an excellent test-retest reliability, good internal consistency, and acceptable construct validity. The Hungarian version of Falls Efficacy Scale-International is a valid and reliable tool for measuring the concerns about falls among Hungarian-speaking community-living older people in everyday clinical practice and scientific studies.

A pilot study of a minimally supervised home exercise and walking program for people with Parkinson's disease in Jordan

Aim: This study aimed to evaluate the feasibility and cultural considerations of a minimally supervised, home-based exercise program in Jordan. Methods: Quantitative and qualitative approaches were used. Thirty participants were randomly allocated to either an 8-week intervention group (n = 16), or a standard care group (n = 14). The intervention incorporated the home use of an exercise DVD, walking program and initial instructional sessions and weekly phone calls provided by a physiotherapist. Interviews were used to explore feasibility. Unified Parkinson's disease rating scale (UPDRS-III); balance and walking speed were assessed. Results: The retention rate was 86.7% and mean adherence rate was 77%. Personal and sociocultural barriers of adherence to the exercise program were identified. UPDRS-III at follow-up was lower in the intervention group. Conclusion: A home exercise program was feasible. Sociocultural barriers specific to Arabic culture may affect the uptake of such an intervention in Parkinson's disease in these countries.