1
|
Tian X, Mai YH, Guo ZJ, Chen JW, Zhou LJ. Contributing factors and interventions for fear of falling in stroke survivors: a systematic review. Top Stroke Rehabil 2024:1-16. [PMID: 38566465 DOI: 10.1080/10749357.2024.2333172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 03/17/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVES The purpose of this study was to provide a comprehensive overview of the prevalence, measurement tools, influencing factors, and interventions for fear of falling (FOF) in stroke survivors. METHODS A PRISMA-guided systematic literature review was conducted. PubMed, EMBASE, Cochrane, and Web of Science were systematically searched. The search time was up to February 2023. All observational and experimental studies investigating FOF in stroke patients were included. The assessment tool of the Joanna Briggs Institute was used to assess the quality of the included studies and the risk of bias assessment. (PROSPERO: CRD42023412522). RESULT A total of 25 observational studies and 10 experimental studies were included. The overall quality of the included studies was "low" to "good." The most common tool used to measure the FOF was the Falls Efficacy Scale-International (FES-I). The prevalence of FOF was 42%- 93.8%. Stroke survivors with physical impairments have the highest prevalence of FOF. The main risk factors for the development of FOF in stroke survivors were female gender, use of assistive devices, balance, limb dysfunction, and functional mobility. The combination of cognitive behavioral and exercise interventions is the most effective strategy. CONCLUSIONS This review suggests that the prevalence of FOF in stroke survivors is high and that understanding the factors associated with FOF in stroke patients can help develop multifactorial prevention strategies to reduce FOF and improve quality of life. In addition, a uniform FOF measurement tool should be used to better assess the effectiveness of interventions for stroke survivors. ETHICS APPROVAL PROSPERO registration (CRD42023412522).
Collapse
Affiliation(s)
- Xue Tian
- School of Nursing, School of Public Health, Yangzhou University, Yangzhou, China
| | - Ying-Hong Mai
- School of Nursing, School of Public Health, Yangzhou University, Yangzhou, China
| | - Zai-Jin Guo
- School of Nursing, School of Public Health, Yangzhou University, Yangzhou, China
| | - Jia-Wen Chen
- School of Nursing, School of Public Health, Yangzhou University, Yangzhou, China
| | - Luo-Jing Zhou
- Science and Technology Division, North Jiangsu People's Hospital of Jiangsu province, Yangzhou, China
| |
Collapse
|
2
|
Bhatt T, Dusane S, Gangwani R, Wang S, Kannan L. Motor adaptation and immediate retention to overground gait-slip perturbation training in people with chronic stroke: an experimental trial with a comparison group. Front Sports Act Living 2023; 5:1195773. [PMID: 37780126 PMCID: PMC10533933 DOI: 10.3389/fspor.2023.1195773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 07/21/2023] [Indexed: 10/03/2023] Open
Abstract
Background Perturbation-based training has shown to be effective in reducing fall-risk in people with chronic stroke (PwCS). However, most evidence comes from treadmill-based stance studies, with a lack of research focusing on training overground perturbed walking and exploring the relative contributions of the paretic and non-paretic limbs. This study thus examined whether PwCS could acquire motor adaptation and demonstrate immediate retention of fall-resisting skills following bilateral overground gait-slip perturbation training. Methods 65 PwCS were randomly assigned to either (i) a training group, that received blocks of eight non-paretic (NP-S1 to NP-S8) and paretic (P-S1 to P-S8) overground slips during walking followed by a mixed block (seven non-paretic and paretic slips each interspersed with unperturbed walking trials) (NP-S9/P-S9 to NP-S15/P-S15) or (ii) a control group, that received a single non-paretic and paretic slip in random order. The assessor and training personnel were not blinded. Immediate retention was tested for the training group after a 30-minute rest break. Primary outcomes included laboratory-induced slip outcomes (falls and balance loss) and center of mass (CoM) state stability. Secondary outcomes to understand kinematic contributors to stability included recovery strategies, limb kinematics, slipping kinematics, and recovery stride length. Results PwCS within the training group showed reduced falls (p < 0.01) and improved post-slip stability (p < 0.01) from the first trial to the last trial of both paretic and non-paretic slip blocks (S1 vs. S8). During the mixed block training, there was no further improvement in stability and slipping kinematics (S9 vs. S15) (p > 0.01). On comparing the first and last training trial (S1 vs. S15), post-slip stability improved on both non-paretic and paretic slips, however, pre-slip stability improved only on the non-paretic slip (p < 0.01). On the retention trials, the training group had fewer falls and greater post-slip stability than the control group on both non-paretic and paretic slips (p < 0.01). Post-slip stability on the paretic slip was lower than that on the non-paretic slip for both groups on retention trials (p < 0.01). Conclusion PwCS can reduce laboratory-induced slip falls and backward balance loss outcomes by adapting their post-slip CoM state stability after bilateral overground gait-slip perturbation training. Such reactive adaptations were better acquired and retained post-training in PwCS especially on the non-paretic slips than paretic slips, suggesting a need for higher dosage for paretic slips. Clinical registry number NCT03205527.
Collapse
Affiliation(s)
- Tanvi Bhatt
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois, Chicago, IL, United States
| | - Shamali Dusane
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois, Chicago, IL, United States
- Ph.D. program in Rehabilitation Sciences, Department of Physical Therapy, College of Applied Health Sciences, University of Illinois, Chicago, IL, United States
| | - Rachana Gangwani
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois, Chicago, IL, United States
- MS program in Rehabilitation Sciences, Department of Physical Therapy, College of Applied Health Sciences, University of Illinois, Chicago, IL, United States
| | - Shuaijie Wang
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois, Chicago, IL, United States
| | - Lakshmi Kannan
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois, Chicago, IL, United States
- Ph.D. program in Rehabilitation Sciences, Department of Physical Therapy, College of Applied Health Sciences, University of Illinois, Chicago, IL, United States
| |
Collapse
|
3
|
Schafer MA, Upright P, Michalik JL, Crandall KJ. Impact of 10-Week Evidence-Based Falls Prevention Program on Outcomes Related to Falls Risk in Community-Dwelling Older Adults. INTERNATIONAL JOURNAL OF EXERCISE SCIENCE 2023; 16:1131-1141. [PMID: 38287933 PMCID: PMC10824292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/31/2024]
Abstract
This quasi-experimental study evaluated the impact of a 10-week evidence-based falls prevention program (Bingocize®) on self-reported fear of falling, general health, physical activity, social isolation, and avoidance behavior, in community-dwelling older adults in Virginia. Participants > 60 years of age (n= 481) attended BingocizeR group sessions twice per week for 10 weeks. The program combined conventional bingo with periodic strength, balance, flexibility exercises, and fall prevention education. Pre and post assessments gauged participants' self-perception of fear of falling, general health, physical activity, social isolation, and avoidance behavior. 481 participants attended at least 80% of the sessions. Following the intervention, paired sample t-tests revealed statistically significant improvements (p <.05) in fear of falling, physical activity, social isolation, avoidance behavior, and yet there was no notable change in self-reported general health. The 10-week BingocizeR program appears to improve physical activity, social isolation, avoidance behavior, and fear of falling. Self-reported general health did not significantly change.
Collapse
Affiliation(s)
- Mark A Schafer
- School of Kinesiology, Recreation & Sport, Center for Applied Science in Health & Aging, Western Kentucky University, Bowling Green, KY, USA
| | - Paula Upright
- School of Kinesiology, Recreation & Sport, Center for Applied Science in Health & Aging, Western Kentucky University, Bowling Green, KY, USA
| | - Jana L Michalik
- School of Kinesiology, Recreation & Sport, Center for Applied Science in Health & Aging, Western Kentucky University, Bowling Green, KY, USA
| | - K Jason Crandall
- School of Kinesiology, Recreation & Sport, Center for Applied Science in Health & Aging, Western Kentucky University, Bowling Green, KY, USA
| |
Collapse
|
4
|
Sarıçan Y, Erdoğanoğlu Y, Pepe M. The effect of body awareness on trunk control, affected upper extremity function, balance, fear of falling, functional level, and level of independence in patients with stroke. Top Stroke Rehabil 2023:1-10. [PMID: 36871579 DOI: 10.1080/10749357.2023.2185995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
OBJECTIVES This study was conducted to examine the effects of body awareness on trunk control, affected upper extremity function, balance, fear of falling, functional level, and level of independence in patients with stroke. METHODS 35 individuals between the ages of 21 and 78 who were diagnosed with stroke were included in the study. The body awareness of the individuals participating in the study was determined with the Body Awareness Questionnaire (BAQ), trunk control with Trunk Impairment Scale (TIS), the affected upper extremity functions with Motor Activity Log-28 (MAL,-28), and Fugl-Meyer Upper Extremity Assessment (FMUEA), balance with Berg Balance Scale (BBS), fear of falling with Tinetti Falls Efficacy Scale (TFES), functional level with Barthel Activities of Daily Living Index (BI) and level of independence with Functional Independence Measures (FIM). RESULTS For patients participating in the study, 26% were female, 74% were male and 43% showed left, 57% showed right hemisphere involvement. In simple linear regression analysis, BAQ measurement had a statistically significant effect on TIS (F = 25.439 p = 0.001), MAL-28 (F = 7.852 p = 0.008), FMUEA (F = 12.155 p = 0.001), BBS (F = 13.506 p = 0.001), TFES (F = 13.119 p = 0.001), BI (F = 19.977 p = 0.001) and FIM (F = 22.014 p = 0.001) in patients with stroke. CONCLUSIONS In conclusion, body awareness was found to be one of the factors affecting trunk control, affected upper extremity function, balance, fear of falling, functional level, and level of independence in patients with stroke. It was thought that there was a need for assessment of body awareness and include bodyawareness in rehabilitation programs in patients with stroke.
Collapse
Affiliation(s)
- Yusuf Sarıçan
- Physiotherapy and Rehabilitation Department, Institute of Health Sciences, Üsküdar University, İstanbul, Türkiye
| | - Yıldız Erdoğanoğlu
- Physiotherapy and Rehabilitation Department, Faculty of Health Sciences, Antalya Bilim University, Antalya, Türkiye
| | - Murad Pepe
- Physiotherapy and Rehabilitation Department, Faculty of Health Sciences, Antalya Bilim University, Antalya, Türkiye
| |
Collapse
|
5
|
Zhang H, Xu K, Sun Y, Xiao LD, Yan F, Tang S. Exercise for preventing falls in post‐stroke patients: A network meta‐analysis. Res Nurs Health 2022; 45:525-536. [DOI: 10.1002/nur.22263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 07/04/2022] [Accepted: 07/21/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Huimin Zhang
- Xiangya School of Nursing Central South University Changsha Hunan China
- College of Nursing Xinxiang Medical University Xinxiang Henan China
| | - Ke Xu
- College of Nursing Xinxiang Medical University Xinxiang Henan China
| | - Yuyan Sun
- College of Nursing Xinxiang Medical University Xinxiang Henan China
| | - Lily Dongxia Xiao
- College of Nursing and Health Science Flinders University Adelaide South Australia Australia
| | - Fang Yan
- Xiangya School of Nursing Central South University Changsha Hunan China
| | - Siyuan Tang
- Xiangya School of Nursing Central South University Changsha Hunan China
| |
Collapse
|
6
|
Lee H, Eizad A, Park J, Kim Y, Hwang S, Oh MK, Yoon J. Development of a Novel 2-Dimensional Neck Haptic Device for Gait Balance Training. IEEE Robot Autom Lett 2022. [DOI: 10.1109/lra.2022.3143568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
7
|
Cerilo PC, Siegmund LA. Pilot testing of nurse led multimodal intervention for falls prevention. Geriatr Nurs 2021; 43:242-248. [PMID: 34952307 DOI: 10.1016/j.gerinurse.2021.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/30/2021] [Accepted: 12/01/2021] [Indexed: 11/16/2022]
Abstract
Patient fall-risk awareness, self-efficacy, and engagement in fall-prevention activities are important aspects of fall-prevention. The current pilot study examined the effect of a nurse-led multimodal intervention on hospitalized adults' levels of fall risk awareness, self-efficacy, and engagement in fall prevention. Sixty hospitalized older adults in an acute care setting in Florida participated in the study. There were significant differences [pre-test (M = 19.02, SD=1.152) and post-test (M = 21.71, SD=0.527); t (17.355) = 58, p≤.001] on level of fall risk awareness in fall prevention. There were no significant findings for fall self-efficacy and engagement. Study findings suggested that the higher the fall self-efficacy, the higher the engagement. Future research is needed to examine self-efficacy and engagement for fall prevention in larger diverse cohorts of hospitalized older adults.
Collapse
Affiliation(s)
- Perlita C Cerilo
- Nursing Operations Manager, Cleveland Clinic, Weston, Florida 33331, USA.
| | | |
Collapse
|
8
|
Shaik AR, Ahmad F, Miraj M, Alqahtani M, Alzhrani M, Alanazi A, Kashoo F. Efficacy of the structured balance awareness program on perceived balance confidence and fear-related maladaptive behaviour in post-stroke survivors. NeuroRehabilitation 2021; 49:547-552. [PMID: 34542039 DOI: 10.3233/nre-210144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The risk of falling for individuals with stroke is about twice that of healthy older adults. Lack of appropriate initiative to address the fear-related maladaptive behaviour can manifest itself in the form of loss of physical functions resulting in disability and handicap. OBJECTIVE To examine the effectiveness of the structured balance awareness program (SBAP) in improving the perceived balance confidence, and thereby modifying the fear-related maladaptive behaviour in post-stroke survivors. METHODS A randomized experimental control design was used on a sample of 97 post-stroke survivors aged between 55 to 75 years. The patients received either the SBAP or health awareness program (HAP) for eight weeks and were compared on Activities-specific Balance Confidence (ABC) Scale, Berg Balance Scale (BBS) and Falls Efficacy Scale International (FESI). RESULTS A paired t-test demonstrated statistically significant improvement among all the variables in the SBAP group. An independent t-test exhibited a statistically significant improvement on ABC (t = 2.57, p = 0.012 *), BBS (t = 3.32, p = 0.001 *) and FESI (t = 3.38, p = 0.001 *) in the SBAP group. CONCLUSION The study showed that the SBAP was effective in minimizing the fear-related maladaptive behaviour in post-stroke survivors.
Collapse
Affiliation(s)
- Abdul Rahim Shaik
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Al-Majmaah, Saudi Arabia
| | - Fuzail Ahmad
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Al-Majmaah, Saudi Arabia
| | - Mohammad Miraj
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Al-Majmaah, Saudi Arabia
| | - Mazen Alqahtani
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Al-Majmaah, Saudi Arabia
| | - Msaad Alzhrani
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Al-Majmaah, Saudi Arabia
| | - Ahmad Alanazi
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Al-Majmaah, Saudi Arabia
| | - Faizan Kashoo
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Al-Majmaah, Saudi Arabia
| |
Collapse
|
9
|
Allen C, Wallace S. AROUND THE WORLD IN 16 WAYS: Searching Internationally for Fall Prevention Strategies. PATIENT SAFETY 2020. [DOI: 10.33940/falls/2020.9.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Pennsylvania fall rates have remained relatively steady over the past six years, ranging from 3.09–3.33 falls per 1,000 patient days. Other studies estimate that hospital falls occur at a rate of 3.56 per 1,000 patient days1 and 700,000 to one million patients fall each year.2
Falls in Pennsylvania continue to be one of the biggest contributors to patient harm and the fourth most frequently reported adverse event. Looking more broadly, falls are also a frequent cause of patient harm across the United States and globally. A review of international fall prevention strategies revealed that while no single country has been able to eradicate patient falls, several had implemented measures showing moderate levels of success. Those struggling with a high incidence of falls may benefit from reviewing and adopting one or more of these innovative techniques.
Collapse
|
10
|
Abou L, Alluri A, Fliflet A, Du Y, Rice LA. Effectiveness of Physical Therapy Interventions in Reducing Fear of Falling Among Individuals With Neurologic Diseases: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil 2020; 102:132-154. [PMID: 32745544 DOI: 10.1016/j.apmr.2020.06.025] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 06/23/2020] [Accepted: 06/30/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To summarize the effectiveness of physical therapy interventions to reduce fear of falling (FOF) among individuals living with neurologic diseases. DATA SOURCES PubMed, Physiotherapy Evidence Database, Scopus, Web of Science, PsycINFO, Cumulative Index to Nursing and Allied Health, and SportDiscuss were searched from inception until December 2019. STUDY SELECTION Clinical trials with either the primary or secondary aim to reduce FOF among adults with neurologic diseases were selected. DATA EXTRACTION Potential articles were screened for eligibility, and data were extracted by 2 independent researchers. Risk of bias was assessed by the Cochrane Risk of Bias tool for randomized controlled trials and the National Institutes of Health Quality Assessment Tool for pre-post studies. A meta-analysis was performed among trials presenting with similar clinical characteristics. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) was used to rate the overall quality of evidence. RESULTS Sixty-one trials with 3954 participants were included in the review and 53 trials with 3524 participants in the meta-analysis. The included studies presented, in general, with a low to high risk of bias. A combination of gait and balance training was significantly more effective compared with gait training alone in reducing FOF among individuals with Parkinson disease (PD) (mean difference [MD]=11.80; 95% CI, 8.22-15.38; P<.001). Home-based exercise and leisure exercise demonstrated significant improvement in reducing FOF over usual care in multiple sclerosis (MS) (MD=15.27; 95% CI, 6.15-24.38; P=.001). No statistically significant between-groups differences were reported among individuals with stroke and spinal cord injury. The overall quality of evidence presented in this review ranges from very low to moderate according to the assessment with the GRADE approach. CONCLUSIONS Gait with lower limb training combined with balance training is effective in reducing FOF in individuals with PD. Also, home-based or leisure exercise is effective among individuals with MS. However, because of several limitations of the included studies, further research is needed to examine the effectiveness of FOF intervention among individuals with neurologic diseases.
Collapse
Affiliation(s)
- Libak Abou
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, Illinois
| | - Aditya Alluri
- Department of Molecular and Cellular Biology, College of Liberal Arts & Sciences, University of Illinois at Urbana-Champaign, Urbana, Illinois
| | - Alexander Fliflet
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, Illinois
| | - Yiting Du
- Department of Interdisciplinary Health Sciences, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, Illinois
| | - Laura A Rice
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, Illinois.
| |
Collapse
|
11
|
Abstract
AIM In this narrative review we aimed to describe how stroke affects emotions and update the readers on the emotional disturbances that occur after stroke. METHODS We searched Medline from 1.1.2013 to 1.7.2019, personal files and references of selected publications. All retrieved systematic reviews and randomized controlled trials were included. Other references were selected by relevance. SUMMARY OF REVIEW The emotional response includes a reactive behavior with arousal, somatic, motivational and motor components, and a distinctive cognitive and subjective affective experience. Emotional category responses and experiences after stroke can show dissociations between the behavioral response and the cognitive and affective experiences. Emotional disturbances that often occur after stroke include fear, anger, emotional indifference, lack of understanding of other emotions, and lack of control of emotional expression. Emotional disturbances limit social reintegration of the persons with stroke and are a source of caregiver burnout. The evidence to support the management of the majority of emotional disorders in stroke survivors is currently weak and of low or very low methodologic quality. An exception are the disorders of emotional expression control where antidepressants can have a strong beneficial effect, by reducing the number and duration of the uncontrollable episodes of crying or laughing. CONCLUSION Our current knowledge of the emotional disorders that occurs in acute stroke patients and in stroke survivors is heterogeneous and limited. Joint efforts of different research approaches, methodologies and disciplines will improve our current understanding on emotional disorder after stroke and indicate rational pathways to manage them.
Collapse
Affiliation(s)
- José M Ferro
- Serviço de Neurologia, Departamento de Neurociências e Saúde Mental, Hospital Santa Maria-,Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal.,Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Ana C Santos
- Hospital do Mar - Cuidados Especializados Lisboa, Bobadela, Portugal
| |
Collapse
|
12
|
Denissen S, Staring W, Kunkel D, Pickering RM, Lennon S, Geurts ACH, Weerdesteyn V, Verheyden GSAF. Interventions for preventing falls in people after stroke. Cochrane Database Syst Rev 2019; 10:CD008728. [PMID: 31573069 PMCID: PMC6770464 DOI: 10.1002/14651858.cd008728.pub3] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Falls are one of the most common complications after stroke, with a reported incidence ranging between 7% in the first week and 73% in the first year post stroke. This is an updated version of the original Cochrane Review published in 2013. OBJECTIVES To evaluate the effectiveness of interventions aimed at preventing falls in people after stroke. Our primary objective was to determine the effect of interventions on the rate of falls (number of falls per person-year) and the number of fallers. Our secondary objectives were to determine the effects of interventions aimed at preventing falls on 1) the number of fall-related fractures; 2) the number of fall-related hospital admissions; 3) near-fall events; 4) economic evaluation; 5) quality of life; and 6) adverse effects of the interventions. SEARCH METHODS We searched the trials registers of the Cochrane Stroke Group (September 2018) and the Cochrane Bone, Joint and Muscle Trauma Group (October 2018); the Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 9) in the Cochrane Library; MEDLINE (1950 to September 2018); Embase (1980 to September 2018); CINAHL (1982 to September 2018); PsycINFO (1806 to August 2018); AMED (1985 to December 2017); and PEDro (September 2018). We also searched trials registers and checked reference lists. SELECTION CRITERIA Randomised controlled trials of interventions where the primary or secondary aim was to prevent falls in people after stroke. DATA COLLECTION AND ANALYSIS Two review authors (SD and WS) independently selected studies for inclusion, assessed trial quality and risk of bias, and extracted data. We resolved disagreements through discussion, and contacted study authors for additional information where required. We used a rate ratio and 95% confidence interval (CI) to compare the rate of falls (e.g. falls per person-year) between intervention and control groups. For risk of falling we used a risk ratio and 95% CI based on the number of people falling (fallers) in each group. We pooled results where appropriate and applied GRADE to assess the quality of the evidence. MAIN RESULTS We included 14 studies (of which six have been published since the first version of this review in 2013), with a total of 1358 participants. We found studies that investigated exercises, predischarge home visits for hospitalised patients, the provision of single lens distance vision glasses instead of multifocal glasses, a servo-assistive rollator and non-invasive brain stimulation for preventing falls.Exercise compared to control for preventing falls in people after strokeThe pooled result of eight studies showed that exercise may reduce the rate of falls but we are uncertain about this result (rate ratio 0.72, 95% CI 0.54 to 0.94, 765 participants, low-quality evidence). Sensitivity analysis for single exercise interventions, omitting studies using multiple/multifactorial interventions, also found that exercise may reduce the rate of falls (rate ratio 0.66, 95% CI 0.50 to 0.87, 626 participants). Sensitivity analysis for the effect in the chronic phase post stroke resulted in little or no difference in rate of falls (rate ratio 0.58, 95% CI 0.31 to 1.12, 205 participants). A sensitivity analysis including only studies with low risk of bias found little or no difference in rate of falls (rate ratio 0.88, 95% CI 0.65 to 1.20, 462 participants). Methodological limitations mean that we have very low confidence in the results of these sensitivity analyses.For the outcome of number of fallers, we are very uncertain of the effect of exercises compared to the control condition, based on the pooled result of 10 studies (risk ratio 1.03, 95% CI 0.90 to 1.19, 969 participants, very low quality evidence). The same sensitivity analyses as described above gives us very low certainty that there are little or no differences in number of fallers (single interventions: risk ratio 1.09, 95% CI 0.93 to 1.28, 796 participants; chronic phase post stroke: risk ratio 0.94, 95% CI 0.73 to 1.22, 375 participants; low risk of bias studies: risk ratio 0.96, 95% CI 0.77 to 1.21, 462 participants).Other interventions for preventing falls in people after strokeWe are very uncertain whether interventions other than exercise reduce the rate of falls or number of fallers. We identified very low certainty evidence when investigating the effect of predischarge home visits (rate ratio 0.85, 95% CI 0.43 to 1.69; risk ratio 1.48, 95% CI 0.71 to 3.09; 85 participants), provision of single lens distance glasses to regular wearers of multifocal glasses (rate ratio 1.08, 95% CI 0.52 to 2.25; risk ratio 0.74, 95% CI 0.47 to 1.18; 46 participants) and a servo-assistive rollator (rate ratio 0.44, 95% CI 0.16 to 1.21; risk ratio 0.44, 95% CI 0.16 to 1.22; 42 participants).Finally, transcranial direct current stimulation (tDCS) was used in one study to examine the effect on falls post stroke. We have low certainty that active tDCS may reduce the number of fallers compared to sham tDCS (risk ratio 0.30, 95% CI 0.14 to 0.63; 60 participants). AUTHORS' CONCLUSIONS At present there exists very little evidence about interventions other than exercises to reduce falling post stroke. Low to very low quality evidence exists that this population benefits from exercises to prevent falls, but not to reduce number of fallers.Fall research does not in general or consistently follow methodological gold standards, especially with regard to fall definition and time post stroke. More well-reported, adequately-powered research should further establish the value of exercises in reducing falling, in particular per phase, post stroke.
Collapse
Affiliation(s)
- Stijn Denissen
- KU LeuvenDepartment of Rehabilitation SciencesLeuvenBelgium
- Vrije Universiteit BrusselCIME Cognition and Modeling group, Center For Neurosciences (C4N)BrusselsBelgium1050
| | - Wouter Staring
- Radboud University Medical CentreDepartment of Rehabilitation, Donders Institute for Brain, Cognition and BehaviourNijmegenNetherlands
| | - Dorit Kunkel
- University of SouthamptonFaculty of Health SciencesSouthampton General HospitalMP 886, Tremona RoadSouthamptonUKSO16 6YD
| | - Ruth M Pickering
- University of SouthamptonDepartment of Public Health Sciences and Medical StatisticsSouthampton General Hospital, MP 805Tremona RoadSouthamptonUKSO16 6YD
| | - Sheila Lennon
- Flinders UniversityPhysiotherapy, College of Nursing & Health SciencesAdelaideAustralia
| | - Alexander CH Geurts
- Radboud University Medical CentreDepartment of Rehabilitation, Donders Institute for Brain, Cognition and BehaviourNijmegenNetherlands
- Sint Maartenskliniek ResearchNijmegenNetherlands
| | - Vivian Weerdesteyn
- Radboud University Medical CentreDepartment of Rehabilitation, Donders Institute for Brain, Cognition and BehaviourNijmegenNetherlands
- Sint Maartenskliniek ResearchNijmegenNetherlands
| | | | | |
Collapse
|
13
|
Ahn BR, Kang HJ, Choi EJ, Jang SW, Chung HS, Jeon KS. Correlation of the Korean Version of Falls Efficacy Scale-International With Quantitative Balance and Gait Parameters Through Exercise Program in Elderly Men. Ann Rehabil Med 2019; 43:195-203. [PMID: 31072086 PMCID: PMC6509572 DOI: 10.5535/arm.2019.43.2.195] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 10/08/2018] [Indexed: 11/10/2022] Open
Abstract
Objective To determine correlation of the Korean version of Falls Efficacy Scale-International (KFES-I) with other gait and balance parameters through exercise program in older men. Methods Between July 2015 and April 2018, 50 men of 103 participants in an exercise program for preventing falls who aged over 60 years, completed the evaluation before and after the program, had fear of falling (FOF), and could walk independently as an outpatient were enrolled retrospectively. The program comprised lower extremities and core muscle strengthening exercises following stretching exercises twice a week for 8 weeks. FOF using the KFES-I, Berg Balance Scale (BBS), Modified Barthel Index (MBI), stair up and gait categories in MBI (MBI-gait), and Timed Up and Go test (TUG) were evaluated. Quantitative gait and balance parameters were measured by gait analysis, posturography, and isokinetic dynamometer. They were compared before and after the program. Moreover, correlations of KFES-I with other parameters were examined. Results Fifty participants were enrolled. After the program, significant improvements were noted in right stride length (p=0.013) in gait analysis, MBI (p=0.012), BBS (p<0.000), TUG test (p<0.000), and KFES-I (p<0.000) scores. KFES-I was significantly correlated with MBI (r=-0.35, p=0.013), and MBI-gait (r=-0.341, p=0.015). Conclusion Risk of falls could be significantly improved through exercise. KFES-I had significant correlations with MBI-gait parameters. Participants showed increases in gait and balancing ability on quantitative measurements through exercises. Therefore, regular stretching, strengthening, and balancing exercises may help prevent falls in older people.
Collapse
Affiliation(s)
- Bo Ram Ahn
- Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center, Seoul, Korea
| | - Hyo Jung Kang
- Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center, Seoul, Korea
| | - Eun Jung Choi
- Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center, Seoul, Korea
| | - Soo Woong Jang
- Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center, Seoul, Korea
| | - Hee Sup Chung
- Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center, Seoul, Korea
| | - Kyung Soo Jeon
- Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center, Seoul, Korea
| |
Collapse
|
14
|
Wang Y, Bhatt T, Liu X, Wang S, Lee A, Wang E, Pai YCC. Can treadmill-slip perturbation training reduce immediate risk of over-ground-slip induced fall among community-dwelling older adults? J Biomech 2018; 84:58-66. [PMID: 30616984 DOI: 10.1016/j.jbiomech.2018.12.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 12/09/2018] [Accepted: 12/10/2018] [Indexed: 11/26/2022]
Abstract
The purpose of this study was to determine any potential falls-resistance benefits that might arise from treadmill-slip-perturbation training. One hundred sixty-six healthy community-dwelling older adults were randomly assigned to either the treadmill-slip-training group (Tt) or the treadmill-control group (Tc). Tt received 40 slip-like perturbations during treadmill walking. Tc received unperturbed treadmill walking for 30 min. Following their treadmill session, both groups were exposed to a novel slip during over-ground walking. Their responses to this novel slip were also compared to previously collected data from participants who received either over-ground-slip training (Ot) with 24 slips or over-ground walking (Oc) with no training before experiencing their novel over-ground slip. Fall rates and both proactive (pre-slip) and reactive (post-slip) stability were assessed and compared for the novel over-ground slip in groups Tt, Tc, and Oc, as well as for the 24th slip in Ot. Results showed Tt had fewer falls than Tc (9.6% versus 43.8%, p < 0.001) but more falls than Ot (9.6% versus 0%, p < 0.001). Tt also had greater proactive and reactive stability than Tc (Tt > Tc, p < 0.01), however, Tt's stabilities were lower than those of Ot (p < 0.01). There was no difference in fall-rate or reactive stability between Tc and Oc, though treadmill walking did improve the proactive stability control of the latter. While the treadmill-slip-training protocol could immediately reduce the numbers of falls from a novel laboratory-reproduced slip, such improvements were far less than that from the motor adaptation to the over-ground-slip-training protocol.
Collapse
Affiliation(s)
- Yiru Wang
- Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL, USA; PhD Program in Rehabilitation Science, College of Applied Health and Science, University of Illinois at Chicago, Chicago, IL, USA
| | - Tanvi Bhatt
- Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL, USA
| | - Xuan Liu
- Human Performance and Engineering Research, Kessler Foundation, West Orange, NJ, USA
| | - Shuaijie Wang
- Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL, USA
| | - Anna Lee
- Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL, USA; PhD Program in Rehabilitation Science, College of Applied Health and Science, University of Illinois at Chicago, Chicago, IL, USA
| | - Edward Wang
- Department of Biomedical and Health Information Sciences, College of Applied Health and Science, University of Illinois at Chicago, Chicago, IL, USA
| | - Yi-Chung Clive Pai
- Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL, USA.
| |
Collapse
|
15
|
|
16
|
Karthikbabu S, Chakrapani M, Ganesan S, Ellajosyula R, Solomon JM. Efficacy of Trunk Regimes on Balance, Mobility, Physical Function, and Community Reintegration in Chronic Stroke: A Parallel-Group Randomized Trial. J Stroke Cerebrovasc Dis 2018; 27:1003-1011. [PMID: 29361348 DOI: 10.1016/j.jstrokecerebrovasdis.2017.11.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 09/26/2017] [Accepted: 11/02/2017] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE The study objective was to examine the efficacy of plinth and Swiss ball-based trunk exercise regimes on balance, mobility, physical function, and community reintegration compared with standard physiotherapy in chronic stroke. SUBJECTS AND METHODS This observer-blinded parallel-group randomized trial was conducted in outpatient stroke units. People with chronic stroke aged between 30 and 75 years, first onset of unilateral cortical lesion, poor trunk performance, 10 m independent walking ability with or without walking aids, and absence of pusher syndrome were included. Trunk Impairment Scale 2.0, Brunel Balance Assessment, Tinetti scale, gait speed, Stroke Impact Scale-16, and Reintegration to Normal Living Index were the measures. Experimental interventions involved the practice of selective upper and lower trunk movements using either plinth or Swiss ball. Control group received standard physiotherapy. All the patients practiced 1 hour exercise session, 3 sessions a week over a duration of 6 weeks and followed up after 3 and 12 months. RESULTS Of 108 patients allocated into 3 groups, baseline characteristics were similar. Postintervention compared with control group, the plinth, and Swiss ball groups showed significant mean changes in the outcome measures: trunk impairment scale 2.0 (3.6;4.1 points), Brunel Balance Assessment (1-level), Tinetti scale (5;5.2 points), gait speed (.06;.08 m/s), Stroke Impact Scale-16 (8.7;7.2 points), and community reintegration (7.6;8.8 points). These improvements were retained during 3-12 months' follow-up. Statistical significant was set at P < .05. CONCLUSION Plinth and Swiss ball-based trunk exercise regimes showed significant improvements in balance, mobility, physical function, and community reintegration in chronic stroke as against standard physiotherapy.
Collapse
Affiliation(s)
- Suruliraj Karthikbabu
- Department of Physiotherapy, School of Allied Health Sciences (SOAHS), Manipal University, Manipal Hospital, Bengaluru, India.
| | - Mahabala Chakrapani
- Department of Medicine, Kasturba Medical College, Manipal University, Mangalore, Karnataka, India
| | - Sailakshmi Ganesan
- Department of Physiotherapy, Spastics Society of Tamil Nadu, Chennai, Tamil Nadu, India
| | | | - John M Solomon
- Department of Physiotherapy, SOAHS, Manipal University, Manipal, India
| |
Collapse
|
17
|
Post Hospital Discharge Care for Complex Chronic Conditions: the Unique Challenges Facing Stroke Patients in their Homes. CURRENT CARDIOVASCULAR RISK REPORTS 2017. [DOI: 10.1007/s12170-017-0560-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
18
|
Watabe T, Suzuki H, Konuki Y, Aoki K, Nagashima J, Sako R. Beneficial falls in stroke patients: evaluation using a mixed method design. Top Stroke Rehabil 2017; 25:137-144. [PMID: 29073830 DOI: 10.1080/10749357.2017.1394631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Purpose To use a mixed method design to evaluate how clinicians judge falls in stroke patients as a beneficial event, and to identify patient-specific characteristics associated with beneficial falls. Methods The definition of beneficial falls was based on interviews with six experienced clinicians in stroke rehabilitation. Interview data were analyzed using the grounded theory approach, with outcomes used to develop a checklist to judge falls as beneficial. We subsequently used the checklist to identify falls sustained by patients in our rehabilitation unit as beneficial events. The characteristics of beneficial fallers were investigated in this retrospective study. Results According to experienced clinicians, beneficial falls result from patient-specific factors and level of independence. Beneficial falls are not associated with after-effects or a diagnosis of cognitive impairment, do not result in physical injury and post-fall syndrome, and do not alter the course of rehabilitation. These falls are considered to enhance patients' self-awareness of their physical status and abilities. Among the 123 stroke patients who experienced a fall in our study group, 23 patients (18.7%) were identified as beneficial fallers according to our checklist. The majority had a left hemiplegia and perceptual impairments, and were at low risk of recurrent falls and made functional gains during rehabilitation. Conclusions Based on our results, we created a 10-item checklist to differentiate beneficial from adverse falls. This differentiation is important to target fall prevention programs to adverse fallers in rehabilitation units.
Collapse
Affiliation(s)
- Takayuki Watabe
- a Department of Occupational Therapy, School of Nursing and Rehabilitation Sciences , Showa University , Yokohama, Japan.,b Rehabilitation Center , Showa University Fujigaoka Rehabilitation Hospital , Yokohama, Japan
| | - Hisayoshi Suzuki
- a Department of Occupational Therapy, School of Nursing and Rehabilitation Sciences , Showa University , Yokohama, Japan
| | - Yusuke Konuki
- b Rehabilitation Center , Showa University Fujigaoka Rehabilitation Hospital , Yokohama, Japan
| | - Keiichiro Aoki
- a Department of Occupational Therapy, School of Nursing and Rehabilitation Sciences , Showa University , Yokohama, Japan.,c Rehabilitation Division , Showa University Koto Toyosu Hospital , Tokyo , Japan
| | - Jun Nagashima
- a Department of Occupational Therapy, School of Nursing and Rehabilitation Sciences , Showa University , Yokohama, Japan.,b Rehabilitation Center , Showa University Fujigaoka Rehabilitation Hospital , Yokohama, Japan
| | - Rikitaro Sako
- b Rehabilitation Center , Showa University Fujigaoka Rehabilitation Hospital , Yokohama, Japan
| |
Collapse
|
19
|
The Association of Judgment and Related Factors That Affect Fall Risk in Older Adults. TOPICS IN GERIATRIC REHABILITATION 2017. [DOI: 10.1097/tgr.0000000000000143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
20
|
Falls and Fear of Falling After Stroke: A Case-Control Study. PM R 2016; 8:1173-1180. [PMID: 27268565 DOI: 10.1016/j.pmrj.2016.05.012] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 05/13/2016] [Accepted: 05/19/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND Falls are common after stroke, with potentially serious consequences. Few investigations have included age-matched control participants to directly compare fall characteristics between older adults with and without stroke. Further, fear of falling, a significant psychological consequence of falls, has only been examined to a limited degree as a risk factor for future falls in a stroke population. OBJECTIVE To compare the fall history between older adults with and without a previous stroke and to identify the determinants of falls and fear of falling in older stroke survivors. DESIGN Case-control observational study. SETTING Primary teaching hospital. PARTICIPANTS Seventy-five patients with stroke (mean age ± standard deviation, 66 ± 7 years) and 50 age-matched control participants with no previous stroke were tested. METHODS Fall history, fear of falling, and physical, cognitive, and psychological function were assessed. A χ2 test was performed to compare characteristics between groups, and logistic regression was performed to determine the risk factors for falls and fear of falling. MAIN OUTCOME MEASURES Fall events in the past 12 months, Fall Efficacy Scale-International, Berg Balance Scale, Functional Ambulation Category, Fatigue Severity Scale, Montreal Cognitive Assessment, and Patient Healthy Questionnaire-9 were measured for all participants. Fugl-Meyer Motor Assessment was used to quantify severity of stroke motor impairments. RESULTS Twenty-three patients and 13 control participants reported at least one fall in the past 12 months (P = .58). Nine participants with stroke had recurrent falls (≥2 falls) compared with none of the control participants (P < .01). Participants with stroke reported greater concern for falling than did nonstroke control participants (P < .01). Female gender was associated with falls in the nonstroke group, whereas falls in the stroke group were not significantly associated with any measured outcomes. Fear of falling in the stroke group was associated with functional ambulation level and balance. Functional ambulation level alone explained 22% of variance in fear of falling in the stroke group. CONCLUSIONS Compared with persons without a stroke, patients with stroke were significantly more likely to experience recurrent falls and fear of falling. Falls in patients with stroke were not explained by any of the outcome measures used, whereas fear of falling was predicted by functional ambulation level. This study has identified potentially modifiable risk factors with which to devise future prevention strategies for falls in patients with stroke. LEVEL OF EVIDENCE III.
Collapse
|
21
|
Abstract
Each year, more than 795,000 people in the United States suffer a stroke and by 2030, it is estimated that 4% of the U.S. population will have had a stroke. Home healthcare clinicians will be increasingly called upon to assist stroke survivors and their caregivers adjust to disability and assist the survivor during their reintegration into the community. Therapeutic modalities are changing with advanced technology. Great strides are being made in the treatment of acute stroke; particularly endovascular interventions. More patients are surviving the acute stroke event and therefore will need to learn how to live with various degrees of disability. It is important for home healthcare clinicians to understand the process from acute event to medical stabilization, and from rehabilitation to long-term adaptation.
Collapse
Affiliation(s)
- Teri Capriotti
- Teri Capriotti, DO, MSN, CRNP, is a Clinical Associate Professor, College of Nursing, Villanova University, Villanova, Pennsylvania. Teresa Murphy, SN, is a Student Nurse, College of Nursing, Villanova University, Villanova, Pennsylvania
| | | |
Collapse
|
22
|
Chang HT, Chen HC, Chou P. Factors Associated with Fear of Falling among Community-Dwelling Older Adults in the Shih-Pai Study in Taiwan. PLoS One 2016; 11:e0150612. [PMID: 26933882 PMCID: PMC4775068 DOI: 10.1371/journal.pone.0150612] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 02/16/2016] [Indexed: 11/29/2022] Open
Abstract
Background Fear of falling is an important risk indicator for adverse health related outcomes in older adults. However, factors associated with fear of falling among community-dwelling older adults are not well-explored. Objectives To explore the quality of life and associated factors in fear of falling among older people in the Shih-Pai area in Taiwan. Methods This community-based survey recruited three thousand eight hundred and twenty-four older adults aged ≥ 65 years. The measurements included a structured questionnaire, including quality of life by using Short-Form 36, and information of fear of falling, fall history, demographics, medical conditions, insomnia, sleep quality, depression and subjective health through face-to-face interviews. Results A total of 53.4% of participants reported a fear of falling. The rate of fear of falling was higher in female subjects. Subjects with fear of falling had lower Short Form-36 scores both for men and women. Falls in the previous year, older age, insomnia, depression and worse subjective health were correlates of fear of falling for both sexes. Male-specific associations with fear of falling were the accessibility of medical help in an emergency, diabetes mellitus and stroke. In parallel, cardiovascular diseases were a female-specific correlate for fear of falling. Conclusions Fear of falling is prevalent among community-dwelling older adults. It is seems that there are gender differences in fear of falling with respect to the prevalence and associated factors in older adults. Gender differences should be considered when planning prevention and intervention strategies for fear of falling among older people.
Collapse
Affiliation(s)
- Hsiao-Ting Chang
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Public Health and Community Medicine Research Center, National Yang-Ming University, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hsi-Chung Chen
- Department of Psychiatry & Center of Sleep Disorders, National Taiwan University Hospital, Taipei, Taiwan
| | - Pesus Chou
- Institute of Public Health and Community Medicine Research Center, National Yang-Ming University, Taipei, Taiwan
- * E-mail:
| |
Collapse
|
23
|
Kim SM, Han EY, Kim BR, Hyun CW. Clinical application of circuit training for subacute stroke patients: a preliminary study. J Phys Ther Sci 2016; 28:169-74. [PMID: 26957751 PMCID: PMC4755997 DOI: 10.1589/jpts.28.169] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 10/14/2015] [Indexed: 11/24/2022] Open
Abstract
[Purpose] To investigate how task-oriented circuit training for the recovery motor control of the lower-extremity, balance and walking endurance could be clinically applied to subacute stroke inpatient group therapy. [Subjects and Methods] Twenty subacute stroke patients were randomly assigned to the intervention group (n=10) or the control group (n=10). The intervention consisted of a structured, progressive, inpatient circuit training program focused on mobility and gait training as well as physical fitness training that was performed for 90 minutes, 5 days a week for 4 weeks. The control group received individual physiotherapy of neurodevelopmental treatment for 60 minutes, 5 days a week for 4 weeks. Outcome measures were lower-extremity motor control, balance, gait endurance and activities of daily living before and after 4 weeks. [Results] There were no significant differences at baseline between the two groups. After 4 weeks, both groups showed significant improvements in all outcome measures, but there were no significant differences between the two groups during the invention period. [Conclusion] In spite of the small sample size, these findings suggest that task-oriented circuit training might be used as a cost-effective and alternative method of individual physiotherapy for the motor recovery of lower-extremity, balance and walking endurance of subacute stroke patients.
Collapse
Affiliation(s)
- Sun Mi Kim
- Department of Rehabilitation Medicine, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Republic of Korea
| | - Eun Young Han
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Republic of Korea
| | - Bo Ryun Kim
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Republic of Korea
| | - Chul Woong Hyun
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Republic of Korea
| |
Collapse
|
24
|
Caballer VB, Lisón JF, Rosado-Calatayud P, Amer-Cuenca JJ, Segura-Orti E. Factors associated with the 6-minute walk test in nursing home residents and community-dwelling older adults. J Phys Ther Sci 2015; 27:3571-8. [PMID: 26696740 PMCID: PMC4681947 DOI: 10.1589/jpts.27.3571] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 08/24/2015] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The main objective of this study was to determine the contributions and extent
to which certain physical measurements explain performance in the 6-minute walk test in
healthy older adults living in a geriatric nursing home and for older adults dwelling in
the community. [Subjects] The subjects were 122 adults aged 65 and older with no cognitive
impairment who were independent in their daily activities. [Methods] The 6-minute walk
test, age, body mass index, walking speed, chair stand test, Berg Balance Scale, Timed
Up-and-Go test, rectus femoris cross-sectional area, Short Physical Performance Battery,
and hand-grip strength were examined. [Results] Strong significant associations were found
between mobility, lower-limb function, balance, and the 6-minute walk test. A stepwise
multiple regression on the entire sample showed that lower-limb function was a significant
and independent predictor for the 6-minute walk test. Additionally, lower-limb function
was a strong predictor for the 6-minute walk test in our nursing home group, whereas
mobility was found to be the best predictor in our community-dwelling group. [Conclusion]
Better lower-limb function, balance, and mobility result in a higher distance covered by
healthy older adults. Lower-limb function and mobility appeared to best determine walking
performance in the nursing home and community-dwelling groups, respectively.
Collapse
Affiliation(s)
| | | | | | | | - Eva Segura-Orti
- Department of Physiotherapy, University Cardenal Herrera-CEU, Spain
| |
Collapse
|