A theoretical framework for addressing fear of falling avoidance behavior in Parkinson’s disease

Fear of Falling Avoidance Behavior in Parkinson’s Disease: Most Frequently Avoided Activities

“…It is important to note that individuals with PD that have not experienced a fall in the past month or year still reported FFAB. This finding is aligned with previous research on this population (Kader et al, 2016; Landers et al, 2017; Rahman et al, 2011) and indicates that FFAB may be working to prevent falls (Landers & Nilsson, 2022). Individuals in the early and mild stages of PD also reported FFAB, indicating that more variables than disease severity are associated with FFAB.…”

“…Going up and down stairs requires significant lower body strength and endurance, and bathing/showering is a common activity of daily living in which people with PD fall (Ashburn et al, 2008). Given that these require high levels of balance, it is possible that individuals who avoid these activities may be responding to their physiological fall risk by avoiding activities that put them at a heightened risk of falling, thereby decreasing the likelihood that they might fall and possibly demonstrating a protective or adaptive form of FFAB (Landers & Nilsson, 2022). Further investigation with cause-and-effect research designs is required to provide evidence to support possible causative relationships between falls and avoided activities.…”

“…FFAB is complex and multifactorial, and rehabilitation clinicians should seek to understand how individuals with PD make decisions about activity engagement and fall risk to better co-design targeted interventions based on the values and priorities of the individual (Rider et al, 2022). If a person with PD reports avoiding activities due to FOF, they should be assessed for safety within that activity to determine if the FFAB is appropriate/adaptive or excessive/ maladaptive (Landers & Nilsson, 2022). Evaluation and treatment should begin in the early stages of PD (Rider et al, 2022).…”

“…Furthermore, individuals with PD have reported increased anxiety and worry about how PD-specific features may attract attention in public, which may also contribute to FFAB in crowded and unfamiliar places (Thordardottir et al, 2014). Rehabilitation approaches such as cognitive behavioral therapy and exposure-based therapy addressing the uncertainty of being in crowded or unfamiliar places may be beneficial in mitigating excessive FFAB (Landers & Nilsson, 2022; Liu et al, 2018). Another example of an activity significantly impacted by FFAB that clinicians could address is lifting and carrying objects.…”

“…and psychological decline (e.g., increased anxiety, depression, isolation, etc. ), identifying the most commonly avoided activities may play a key role in designing exposure-based interventions to mitigate FFAB, increase participation in daily activities, and prevent further functional decline (Landers & Nilsson, 2022; Landers et al, 2021). Among PD participants, three studies have characterized specific activities impacted by FFAB.…”