Effectiveness of a combination of cognitive behavioral therapy and task-oriented balance training in reducing the fear of falling in patients with chronic stroke: study protocol for a randomized controlled trial

Abstract

BackgroundThe consequences of falls are devastating for patients with stroke. Balance problems and fear of falling are two major challenges, and recent systematic reviews have revealed that habitual physical exercise training alone cannot reduce the occurrence of falls in stroke survivors. However, recent trials with community-dwelling healthy older adults yielded the promising result that interventions with a cognitive behavioral therapy (CBT) component can simultaneously promote balance and reduce the fear of falling. Therefore, the aim of the proposed clinical trial is to evaluate the effectiveness of a combination of CBT and task-oriented balance training (TOBT) in promoting subjective balance confidence, and thereby reducing fear-avoidance behavior, improving balance ability, reducing fall risk, and promoting independent living, community reintegration, and health-related quality of life of patients with stroke.MethodsThe study will constitute a placebo-controlled single-blind parallel-group randomized controlled trial in which patients are assessed immediately, at 3 months, and at 12 months. The selected participants will be randomly allocated into one of two parallel groups (the experimental group and the control group) with a 1:1 ratio. Both groups will receive 45 min of TOBT twice per week for 8 weeks. In addition, the experimental group will receive a 45-min CBT-based group intervention, and the control group will receive 45 min of general health education (GHE) twice per week for 8 weeks. The primary outcome measure is subjective balance confidence. The secondary outcome measures are fear-avoidance behavior, balance ability, fall risk, level of activities of daily living, community reintegration, and health-related quality of life.DiscussionThe proposed clinical trial will compare the effectiveness of CBT combined with TOBT and GHE combined with TOBT in promoting subjective balance confidence among chronic stroke patients.We hope our results will provide evidence of a safe, cost-effective, and readily transferrable therapeutic approach to clinical practice that reduces fear-avoidance behavior, improves balance ability, reduces fall risk, promotes independence and community reintegration, and enhances health-related quality of life.Trial registrationClinicalTrials.gov, NCT02937532. Registered on 17 October 2016.

The impact of physical exercises with elements of dance movement therapy on the upper limb grip strength and functional performance of elderly wheelchair users living in nursing homes – a randomized control trial

“…The study was conducted in five randomly selected NHs for elderly people suffering from chronic physical illnesses in southeastern Poland (the region of the Podkarpackie voivodeship). Participants who were eligible for the trial were required to comply with the following criteria: age, 65–85 years; Mini-Mental State Examination (MMSE) score, ≥ 19 [ 32 ]; Geriatric Depression Scale (GDS) score, ≤ 10 points [ 33 ]; use of a manual wheelchair as the primary mean of mobility; Berg Balance Scale (BBS) score, 4 < 21 points [ 34 ]; Barthel Index (BI) score, 21 < 75 points [ 35 ]; and suffered no severe physical disease that could affect participation in the study. The exclusion criteria were: symptoms of cardiovascular diseases, severe systemic diseases, severe circulatory or organic insufficiency, severe neurological disorder and lack of consent to participate in the study.…”

“…A maximum score of 56 points is possible. A score below 20 points indicates a high risk of falling and the need to use a wheelchair by the participants [ 34 ].…”

Effects of Cognitive Sensory Motor Training on Lower Extremity Muscle Strength and Balance in Post Stroke Patients: A Randomized Controlled Study

“…Lim [ 36 ] has reported that a multi-sensorimotor training program was effective in improving the proprioception and balance ability for 8 weeks. Liu et al [ 37 ] of 88 chronic stroke patients, it was argued that subjects with cognitive behavioral therapy with task oriented showed increased balance ability and reduced fall risk. Kannan et al [ 38 ] have reported a significant increase in balance control of stroke patients after cognitive-motor exergame training with Wii-fit games.…”

Practices and behaviors of professionals after falls in institutionalized elderly with and without cognitive decline

“…Despite fear of falling being frequent in nursing homes, 16,17 interventions to decrease fear are rare. 18 A study examining the efficacy of cognitive-behavioral strategies with or without exercise to reduce fear of falling in elderly residents of nursing homes suggested that interventions (education, helping to understand that fall risk and fear can be controlled, defining objectives to increase activity and eliminating environmental barriers) helped the elderly to manage their fear of falls, decrease their depressive inclination, and improve their mobility and physical strength. 17 The second scale factor obtained a score of 17.76 out of 20, which indicates good practices in communicating fall episodes to health professionals.…”