Effectiveness of Physical Therapy Interventions in Reducing Fear of Falling Among Individuals With Neurologic Diseases: A Systematic Review and Meta-analysis

Abou, Libak; Alluri, Aditya; Fliflet, Alexander; Du, Yiting; Rice, Laura A.

doi:10.1016/j.apmr.2020.06.025

Cited by 44 publications

(22 citation statements)

References 107 publications

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“…Regarding the effect of FOF on mobility, PD-FOF+ needed more time to perform the TUG test than the PD- FOF−, which was –at least partly- explained by the slower performance of the two turns included in this test ( Table 2 ). This supports previous findings ( Bryant et al, 2014 ; Haertner et al, 2018 ; Abou et al, 2021 ) and suggests that PD-FOF+ suffer from increased fear, especially during turns. This fear may be justified, e.g., through increased dysbalance or other constraints associated with FOF ( Pourghayoomi et al, 2020 ).…”

Section: Discussionsupporting

confidence: 93%

Effect of Fear of Falling on Mobility Measured During Lab and Daily Activity Assessments in Parkinson’s Disease

Atrsaei

Hansen

Elshehabi

et al. 2021

Front. Aging Neurosci.

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In chronic disorders such as Parkinson’s disease (PD), fear of falling (FOF) is associated with falls and reduced quality of life. With inertial measurement units (IMUs) and dedicated algorithms, different aspects of mobility can be obtained during supervised tests in the lab and also during daily activities. To our best knowledge, the effect of FOF on mobility has not been investigated in both of these settings simultaneously. Our goal was to evaluate the effect of FOF on the mobility of 26 patients with PD during clinical assessments and 14 days of daily activity monitoring. Parameters related to gait, sit-to-stand transitions, and turns were extracted from IMU signals on the lower back. Fear of falling was assessed using the Falls Efficacy Scale-International (FES-I) and the patients were grouped as with (PD-FOF+) and without FOF (PD-FOF−). Mobility parameters between groups were compared using logistic regression as well as the effect size values obtained using the Wilcoxon rank-sum test. The peak angular velocity of the turn-to-sit transition of the timed-up-and-go (TUG) test had the highest discriminative power between PD-FOF+ and PD-FOF− (r-value of effect size = 0.61). Moreover, PD-FOF+ had a tendency toward lower gait speed at home and a lower amount of walking bouts, especially for shorter walking bouts. The combination of lab and daily activity parameters reached a higher discriminative power [area under the curve (AUC) = 0.75] than each setting alone (AUC = 0.68 in the lab, AUC = 0.54 at home). Comparing the gait speed between the two assessments, the PD-FOF+ showed higher gait speeds in the capacity area compared with their TUG test in the lab. The mobility parameters extracted from both lab and home-based assessments contribute to the detection of FOF in PD. This study adds further evidence to the usefulness of mobility assessments that include different environments and assessment strategies. Although this study was limited in the sample size, it still provides a helpful method to consider the daily activity measurement of the patients with PD into clinical evaluation. The obtained results can help the clinicians with a more accurate prevention and treatment strategy.

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Section: Discussionsupporting

confidence: 93%

Effect of Fear of Falling on Mobility Measured During Lab and Daily Activity Assessments in Parkinson’s Disease

Atrsaei

Hansen

Elshehabi

et al. 2021

Front. Aging Neurosci.

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“…Overall, the studies are rated as good, fair, or poor methodological quality [ 23 ]. Studies with 8 or more than 50% of the total applicable questions responded as “yes” were considered “good quality,” studies with 5–7 or less than 50% of the total applicable questions responded as “yes” were considered “fair quality.” Studies with < 5 questions responded as “yes” were considered “low quality” [ 24 ]. Any discrepancies between the authors during methodological quality assessment were resolved through discussion with a third author (LA).…”

Section: Methodsmentioning

confidence: 99%

Gait and Balance Assessments using Smartphone Applications in Parkinson’s Disease: A Systematic Review

et al. 2021

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Gait dysfunctions and balance impairments are key fall risk factors and associated with reduced quality of life in individuals with Parkinson’s Disease (PD). Smartphone-based assessments show potential to increase remote monitoring of the disease. This review aimed to summarize the validity, reliability, and discriminative abilities of smartphone applications to assess gait, balance, and falls in PD. Two independent reviewers screened articles systematically identified through PubMed, Web of Science, Scopus, CINAHL, and SportDiscuss. Studies that used smartphone-based gait, balance, or fall applications in PD were retrieved. The validity, reliability, and discriminative abilities of the smartphone applications were summarized and qualitatively discussed. Methodological quality appraisal of the studies was performed using the quality assessment tool for observational cohort and cross-sectional studies. Thirty-one articles were included in this review. The studies present mostly with low risk of bias. In total, 52% of the studies reported validity, 22% reported reliability, and 55% reported discriminative abilities of smartphone applications to evaluate gait, balance, and falls in PD. Those studies reported strong validity, good to excellent reliability, and good discriminative properties of smartphone applications. Only 19% of the studies formally evaluated the usability of their smartphone applications. The current evidence supports the use of smartphone to assess gait and balance, and detect freezing of gait in PD. More studies are needed to explore the use of smartphone to predict falls in this population. Further studies are also warranted to evaluate the usability of smartphone applications to improve remote monitoring in this population. Registration: PROSPERO CRD 42020198510 Supplementary Information The online version contains supplementary material available at 10.1007/s10916-021-01760-5.

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“…7 Fear of falling is frequently underrecognized but jeopardizes independence by eroding an individual's confidence in their ability to walk. Despite a growing body of evidence examining interventions for fear of falling in the PD population, 8 this has a considerable effect on quality of life for individuals with a postural imbalance and gait disorder (PIGD) subtype. Symptoms of gait dysfunction are at best only partially ameliorated by a majority of pharmacological therapies used for the treatment of PD, and in the later stages of the condition, dopaminergic medications can paroxysmally worsen gait, such as by causing episodes of "on" freezing.…”

Section: Introductionmentioning

confidence: 99%

Current Perspectives on the Assessment and Management of Gait Disorders in Parkinson’s Disease

Smith¹,

Brazier²,

Henderson³

2021

NDT

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Gait dysfunction is a key defining feature of Parkinson’s disease (PD), and is associated with symptoms of freezing and an increased risk of falls. In this narrative review, we cover the putative mechanisms of gait dysfunction in PD, the assessment of gait abnormalities, and the management of symptoms caused by the inherent difficulty in walking. Our understanding of the causes of gait problems in PD has progressed in recent times, moving from neurocognitive theory to correlates of affected neuronal pathways. In particular, this can be shown to correspond with abnormalities in responses to dual-task paradigms and dysfunction in cholinergic signaling. Great progress has been made in the sophistication and precision of gait assessment; however, it has firmly remained in the research domain. There is significant momentum behind wearable technologies that can be used by patients in their own environment, acting as digital biomarkers that can not only reflect progression but also independently discriminate PD from non-PD individuals. The treatment of gait dysfunction has historically relied on physical therapies and training combined with a view to mitigating the impact of such consequences as falls. Pharmacological therapies that are the mainstay of treatment in PD have tended to address symptoms like bradykinesia; however, optimization of dopaminergic therapies likely has a positive effect on quality of gait. Other targets have been assessed with the goal of improving gait, of which medications that improve cholinergic signaling appear most promising. Neuromodulation techniques are increasingly used in the form of deep-brain stimulation; however, standard targets, such as the globus pallidus interna, have a modest effect on gait. Considerable benefit has been seen through targeting the pedunculopontine nucleus, and a dual-target approach may be warranted. Stimulation of the spinal cord and brain through direct or magnetic approaches has been assessed, but requires further evidence.

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Effectiveness of Physical Therapy Interventions in Reducing Fear of Falling Among Individuals With Neurologic Diseases: A Systematic Review and Meta-analysis

Cited by 44 publications

References 107 publications

Effect of Fear of Falling on Mobility Measured During Lab and Daily Activity Assessments in Parkinson’s Disease

Effect of Fear of Falling on Mobility Measured During Lab and Daily Activity Assessments in Parkinson’s Disease

Gait and Balance Assessments using Smartphone Applications in Parkinson’s Disease: A Systematic Review

Current Perspectives on the Assessment and Management of Gait Disorders in Parkinson’s Disease

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