Effect of physical exercise on fear of falling in patients with stroke: A systematic review and meta-analysis

Abstract

Objective To consolidate the evidence on the effect of physical exercise on fear of falling in individuals with stroke. Data Sources PubMed, CINAHL, Cochrane Database and MEDLINE Methods An extensive database search was conducted to identify the randomised controlled trials that examined the effect of physical exercise on fear of falling post-stroke. Grading of Recommendation, Assessment, Development and Evaluation (GRADE) was used to assess the quality of evidence for each meta-analysis. Results Fourteen trials totalling 1211 participants were included in this review. Thirteen of these (1180 participants) were included in the meta-analyses. In the primary analysis, very low-quality evidence suggested that exercise reduced fear of falling post-stroke (standardized mean difference (SMD) 0.48; 95% confidence interval (CI) 0.23 to 0.72). The effect was diminished at three- to six-month follow-up after exercise training ended (SMD −0.09; 95% CI −0.27 to 0.10; high-quality evidence). In the sensitivity analyses, the treatment effect was more pronounced in individuals with a lower baseline Berg balance score (BBS ≤45; SMD 0.53; 95%CI 0.17 to 0.88) and for those trials with exercise frequency of ≥3 sessions per week (SMD 0.70; 95%CI 0.39 to 1.01). Compared with circuit-based training consisting of a combination of walking, balance and strengthening exercises (SMD 0.27; 95% CI −0.09 to 0.63), walking programmes seemed to generate a larger effect on fear of falling (SMD 1.06; 95%CI 0.43 to 1.70). Conclusion Physical exercise was beneficial for reducing fear of falling in individuals with stroke, particularly those with poorer balance ability.

Effect of adding systematic desensitization to goal-directed paradigm on risk of falling in patients with stroke: a randomized controlled trial

“…Regarding the significantly improving effect of applying GDT only in the control group, the patient gained more self-assurance and fall efficacy as a result. This is supported by the results of a recent systematic review that found a substantial overall positive effect of GDT on FoF from six studies included in their systemic review analysis (four showed a significant difference between GDT and control) (16). There was no clear explanation for this decrease in FoF after the GDT application.…”

“…Furthermore, GDT can preferentially activate self-efficacy, which is a creative capacity that requires the integration of several types of knowledge and skill research, including intellectual, social, and behavioral capacities ( 13 ). Furthermore, verbal encouragement and feedback from the physical therapist during exercise may also promote a sense of balance self-efficacy ( 16 ).…”

“…Understanding stroke, addressing a patient's fear of falling, and developing comprehensive treatment in this area may help break the cycle of fear and risk of falling, reducing anxiety, promoting community involvement, and improving the quality of life ( 17 ). While many other researchers have tested the effect of GDT on the risk of falling ( 18 – 21 ) and fear of falling ( 16 ), as well as the effect of CBT on confidence and fear of falling ( 22 , 23 ) in stroke patients, there remains a lack of primary research that tests the effect of a desensitization approach, as a CBT intervention, in addition to GDT, to tackle this problem. Therefore, this study was conducted to investigate whether adding systematic desensitization to the goal-directed paradigm would be better than GDT alone in improving functional mobility and balance as well as reducing the risk of falling and the fear of falling in patients with stroke.…”