The effect of exercise and education on fear of falling in elderly women with osteoporosis and a history of vertebral fracture: results of a randomized controlled trial

Olsen, Cecilie Fromholt; Bergland, Astrid

doi:10.1007/s00198-014-2724-3

Cited by 43 publications

(42 citation statements)

References 36 publications

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“…Although there are no definitions of minimal clinically significant changes in FES-I or any other fear of falling measure, 25 our FES-I effect size is among the highest reported, with recent randomised studies on interventions in fear of falling using the FES-I reporting significant decreases in scores ranging from 0.53 to 3.7. [118][119][120] Dropouts from the study were at variable time points and tended to be triggered by activities arising from the study (e.g. example the CBTi in the intervention group).…”

Section: Summary Of Main Findings Of the Phase II Randomised Controllmentioning

confidence: 99%

Cognitive–behavioural therapy-based intervention to reduce fear of falling in older people: therapy development and randomised controlled trial – the Strategies for Increasing Independence, Confidence and Energy (STRIDE) study

Parry

Bamford

Deary

et al. 2016

Health Technol Assess

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BackgroundFalls cause fear, anxiety and loss of confidence, resulting in activity avoidance, social isolation and increasing frailty. The umbrella term for these problems is ‘fear of falling’, seen in up to 85% of older adults who fall. Evidence of effectiveness of physical and psychological interventions is limited, with no previous studies examining the role of an individually delivered cognitive–behavioural therapy (CBT) approach.ObjectivesPrimary objective To develop and then determine the effectiveness of a new CBT intervention (CBTi) delivered by health-care assistants (HCAs) plus usual care compared with usual care alone in reducing fear of falling.Secondary objectives To measure the impact of the intervention on falls, injuries, functional abilities, anxiety/depression, quality of life, social participation and loneliness; investigate the acceptability of the intervention for patients, family members and professionals and factors that promote or inhibit its implementation; and measure the costs and benefits of the intervention.DesignPhase I CBTi development.Phase II Parallel-group patient randomised controlled trial (RCT) of the new CBTi plus usual care compared with usual care alone.SettingMultidisciplinary falls services.ParticipantsConsecutive community-dwelling older adults, both sexes, aged ≥ 60 years, with excessive or undue fear of falling per Falls Efficacy Scale–International (FES-I) score of > 23.InterventionsPhase I Development of the CBTi. The CBTi was developed following patient interviews and taught to HCAs to maximise the potential for uptake and generalisability to a UK NHS setting.Phase II RCT. The CBTi was delivered by HCAs weekly for 8 weeks, with a 6-month booster session plus usual care.Main outcome measuresThese were assessed at baseline, 8 weeks, 6 months and 12 months.Primary outcome measure Fear of falling measured by change in FES-I scores at 12 months.Secondary outcome measures These comprised falls, injuries, anxiety/depression [Hospital Anxiety and Depression Scale (HADS)], quality of life, social participation, loneliness and measures of physical function. There were process and health-economic evaluations alongside the trial.ResultsFour hundred and fifteen patients were recruited, with 210 patients randomised to CBTi group and 205 to the control group. There were significant reductions in mean FES-I [–4.02; 95% confidence interval (CI) –5.95 to –2.1], single-item numerical fear of falling scale (–1.42; 95% CI –1.87 to 1.07) and HADS (–1; 95% CI –1.6 to –0.3) scores at 12 months in the CBTi group compared with the usual care group. There were no differences in the other secondary outcome measures. Most patients found the CBTi acceptable. Factors affecting the delivery of the CBTi as part of routine practice were identified. There was no evidence that the intervention was cost-effective.ConclusionsOur new CBTi delivered by HCAs significantly improved fear of falling and depression scores in older adults who were attending falls services. There was no impact on other measures.Further workFurther work should focus on a joint CBTi and physical training approach to fear of falling, more rational targeting of CBTi, the possibility of mixed group and individual CBTi, and the cost-effectiveness of provision of CBTi by non-specialists.Trial registrationCurrent Controlled Trials ISRCTN78396615.FundingThis project was funded by the NIHR Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 20, No. 56. See the NIHR Journals Library website for further project information.

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Section: Summary Of Main Findings Of the Phase II Randomised Controllmentioning

confidence: 99%

Cognitive–behavioural therapy-based intervention to reduce fear of falling in older people: therapy development and randomised controlled trial – the Strategies for Increasing Independence, Confidence and Energy (STRIDE) study

Parry

Bamford

Deary

et al. 2016

Health Technol Assess

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“…Osteoporosis can decrease the quality of life and is associated with limitations in the functional capacity, pain, reduced social participation and fear of falling (22). In the present study, the quality of life was evaluated using the MOS 36-item Short Form Health Survey (SF-36), which comprised of physical functioning (PF), role physical (RP), bodily pain (BP), general health (GH), vitality (VT), social functioning (SF), role emotional (RE) and mental health (MH).…”

Section: Osteoporosis Clubmentioning

confidence: 99%

A model of health education and management for osteoporosis prevention

Wang

Zhang

et al. 2016

Experimental and Therapeutic Medicine

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Abstract. Osteoporosis, a chronic disease with no therapeutic cure, affects a growing number of people as the aging population in China rapidly increases. Therefore, developing an evidence-based model of health education and management for osteoporosis prevention is required. In the present study, an osteoporosis club was established, which is a novel model of health education and management for osteoporosis prevention. A unified management of membership was used based on a digitized database. A total of 436 patients with osteoporosis were randomly assigned to the osteoporosis club group or the self-management control group. For the osteoporosis club group, multiple activities of health education were performed, including monthly systematic health education lectures, exercise programs and communication parties once a year. For the control group, the participants took charge of their own musculoskeletal health. All data of the participants were collected and evaluated prior to and following intervention. In the pre-intervention assessment, no significant difference was identified in the health education between the two groups. Through the four-year intervention, the osteoporosis knowledge, health beliefs, living behavior, medication compliance, quality of life and bone mineral density of the osteoporosis club group were improved significantly compared with the control group (P<0.001), while the pain degree of the osteoporosis club group was relieved significantly more compared with the control group (P<0.001). The results in the present study suggest that setting up an osteoporosis club is an evidence-based model of health education and management for osteoporosis prevention in China.

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“…Some of the most commonly adopted interventions for this purpose include, usage of hip protectors, educating the geriatric population regarding the causes and implications of FOF, teaching and encouraging them to follow exercise routines and improve their socialization skills [19][20][21].…”

Section: Introductionmentioning

confidence: 99%

“…Tai Chi, yoga and strength training are helpful in reducing the levels of FOF and thus minimizes the chances of falling [21][22][23][24][25], but others also have no significant relationship [26,27]. Though it is proposed that sports can imply significant beneficial effects in the elderly population, there is still no agreement on the individualistic impacts of different sports exercises on specific traits of physical abilities of the elderly.…”

Section: Introductionmentioning

confidence: 99%

Effect of Pilates Exercise on Fear of Falling in Iranian Elderly Women

Badiei

Shahboulaghi

Hosseini

et al. 2017

IRJ

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Objectives:The aim of this study was to determine the effect of Pilates exercise on Fear of Falling (FOF) among elderly women. Methods:The present study is a clinical trial that was conducted on 44 elderly women aged between 60-80 years. Subjects were recruited through the convenience sampling method and were then randomly divided into two groups of inference viz. pilates exercise group, the members of which underwent Pilates exercise training along with the routine sanatorium exercises and the control group in which members stuck with (routine exercise only. Data was gathered by using demographic questionnaire and Fall Efficacy Scale-International (FES-I). For the intervention group, Pilates training was done for 8 weeks, three times a week (1 hour per session) under the supervision of a trained coach. Data were analyzed by the SPSS software v.16. Results:The findings indicated that the means of FES-I scores in Pilates group improved from 32.90 to 22.18 (MD=10.72) after the intervention. According to the independent t-test, there was a significant difference in the means of post intervention FES-I scores, between the two groups (P<0.001). In the Pilates group, the effect size of intervention was much more than the control group (ES=0.89). Discussion:Pilates training could decrease the FOF and may thus be implemented as an effective interventional method for fall prevention in elderly women.

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The effect of exercise and education on fear of falling in elderly women with osteoporosis and a history of vertebral fracture: results of a randomized controlled trial

Abstract: The intervention had a positive and durable effect on fear of falling as measured with the FES-I.

Cited by 43 publications

References 36 publications

Cognitive–behavioural therapy-based intervention to reduce fear of falling in older people: therapy development and randomised controlled trial – the Strategies for Increasing Independence, Confidence and Energy (STRIDE) study

Cognitive–behavioural therapy-based intervention to reduce fear of falling in older people: therapy development and randomised controlled trial – the Strategies for Increasing Independence, Confidence and Energy (STRIDE) study

A model of health education and management for osteoporosis prevention

Effect of Pilates Exercise on Fear of Falling in Iranian Elderly Women

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