Abstract
Objective
To summarize the effectiveness of physical therapy interventions to reduce fear of
falling (FOF) among individuals living with neurologic diseases.
Data Sources
PubMed, Physiotherapy Evidence Database, Scopus, Web of Science, PsycINFO, Cumulative
Index to Nursing and Allied Health, and SportDiscuss were searched from inception
until December 2019.
Study Selection
Clinical trials with either the primary or secondary aim to reduce FOF among adults
with neurologic diseases were selected.
Data Extraction
Potential articles were screened for eligibility, and data were extracted by 2 independent
researchers. Risk of bias was assessed by the Cochrane Risk of Bias tool for randomized
controlled trials and the National Institutes of Health Quality Assessment Tool for
pre-post studies. A meta-analysis was performed among trials presenting with similar
clinical characteristics. The Grading of Recommendations, Assessment, Development,
and Evaluation (GRADE) was used to rate the overall quality of evidence.
Results
Sixty-one trials with 3954 participants were included in the review and 53 trials
with 3524 participants in the meta-analysis. The included studies presented, in general,
with a low to high risk of bias. A combination of gait and balance training was significantly
more effective compared with gait training alone in reducing FOF among individuals
with Parkinson disease (PD) (mean difference [MD]=11.80; 95% CI, 8.22-15.38; P<.001). Home-based exercise and leisure exercise demonstrated significant improvement
in reducing FOF over usual care in multiple sclerosis (MS) (MD=15.27; 95% CI, 6.15-24.38;
P=.001). No statistically significant between-groups differences were reported among
individuals with stroke and spinal cord injury. The overall quality of evidence presented
in this review ranges from very low to moderate according to the assessment with the
GRADE approach.
Conclusions
Gait with lower limb training combined with balance training is effective in reducing
FOF in individuals with PD. Also, home-based or leisure exercise is effective among
individuals with MS. However, because of several limitations of the included studies,
further research is needed to examine the effectiveness of FOF intervention among
individuals with neurologic diseases.
Keywords
List of abbreviations:
ABC (Activities-specific Balance Confidence), CP (cerebral palsy), FES-I (Fall Efficacy Scale-International), FOF (fear of falling), GRADE (Grading of Recommendations, Assessment, Development, and Evaluation), MCID (minimal clinically important difference), MD (mean difference), MS (multiple sclerosis), PD (Parkinson disease), PT (physical therapy), RCT (randomized controlled trial), SCI-FCS (Spinal Cord Injury-Falls Concern Scale), SCI (spinal cord injury), SMD (standardized mean difference), TBI (traumatic brain injury)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: July 31, 2020
Footnotes
Disclosures: none.
PROSPERO Registration No.: CRD 42019135628.
Identification
Copyright
© 2020 by the American Congress of Rehabilitation Medicine
