Interventions for falls efficacy
Summary
Falls efficacy refers to one’s judgement of self-abilities to prevent and manage falls. It is essential that interventions address the different aspects of falls efficacy in terms of balance confidence, balance recovery confidence, safe landing confidence and post-fall recovery confidence to improve their agency to deal with falls.
Evidence has shown that interventions addressing falls prevention can reduce the risk of falls in older adults. In our opinion, this is not enough. Reducing the risk of falls does not mean that falls will not occur. Globally, a third of older adults still experience a fall annually. Those who had a fall are known to have a higher risk of another fall within the year. Some falls are reported, but many go nonhighlighted because the impact of the fall may not warrant significant medical attention. Fall vignettes can affect falls efficacy which can lead to activity curtailment and activity avoidance. Suitable interventions should be introduced to regulate falls efficacy and maximize the quality of life for individuals.
Strength and balance exercises may be the most straightforward recommendation to help individuals prevent and manage falls. However, skilled clinicians and experienced researchers acknowledge the multifactorial complexity and adopt a person-centred approach when helping individuals develop their psychological and physical resiliency to deal with falls.
This research aims to advance the clinical reasoning processes and interventional approaches towards helping individuals to prevent and manage falls. That is, across the four different stages of falls (pre-fall, near-fall, fall-landing, and completed falls), novel strategies are explored to enhance the perceived ability of individuals to achieve several attainments, such as to perform activities steadily, to arrest falls in response to perturbations, to fall safely on the ground, and to get up from the ground.
A literature search of interventions targeting falls efficacy (dated October 2021) found that there had been 85 randomised controlled trials conducted from the Year 1990 involving over 12,000 older adults across 21 countries. Various fall prevention and management strategies are helpful in improving the agency of older adults to tackle falls. But which interventions are effective in addressing critical aspects of falls efficacy?
| Authors/Year/Country | Intervention | Control | Remarks |
| Devasahayam et al., 2023 | The Effect of Reactive Balance Training on Falls in Daily Life: An Updated Systematic Review and Meta-Analysis | Find it in journal | |
| Li et al., 2023 | Slow Poomsae (SP) training | Find it on Pubmed. | |
| Gerards MHG, 2023 | The next step: perturbation-based balance training and falls prevention in older adults. | Doctoral Thesis | |
| Barash et al., 2023 | Physical Therapy Exercise and Dance Movement Therapy | Physical Therapy Exercise | A systematic review of multifactorial fall prevention interventions |
| Vandervelde et al., 2023 | Systematic review of multifactorial fall prevention interventions | Find it on Pubmed. | |
| Aibar-Almazan et al., 2019, Spain. | Pilates program. | A series of guidelines aimed at fostering physical activity. | Find it on Pubmed. |
| Anson et al., 2018, United States. | Trunk motion visual feedback (VFB) training. | Treadmill walking with no VFB. | Find it on Pubmed. |
| Arai et al., 2007, Japan. | An exercise program. | Health promotion education. | Find it on Pubmed. |
| Arghavani et al., 2020, Iran. | Exercise training including perturbation training. | No intervention. | Find it on Pubmed. |
| Bao et al. 2018, United States. | Exercise training incorporated balance exercises and vibrotactile sensory augmentation. | Similar exercises but without vibrotactile SA. | Find it on Pubmed. |
| Beyer et al., 2007, Denmark. | A multicomponent intervention. | No intervention. | Find it on Pubmed. |
| Okuyan and Bilgili, 2017, Turkey. | Tai Chi Chuan. | Usual care exercises. | Find it on PEDro. |
| Brouwer et al., 2003, Canada. | Exercise training using therabands. | Health education program. | Find it on Pubmed. |
| Brownsell and Hawley, 2004, United Kingdom. | Use of fall detector devices. | No intervention. | Find it on Pubmed. |
| Cameron et al., 2000, Australia. | Use of hip protectors. | No intervention. | Find it on Pubmed. |
| Chang et al., 2011, South Korea. | Cognitive-behavioural therapy. | No intervention. | Find it in journal. |
| Chen et al., 2012, Taiwan. | Video game-based training. | Sit to stand exercises. | Find it on Pubmed. |
| Chewning et al., 2020, United States. | Tai Chi Prime (TCP). | No intervention. | Find it on Pubmed. |
| Clemson et al., 2004, Australia. | Stepping On program. | Two social visits. | Find it on Pubmed. |
| Clemson et al., 2012, Australia. | Multicomponent with Lifestyle integrated Functional Exercise (LiFE). | Flexibility exercises. | Find it in journal. |
| Covill et al., 2017, United States. | Ai Chi program. | Impairment based aquatic therapy (IBAT). | Find it on Pubmed. |
| Cyarto et al., 2008, Australia. | Exercise training. | A supervised walking program. | Find it on Pubmed. |
| Daniel, 2012, United States. | Exercise gaming system. | No intervention. | Find it on Pubmed. |
| Davison et al., 2005, United Kingdom. | A multicomponent intervention program. | No intervention. | Find it on Pubmed. |
| De Bruin et al., 2013, Switzerland. | A multicomponent intervention program. | Exercise. | Find it on Pubmed. |
| Devereux et al., 2005, Australia. | A multicomponent intervention. | No intervention. | Find it on Pubmed. |
| Elley et al., 2008, New Zealand. | A multicomponent intervention. | Usual care and two social visits. | Find it on Pubmed. |
| Foss et al., 2006, United Kingdom. | Cataract surgery. | No intervention. | Find it on Pubmed. |
| Freiberger et al., 2012, Germany. | A multicomponent intervention. | No intervention. | Find it on Pubmed. |
| Gallo et al., 2018, United States. | Home-exercise program (HEP). | Usual care. | Find it on Pubmed. |
| Gine-Garriga et al., 2013, Spain. | Functional circuit training. | Usual care and social meeting. | Find it on Pubmed. |
| Gitlin et al., 2006, United States. | A multicomponent intervention. | No intervention. | Find it on Pubmed. |
| Hale et al., 2012, New Zealand. | Water-based exercise. | Computer-skills training program. | Find it on Pubmed. |
| Halvarsson et al., 2015, Sweden. | Balance training. | No intervention. | Find it on Pubmed. |
| Hamrick et al., 2017, United States. | Yoga. | 5 minutes home relaxation. | Find it on Pubmed. |
| Harwood et al., 2005, United Kingdom. | Cataract surgery. | No intervention. | Find it on Pubmed. |
| Westlake and Culham, 2007, Canada. | Sensory-specific exercise program. | Falls prevention education group. | Find it on Pubmed. |
| Whitehead et al., 2018, United Kingdom. | Housing adaptation. | Usual routine service. | Find it on Pubmed. |
| Whyatt et al., 2015, United Kingdom. | Wii Balance board exercise. | No intervention. | Find it on Pubmed. |
| Wu et al., 2010, United States. | Tai Chi Chuan. | Exercise. | Find it on Pubmed. |
| Zhang et al., 2006, China. | Tai Chi Chuan. | No intervention. | Find it on Pubmed. |
| Zhang et al., 2014, China. | Whole-body vibration. | Physical modalities, e.g., phototherapy. | Find it on Pubmed. |
| Zhao et al., 2016, Hong Kong. | Exercise for Balance Improvement Program (ExBP). | Tai-chi. | Find it on Pubmed. |
| Ziden et al., 2014, Sweden. | Cognitive behavioural therapy. | Usual care. | Find it on Pubmed. |
| Zijlstra et al., 2011, Netherlands. | Cognitive behavioural therapy. | No intervention. | Find it on Pubmed. |
| Headley & Payne, 2014, United States. | A community-based fall prevention program. | Lifelong learning educational activities. | Find it on site. |
| Henwood et al., 2008, Australia. | A resistance training exercise. | No intervention. | Find it on Pubmed. |
| Hofmeyer et al., 2002, United States. | A floor-rise training program. | Chair-based flexibility exercises. | Find it on Pubmed. |
| Hong et al., 2018, South Korea. | Telepresence exercise program. | Nutrition & exercise education. | Find it on Pubmed. |
| Huang & Acton, 2004, Taiwan. | A multicomponent intervention. | Fall prevention information. | Find it on Pubmed. |
| Huang et al., 2011, Taiwan. | Cognitive behavioural therapy (CBT) and Tai Chi. | No intervention. | Find it on Pubmed. |
| Iliffe et al., 2015, United Kingdom. | Otago Exercise Program (OEP) and Falls Management Exercise (FaME). | Usual care. | Find it on Pubmed. |
| Jagdhane et al., 2016, United States. | An exercise training aiming to improve anticipatory postural adjustments (APAs) for balance control. | No intervention. | Find it on Pubmed. |
| Jeon et al., 2014, South Korea. | A fall prevention program. | No intervention. | Find it on Pubmed. |
| Jiménez-García et al., 2019, Spain. | High-intensity interval training (HIIT). | Health education. | Find it on Pubmed. |
| Johnson et al., 2021, Sweden. | Otago exercise program (OEP) and motivational interview. | General safety recommendation booklet. | Find it on Pubmed. |
| Josephs et al., 2016, United States. | Pilates. | Strength, flexibility, and balance exercises. | Find it on Pubmed. |
| Kim et al., 2012, United States. | Guided relaxation and imagery (GRI). | Relaxation instructions. | Find it on Pubmed. |
| Kurz et al., 2016, Israel. | Unexpected perturbation balance exercises. | Treadmill walking without unexpected perturbations. | Find it on Pubmed. |
| Kyrdalen et al., 2013, Norway. | Otago exercise program (OEP). | Home training. | Find it on Pubmed. |
| Lastayo et al., 2017, United States. | Resistance exercises. | Traditional resistance exercise. | Find it on Pubmed. |
| Latham et al., 2003, New Zealand & Australia. | A multicomponent intervention and Vitamin D. | Telephone calls and home visits. | Find it on Pubmed. |
| Li et al., 2019, United States | Tai Chi and multimodal exercise. | Stretching group. | Find it on Pubmed. |
| Lipsitz et al., 2019, United States | Tai Chi. | Health education | Find it on Pubmed. |
| Liston et al., 2014, United Kingdom | Customised multisensory balance exercises and the modified OTAGO group exercise. | Active range of motion stretching exercises with modified OTAGO group exercise. | Find it on Pubmed. |
| Liu et al., 2021, United States | A multicomponent intervention. | Attention-control, home visits. | Find it on Pubmed. |
| Liu-Ambrose et al., 2004, Canada | Resistance training and agility training. | Stretching. | Find it on Pubmed. |
| Liu-Ambrose et al., 2010, Canada | Resistance training (RT). | Balance and Tone. | Find it on Pubmed. |
| Logghe et al., 2009, Netherlands | Tai Chi Chuan. | Usual care. | Find it on Pubmed. |
| Ma et al., 2019, Hong Kong | Ving Tsun (VT). | Usual care. | Find it on Pubmed. |
| Oh et al., 2012, South Korea | A multicomponent intervention. | No intervention. | Find it on Pubmed. |
| Nick et al., 2016, Iran | Hatha yoga. | No intervention. | Find it on Pubmed. |
| Plummer-D’Amato et al., 2012, United States | Dual-task training. | Balance, gait and agility training. | Find it on Pubmed. |
| Prossegger et al., 2019, Germany & Austria. | A program of mountain hiking and balneotherapy. | 7-day sightseeing activities. | Find it on Pubmed. |
| Rendon et al., 2012, United States. | Virtual reality gaming. | No intervention. | Find it on Pubmed. |
| Roller et al., 2018, United States. | Pilates reformer exercises. | No intervention. | Find it on Pubmed. |
| Schilling, 2009, Canada. | The unstable surface balance training (USBT) program. | No intervention. | Find it on Pubmed. |
| Shigematsu et al., 2008, Japan. | Square-stepping exercise (SSE). | Strength and balance exercises. | Find it on Pubmed. |
| Shigematsu et al., 2008, Japan. | Square-stepping exercise (SSE). | Outdoor walking session. | Find it on Pubmed. |
| Silsupadol et al., 2009, Thailand. | Dual-task training. | Single task training of balance. | Find it on Pubmed. |
| Smulders et al., 2010, Netherlands. | The Nijmegen Fall Prevention Program (NFPP). | No intervention. | Find it on Pubmed. |
| Szturm et al., 2011, Canada. | Interactive computer game exercise. | Strengthening and balance exercises. | Find it on Pubmed. |
| Tennstedt et al., 1998, United States. | A cognitive-behavioural intervention. | Social contact and falls education. | Find it on Pubmed. |
| Tinetti et al., 1994, United States. | A multicomponent strategy of risk-factor abatement. | Social home visits. | Find it on Pubmed. |
| Tousignant et al., 2012, Canada. | Tai Chi Chuan (TCC). | Physiotherapy balance rehabilitation intervention. | Find it on Pubmed. |
| Ullmann et al., 2010, United States. | Feldenkrais Method (FM) exercise. | No intervention. | Find it on Pubmed. |
| Voukelatos et al., 2015, Australia. | The walking program with telephone coaching. | Health education. | Find it on Pubmed. |
| Weerdesteyn et al., 2006, Netherlands. | The Nijmegen Fall Prevention Program (NFPP). | No intervention. | Find it on Pubmed. |
| Lurie et al., 2020, United States. | Surface perturbation training. | Usual gait/balance intervention. | Find it on Pubmed. |
| Paquette et al., 2015, United States. | Reactive balance training | Ergometer cycling. | Find it on Pubmed. |
On Fall Recovery strategies
The paper, “Are interventions effective in improving the ability of older adults to rise from the floor independently? A mixed method systematic review” by Burton et al. (2020) gives greater insights into the different interventions that could be helpful to improve older adults’ confidence to get up from the floor after a fall. Click link to the paper.
A summary of the paper:
- Forty-one studies were included in this review.
- Resistance training and/or teaching the skill were commonly adopted as strategies. The backward chaining method might be more effective than the conventional approach and less stressful for participants.
- Four types of characteristics were found to be associated with difficulty getting up: (1) mobility, (2) health conditions, (3) age, and (4) needing care in the home. Burton et al (2020) suggested screening some of these characteristics into a screen for identifying those at risk of not being able to get up from the floor.
- The meta-analyses of all RCT interventions indicated no significant change in the time it takes older people to get up off the floor independently with intervention (MD: –0.43[–1.38, 0.51]). Sub-analyses of interventions utilizing resistance training showed an improvement trending towards significance (MD: –0.81[–1.72, 0.09]).
- Knowledge of specific techniques for getting up and the effect of simply practising getting off the floor must be further explored.
- It is unknown what impact these interventions have on their fall recovery confidence.
19 May 2024
Updates for interventions for safe falling techniques. Click link.