Balance Confidence and Fear of Falling Avoidance Behavior Are Most Predictive of Falling in Older Adults: Prospective Analysis
Balance Confidence and Fear of Falling Avoidance Behavior Are Most Predictive of Falling in Older Adults: Prospective Analysis
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DOI：
10.2522/ptj.20150184
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发表时间：
2016-04-01
期刊：
影响因子：
3.2
通讯作者：
Vaughn, Kyle
中科院分区：
文献类型：
--
作者：
Landers, Merrill R.;Oscar, Sarrie;Vaughn, Kyle
背景。有证据表明，老年人群中有几个跌倒预测因素，包括既往跌倒史和平衡障碍。然而，迄今为止，心理因素与身体因素作为未来跌倒预测因素的作用尚未得到彻底审查。 目的。本研究的目的是确定哪些身体和心理指标最能预测老年人跌倒。设计。这是一项前瞻性队列研究。方法。 64 名参与者（平均年龄 = 72.2 岁，SD = 7.2；40 名女性，24 名男性）有或没有病理（25 名健康患者、17 名帕金森病患者、11 名脑血管意外患者、6 名糖尿病患者和 5 名心血管诊断患者）参加。参与者报告了跌倒史并完成了基于身体的测量（即伯格平衡量表、动态步态指数、自选步态速度、定时“Up & Go”测试、感觉组织测试）和基于心理的测量（即害怕跌倒避免行为问卷、跌倒功效量表、特定活动平衡信心量表）。一年后进行联系以确定随后一年的跌倒情况（8 名参与者在随访中失访）。结果。使用多元回归，将跌倒历史、病理学和所有测量值作为候选预测因子输入。最终模型中包含三个变量，解释了 49.2% 的方差：特定活动平衡信心量表（38.7% 的方差）、害怕跌倒回避行为问卷（5.6% 的额外方差）和定时“Up & Go”测试（4.9% 的额外方差）。跌倒是基于参与者的回忆而不是日记。结论。平衡信心是跌倒的最佳预测因素，其次是对跌倒避免行为的恐惧，以及定时“起身”测试。跌倒史、病理情况和身体测试并不能预测跌倒。这些发现表明，与提供平衡能力快照的测试相比，参与者可能对跌倒风险有更好的认识。
Background. Evidence suggests that there are several fall predictors in the elderly population, including previous fall history and balance impairment. To date, however, the role of psychological factors has not yet been thoroughly vetted in conjunction with physical factors as predictors of future falls.Objective. The purpose of this study was to determine which measures, physical an psychological, are most predictive of falling in older adults.Design. This was a prospective cohort study.Methods. Sixty-four participants (mean age=72.2 years, SD = 7.2; 40 women, 24 men) with and without pathology (25 healthy, 17 with Parkinson disease, 11 with cerebrovascular accident, 6 with diabetes, and 5 with a cardiovascular diagnosis) participated. Participants reported fall history and completed physical-based measures (ie, Berg Balance Scale, Dynamic Gait Index, self-selected gait speed, Timed "Up & Go" Test, Sensory Organization Test) and psychological-based measures (ie, Fear of Falling Avoidance Behavior Questionnaire, Falls Efficacy Scale, Activities-specific Balance Confidence Scale). Contact was made 1 year later to determine falls during the subsequent year (8 participants lost at follow-up).Results. Using multiple regression, fall history, pathology, and all measures were entered as predictor candidates. Three variables were included in the final model, explaining 49.2% of the variance: Activities-specific Balance Confidence Scale (38.7% of the variance), Fear of Falling Avoidance Behavior Questionnaire (5.6% additional variance), and Timed "Up & Go" Test (4.9% additional variance).Limitations. Falls were based on participant recall rather than a diary.Conclusions. Balance confidence was the best predictor of falling, followed by fear of falling avoidance behavior, and the Timed "Up & Go" Test. Fall history, presence of pathology, and physical tests did not predict falling. These findings suggest that participants may have had a better sense of their fall risk than with a test that provides a snapshot of their balance.