Development of a scale to assess avoidance behavior due to a fear of falling: the fear of falling avoidance behavior questionnaire

Journal ArticleBackground. A history of falls or imbalance may lead to a fear of falling, which may lead to self-imposed avoidance of activity; this avoidance may stimulate a vicious cycle of deconditioning and subsequent falls. Objective. The purpose of this study was to develop a questionnaire that would quantify avoidance behavior due to a fear of falling. Design. This study consisted of 2 parts: questionnaire development and psychometric testing. Questionnaire development involved an expert panel and 39 residents of an assisted living facility. Sixty-three community-dwelling individuals with various health conditions participated in psychometric testing. Method. Questionnaire development included the evaluation of face and content validity and factor analysis of the initial questionnaire. The final result of questionnaire development was the Fear of Falling Avoidance Behavior Questionnaire (FFABQ). In order to determine its psychometric properties, reliability and construct validity were assessed through administration of the FFABQ to participants twice, 1 week apart, and comparison of the FFABQ with other questionnaires related to fear of falling, functional measures of balance and mobility, and daily activity levels using an activity monitor. Results. The FFABQ had good overall test-retest reliability (intraclass correlation coefficient=.812) and was found to differentiate between participants who were considered ?fallers? (ie, at least one fall in the previous year) and those who were considered ?nonfallers.? The FFABQ predicted time spent sitting or lying and endurance. Limitations. A relatively small number of people with a fear of falling were willing to participate. Conclusion. Results from this study offer evidence for the reliability and validity of the FFABQ and support the notion that the FFABQ measures avoidance behavior rather than balance confidence, self-efficacy, or fear

Managing Bitterweed to Reduce Sheep Losses.

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A Mobile App Specifically Designed to Facilitate Exercise in Parkinson Disease: Single-Cohort Pilot Study on Feasibility, Safety, and Signal of Efficacy

Background: Many people with Parkinson disease do not have access to exercise programs that are specifically tailored to their needs and capabilities. This mobile app allows people with Parkinson disease to access Parkinson disease–specific exercises that are individually tailored using in-app demographic questions and performance tests which are fed into an algorithm which in turn produces a video-guided exercise program. Objective: To test the feasibility, safety, and signal of efficacy of a mobile app that facilitates exercise for people with Parkinson disease. Methods: A prospective, single-cohort design of people with Parkinson disease who had downloaded the 9zest app for exercise was used for this 12-week pilot study. Participants, who were recruited online, were encouraged to exercise with the full automated app for ≥150 minutes each week. The primary endpoints were feasibility (app usage and usability questions) and safety (adverse events and falls). The primary endpoints for signal of efficacy were a comparison of the in-app baseline and 8-week outcomes on the 30-second Sit-To-Stand (STS) test, Timed Up and Go (TUG) test, and the Parkinson’s Disease Questionnaire 8 (PDQ8). Results: For feasibility, of the 28 participants that completed the study, 12 participants averaged... (See full article for abstract)

Coordinated Speech Therapy, Physiotherapy, and Pharmaceutical Care Telehealth for People with Parkinson Disease in Rural Communities: An Exploratory, 8-Week Cohort Study for Feasibility, Safety, and Signal of Efficacy

Introduction: The potential for coordinated, multidisciplinary telehealth to help connect people with Parkinson disease (PD) in rural areas to PD specialists is crucial in optimizing care. Therefore, this study aimed to test the feasibility, safety, and signal of efficacy of a coordinated telehealth program, consisting of speech therapy, physiotherapy, and pharmaceutical care, for people with PD living in some rural US communities. Methods: Fifteen individuals with PD living in rural Wyoming and Nevada, USA, participated in this single-cohort, 8-week pilot study. Participants were assessed before and after 8 weeks of coordinated, one-on-one telehealth using the following outcomes: (1) feasibility: session attendance and withdrawal rate; (2) safety: adverse events; and (3) signal of efficacy: Communication Effectiveness Survey, acoustic data (intensity, duration, work (intensity times duration)), Parkinson’s Fatigue Scale, 30 second Sit-to-Stand test, Parkinson’s Disease Questionnaire – 39, Movement Disorder Society Unified Parkinson’s Disease Rating Scale – Part III, and medication adherence. Results: Average attendance was greater than 85% for all participants. There were no serious adverse events and only nine minor events during treatment sessions (0.9% of all treatment sessions had a participant report of an adverse event); all nine cases resolved without medical attention. Although 14 of 16 outcomes had effect sizes trending in the direction of improvement, only two were statistically significant using non-parametric analyses: 30 second Sit-to-Stand (pre-test median=11.0 (interquartile range (IQR)=6.0); post-test median=12.0 (IQR=3.0) and acoustic data work (pre-test median=756.0 dB s (IQR=198.4); post-test median=876.3 dB s (IQR=455.5), p \u3c 0.05. Conclusion: A coordinated, multidisciplinary telehealth program was safe and feasible for people in rural communities who have PD. This telehealth program also yielded a signal of efficacy for most of the outcomes measured in the study

A Vicious Cycle of Fear of Falling Avoidance Behavior in Parkinson’s Disease: A Path Analysis

Background: Postural instability (PI) in Parkinson\u27s disease (PD) is associated with several negative downstream consequences. Objective: The purpose was to explore the validity of a theoretical model of these downstream consequences arranged in a vicious cycle wherein PI leads to decreased balance confidence, which in turn leads to increased fear of falling (FOF) avoidance behavior, which in turn leads to decreased physical conditioning, which then feeds back and negatively affects PI. Methods: A path analysis of cross-sectional data from 55 participants with PD was conducted. The four constructs in the model connected in succession were: 1. PI (principal components analysis (PCA) composite of the Unified Parkinson\u27s Disease Rating Scale PI and Gait Difficulty score, Timed Up and Go test, and Berg Balance Scale); 2. balance confidence (Activities-Specific Balance Confidence Scale); 3. FOF avoidance behavior (PCA composite of the FOF Avoidance Behavior Questionnaire and average number of steps per day); and, 4. physical conditioning (2-Minute Step Test). Results: The path model was an excellent fit to the data, χ2 (7) = 7.910, p =.341, CFI = 0.985, TLI = 0.968, RMSEA = 0.049 (90% CI: 0.000 to 0.179). The moderate to strong and uniformly significant parameter estimates were −0.519, −0.651, −0.653, and −0.570, respectively (ps \u3c 0.01). Conclusions: PI directly and inversely predicted balance confidence, which in turn directly and inversely predicted FOF avoidance behavior. Furthermore, FOF avoidance behavior directly and inversely predicted physical conditioning, which directly and inversely predicted PI, thereby closing the cycle. These findings highlight the downstream consequences of PI in PD and support the notion of a vicious cycle of FOF avoidance behavior

A theoretical framework for addressing fear of falling avoidance behavior in Parkinson’s disease

Postural instability in Parkinson’s disease (PD) is associated with several downstream consequences that ultimately lead to a greater risk of falling. Among the prominent downstream consequences is fear of falling (FOF), which is both common and problematic in PD. It can lead to a vicious cycle of FOF avoidance behavior that results in more sedentary behavior, physical deconditioning, and weakening of already impaired balance systems. This, in turn, may make the person with PD more susceptible to a future fall even with benign daily tasks. While FOF activity avoidance can be adaptive (appropriate), it can also be maladaptive (inappropriate or exaggerated). When this adaptive and maladaptive FOF avoidance behavior is contextualized to gait/balance performance, it provides a theoretical framework that can be used by clinicians to match patterns of behavior to a concordant treatment approach. In the theoretical framework proposed in this perspective, four different patterns related to FOF avoidance behavior and gait/balance performance are suggested: appropriate avoiders, appropriate non-avoiders, inappropriate avoiders, and inappropriate non-avoiders. For each of the four FOF avoidance behavior patterns, this paper also provides suggested treatment focuses, approaches and recommendations

Managing Bitterweed to Reduce Sheep Losses.

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Effects of Three Recovery Protocols on Range of Motion, Heart Rate, Rating of Perceived Exertion, and Blood Lactate in Baseball Pitchers During a Simulated Game

Baseball pitching has been described as an anaerobic activity from a bioenergetics standpoint with short bouts of recovery. Depending on the physical conditioning and muscle fiber composition of the pitcher as well as the number of pitches thrown per inning and per game, there is the possibility of pitchers fatiguing during a game, which could lead to a decrease in pitching performance. Therefore, the purpose of this study was to evaluate the effects of 3 recovery protocols: passive recovery, active recovery (AR), and electrical muscle stimulation (EMS) on range of motion (ROM), heart rate (HR), rating of perceived exertion (RPE), and blood lactate concentration in baseball pitchers during a simulated game. The use of EMS was the most effective method at reducing blood lactate concentration after 6 minutes of recovery during a simulated game (controlled setting). Although EMS significantly reduced blood lactate concentrations after recovery, blood lactate concentrations after pitching in the simulated games were never high enough to cause skeletal muscle fatigue and decrease pitching velocity. If a pitcher were to throw more than 14 pitches per inning, throw more total pitches than normal per game, and have blood lactate concentrations increase higher than in the simulated games in this study, the EMS recovery protocol may be beneficial to pitching performance by aiding recovery. This could potentially reduce some injuries associated with skeletal muscle fatigue during pitching, may allow a pitcher throw more pitches per game, and may reduce the number of days between pitching appearances

Physical Therapy for Gait, Balance, and Cognition in Individuals with Cognitive Impairment: A Retrospective Analysis

Objectives. The purpose of this study was to determine if a pragmatic physical therapy (PT) program was associated with improved cognition, gait, and balance in individuals with cognitive impairment. This study investigated these associations for individuals with Alzheimer disease (AD), vascular dementia (VaD), dementia with Lewy bodies (DLB), and mild cognitive impairment (MCI) in order to better characterize outcomes to PT for each diagnostic group. Methods. Data before and after one month of physical therapy were extracted from patient records (67 with AD, 34 with VaD, 35 with DLB, and 37 with MCI). The mean number of PT sessions over a month was 3.4 (±1.8). Outcomes covered the domains of gait, balance, and cognition with multiple outcomes used to measure different constructs within the balance and gait domains. Results. All groups showed improvements in balance and at least one gait outcome measure. Those with MCI improved in every measure of gait and balance performance. Lastly, cognition as measured by Montreal Cognitive Assessment improved in individuals in the AD, VaD, and MCI groups. Conclusion. While this retrospective analysis is not appropriate for causal inference, results of one month of physical therapy were associated with decreases in gait, balance, and cognitive impairment in individuals with AD, VaD, DLB<, and MCI. Clinical Implications. While physical therapy is not typically a primary treatment strategy for individuals with cognitive impairment, the results of this study are consistent with the literature that demonstrates improvement from physical therapy for other neurodegenerative diseases. Further clinical and research exploration for physical therapy as a primary treatment strategy in these populations is warranted

Mandatory continuing education in physical therapy: Survey of physical therapists in states with and states without a mandate

Background and Purpose. Although formal continuing education (CE) in physical therapy is one part of professional development, its value for renewing licensure is not shared by all states. The purpose of this study was to explore the differences in how physical therapists pursue formal continuing education on the basis of state mandate, sex, years of experience, practice specialty, American Physical Therapy Association membership, motivation, and perception of the benefits of CE. Subjects and Methods. A survey questionnaire was sent to 3,000 physical therapists in 7 states-1,500 to physical therapists in states with mandatory CE and 1,500 to physical therapists in states without a requirement. A total of 1,145 usable survey questionnaires were returned, for a response rate of 38.2%. Results. Physical therapists in states with mandatory CE averaged 33.8 hours of CE per year, whereas physical therapists in states without a mandate averaged 28.3 hours per year; 5.9% of therapists in states without a mandate reported taking no CE at all, and 10.8% reported taking 2 or fewer hours of CE within the preceding 5 years. No statistically significant relationships were observed between the amount of CE taken and years of experience, sex, or practice specialty. Therapists who reported membership in the American Physical Therapy Association participated in 7.2 more hours of CE per year than therapists who did not report membership. Significant motivational variables that respondents noted for taking CE were state mandate, increased clinical competence, and certification. Therapists overwhelmingly (96.2%) believed that CE had a beneficial effect on their clinical practice. Discussion and Conclusion. Results from this study suggest that mandatory CE does have a significant association with the number of formal CE hours taken by physical therapists