DEVELOPMENT OF A BALANCE RECOVERY CONFIDENCE SCALE FOR COMMUNITY-DWELLING OLDER ADULTS

Falls are concerning issues for older people. There is a lack of instruments that measure balance recovery confidence. Balance recovery confidence refers to the perceived ability to arrest falls. Patient-reported outcome measures (PROMs) are used to obtain information directly from the person being cared for. The overall aim of this thesis is to present the development of a PROM that measures balance recovery confidence in community-dwelling older adults. Methods: A sequential series of steps was taken to develop the PROM. First, a literature review was done to understand the self-efficacy theory, types of falls-related psychological concerns, PROMs used, the role of balance recovery control and the development of a PROM for the construct of interest. Four studies were then implemented. The first study systematically reviewed existing falls efficacy-related PROMs for their development, content validity and structural validity. The second study assessed the feasibility of studying near-falls and balance recovery among community-dwelling older adults. The third study constructed and validated the content of the balance recovery confidence scale with 22 community-dwelling older adults and 28 healthcare professionals. The final study assessed the psychometric properties of the newly developed PROM with 84 community-dwelling older adults in Singapore. Results and conclusions: Existing falls efficacy-related PROMs lack high-quality evidence in their development and content validity. The systematic review affirmed an absence of a suitable PROM of balance recovery confidence for community-dwelling older adults. The feasibility study demonstrated that balance recovery was a relatable concept for older adults. A 19-item balance recovery confidence scale was constructed and validated with experts’ consensus. Field testing showed that the scale has excellent psychometric properties, having moderate correlations with the Activities-specific Balance Confidence Scale, Falls Efficacy Scale-International, Late Life Function and Disability Instrument-Function and strong correlation with reactive postural control performance. Keywords: Patient-reported outcome measures, falls efficacy, balance recovery confidence, psychometric propertie

Measures of falls efficacy, balance confidence, or balance recovery confidence for perturbation-based balance training

From Frontiers via Jisc Publications RouterHistory: collection 2022, received 2022-08-22, accepted 2022-09-28, epub 2022-10-12Peer reviewed: TrueAcknowledgements: The Balance Recovery Confidence Scale was developed as part of the author's PhD studies under the tutelage of Dr Judith Lane, Dr Chee-Wee Tan, and Prof Nigel Gleeson. The author was awarded a PhD scholarship by the Singapore Institute of Technology.Publication status: Publishe

Researcher as instrument: A critical reflection using nominal group technique for content development of a new patient-reported outcome measure

Shawn Leng-Hsien Soh - ORCID: 0000-0002-8725-5182 https://orcid.org/0000-0002-8725-5182Judith Lane - ORCID: 0000-0003-0413-8421 https://orcid.org/0000-0003-0413-8421Background: This article presents a critical reflection on the application of the ‘researcher as instrument’ concept within a study employing the nominal group technique. Twelve community-dwelling older adults were recruited to generate a list of items for a new patient-reported outcome measure on perceived ability to recover balance. The ontological position and epistemological stance of the first author are presented to provide a philosophical context of his lens and biases of his reflection.Aim: The article aims to share reflective insights into the process of taking the role of researcher as instrument, to highlight the concept’s strengths and limitations for other researchers and demonstrate how it is applied from the perspectives of a physiotherapist conducting person-centred research with older clients.Conclusions: Essential practice skills such as reflectivity and reflexivity are necessary for a researcher as an instrument to build a trusting relationship with participants in person-centred research. Novice researchers should explore their philosophical orientation to develop their research methodology and methods.Implications for practice: Researcher as instrument can be applied to conduct the nominal group technique In person-centred research, researchers need to critically reflect on their roles to build trust with participants during the planning and delivery of their methods, being reflective and reflexive Consideration of one’s ontological and epistemological position allows growth in research learninghttps://doi.org/10.19043/ipdj.102.01010pubpub

Falls efficacy instruments for community-dwelling older adults: A COSMIN-based systematic review

From Springer Nature via Jisc Publications RouterBackground: Falls efficacy is a widely-studied latent construct in community-dwelling older adults. Various self-reported instruments have been used to measure falls efficacy. In order to be informed of the choice of the best measurement instrument for a specific purpose, empirical evidence of the development and measurement properties of falls efficacy related instruments is needed. Methods: The Consensus-based Standards for the Selection of Health Measurement Intruments (COSMIN) checklist was used to summarise evidence on the development, content validity, and structural validity of instruments measuring falls efficacy in community-dwelling older adults. Databases including MEDLINE, Web of Science, PsychINFO, SCOPUS, CINAHL were searched (May 2019). Records on the development of instruments and studies assessing content validity or structural validity of falls efficacy related scales were included. COSMIN methodology was used to guide the review of eligible studies and in the assessment of their methodological quality. Evidence of content validity: relevance, comprehensiveness and comprehensibility and unidimensionality for structural validity were synthesised. A modified GRADE approach was applied to evidence synthesis. Results: Thirty-five studies, of which 18 instruments had been identified, were included in the review. High-quality evidence showed that the Modified Falls Efficacy Scale (FES)-13 items (MFES-13) has sufficient relevance, yet insufficient comprehensiveness for measuring falls efficacy. Moderate quality evidence supported that the FES-10 has sufficient relevance, and MFES-14 has sufficient comprehensibility. Activities-specific Balance Confidence (ABC) Scale–Simplified (ABC-15) has sufficient relevance in measuring balance confidence supported by moderate-quality evidence. Low to very low-quality evidence underpinned the content validity of other instruments. High-quality evidence supported sufficient unidimensionality for eight instruments (FES-10, MFES-14, ABC-6, ABC-15, ABC-16, Iconographical FES (Icon-FES), FES–International (FES-I) and Perceived Ability to Prevent and Manage Fall Risks (PAPMFR)). Conclusion: Content validity of instruments to measure falls efficacy is understudied. Structural validity is sufficient for a number of widely-used instruments. Measuring balance confidence is a subset of falls efficacy. Further work is needed to investigate a broader construct for falls efficacy.21pubpu

Near-falls in Singapore community-dwelling older adults: A feasibility study

From Springer Nature via Jisc Publications RouterBackground: A near-fall is defined as a loss of balance that would result in a fall if sufficient balance recovery manoeuvres are not executed. Compared to falls, near-falls and its associated balance recovery manoeuvres have been understudied. Older adults may not recognise a near-fall or identify the use of their balance recovery manoeuvres to prevent a fall. The consensus on the methods to collect near-fall data is lacking. The primary objective of this study was to determine the feasibility of recruitment and retention. Secondary objectives were to establish evidence that Singapore community-dwelling older adults can identify near-falls and associated balance recovery manoeuvres. Texting and calling methods were explored as reporting methods. Methods: This study took place in Singapore (September to October 2019). Participants were healthy, community-dwelling adults aged 65 or older. Recruitment was done through poster advertisement, and all participants gave informed consent. Participants attended a briefing session and reported their near-fall or fall incidence over 21 days using either daily texting or calling. The primary outcome measures were the recruitment rate, retention rate, preferred modes for data reporting and ability to report near-falls or falls. Secondary outcomes included the self-reported incidence of falls and near-falls. Results: Thirty older adults were recruited in 5 weeks. All participants completed the study. They understood near-fall concepts and were able to report the occurrence and relevant balance recovery manoeuvres used to prevent a fall. 87% (26/30) chose to text while 13% (4/30) selected calling as their reporting method. One actual fall (0.16%) out of 630 responses was reported. Thirty-six incidents (5.7%) of near-falls were recorded. Sixteen participants (53.3%) experienced near-falls and half of this group experienced two or more near-falls. The use of reach-to-grasp strategy (36%), compensatory stepping (52.8%), and other body regions (11.2%) were used to prevent the fall. Conclusions: The study provided evidence that studying near-falls in Singapore community-dwelling older adults is feasible and can be applied to a large-scale study. Recruitment and retention rates were good. Older adults were able to identify near-falls and balance recovery manoeuvres. Both texting and calling were feasible reporting methods, but texting was preferred. Trial registration: ClinicalTrials identifier: NCT04087551. Registered on September 12, 2019This study was financially supported by the Singapore Institute of Technology, Seed Funding Grant (R-MOE-E103-D018). The funders took no part in the design or execution of the study.7pubpu

Falls efficacy: Extending the understanding of self-efficacy in older adults towards managing falls

Shawn Leng-Hsien Soh - ORCID: 0000-0002-8725-5182 https://orcid.org/0000-0002-8725-5182Janet Thomas - ORCID: 0000-0002-1037-7923 https://orcid.org/0000-0002-1037-7923Judith Lane - ORCID: 0000-0003-0413-8421 https://orcid.org/0000-0003-0413-8421Publisher's accepted article replaced by VoR 2021-09-02Falls efficacy is a widely studied construct. The understanding of falls efficacy has evolved over time. Falls efficacy was initially perceived to be suitably used as a measure of fear of falling. However, further research suggested that falls efficacy and fear of falling are distinct constructs, and therefore, would be inappropriate to be used as a proxy. Instead, some researchers posited that falls efficacy is synonymous with balance confidence. Falls efficacy has been conventionally understood as the perceived ability of individuals to perform activities without losing balance or falling. A recently conducted systematic review by the authors on existing falls efficacy related measures had revealed a fresh perspective of recognising falls efficacy as a perceived ability to manage a threat of a fall. Falls efficacy, with a broadened interpreted construct, relates to the individual’s perceived self-efficacy of performing necessary actions needed in different scenarios, including pre-fall, near-fall, fall-landing and completed fall. The conventional interpretation of falls efficacy needs a rethinking of perspective. An extended understanding of falls efficacy would provide an integral approach towards improving the agency of individual to deal with falls and would enhance person-centred care.https://doi.org/10.22540/JFSF-06-1316pubpub

Constructing a measure of balance recovery confidence for older persons: Content themes from different stakeholders

Shawn Leng-Hsien Soh - ORCID: https://orcid.org/0000-0002-8725-5182 0000-0002-8725-5182Judith Lane - ORCID: 0000-0003-0413-8421 https://orcid.org/0000-0003-0413-8421Fiona Gilmour - ORCID: 0000-0002-9106-3618 https://orcid.org/0000-0002-9106-3618Background: The absence of patient-reported outcome measures (PROMs) for a specific construct or target population suggests a need for such measures to be developed. A case in point is the domain of falls efficacy; a PROM for balance recovery confidence was proposed to improve older persons ’agency to arrest a fall. Appropriate participation in its development by relevant stakeholders was identified as essential to maximise the utility of the PROM and its potential to enhance patient care. There is a gap in the practice development literature in terms of PROMs for older persons. This article aims to encourage researchers to use the principles of practice development to address this gap by involving relevant stakeholders to gain greater insight.Methods: The nominal group technique and the Delphi technique were used to generate and refine the content of the measure, and content analysis was applied to assess and summarise the data.Findings: Unique themes emerged, such as ‘agency of older people in the prevention of falls ’from the community-dwelling older adults in Singapore, and ‘clinical specificity ’from an international panel of healthcare professionals. Common themes including ‘relevance to the target population’, ‘comprehensibility ’and ‘cultural and contextual sensitivity ’were found in both groups.Conclusion: A collaborative, inclusive and participatory approach involving different stakeholders, underpinned by practice development methodology, can offer rich insights for PROM developers.Implications for practice: Meaningful perspectives are generated from a diversity of views shared by representatives from all stakeholder groups involved in caregiving Participation of different stakeholders, such as physiotherapists, occupational therapists, nurses, doctors, podiatrists and older persons, provides a more robust and authentic approach to developing a PROM for older personshttps://doi.org/10.19043/ipdj.111.00911pubpub

Validation of a new patient-reported outcome measure of balance recovery confidence (BRC) for community-dwelling older adults: A study protocol

From Crossref journal articles via Jisc Publications RouterBackground: Patient-reported outcome measures (PROMs) provide clinicians a greater understanding of patients’ perceived ability in their physical performance. Existing PROMs on falls efficacy provide meaningful information about the perceived ability in older people to perform common activities of daily living without falling. However, the perceived ability to recover balance from a slip, a trip, or volitional movements has been inadequately assessed. Balance recovery confidence relates to the judgment of self-reactive ability. The scale of balance recovery confidence (BRC) is a new PROM that measures perceived balance recovery self-efficacy. The purpose of the study protocol is to describe the first psychometric evaluation of BRC’s measurement properties.Objective: This study is a validation phase of a newly developed PROM conducted in Singapore.Methods: Two hundred community-dwelling older adults, aged 65 years and older, will complete five self-reported instruments (BRC, Activities-specific Balance Confidence Scale, Falls Efficacy Scale-International, Late-Life Function and Disability Instrument-Function and Global Perceived Effect) and three performance measures (Hand strength dynamometer, 30-second Chair Stand, Mini BESTest). Classical test theory methods will assess acceptability, data completeness, targeting of the items, scaling assumptions, internal consistency reliability and construct validity. Factor analysis will establish unidimensionality. Rasch analysis will evaluate item fit, differential item functioning, response scale ordering, targeting of persons and items and the reliability.Results: The findings from this study will be published in peer-reviewed journals and presented at national and international conferences in rehabilitation-specific context.Conclusions: This is the first validation study of BRC. The study will give confidence among clinicians and researchers to use the BRC in fall management research and clinical practice.https://doi.org/10.1080/10833196.2021.193886726pubpub

Measures of falls efficacy, balance confidence, or balance recovery confidence for perturbation-based balance training.

From PubMed via Jisc Publications RouterHistory: received 2022-08-22, accepted 2022-09-28Publication status: epublis

Falls efficacy: The self-efficacy concept for falls prevention and management.

Shawn Leng-Hsien Soh - ORCID: 0000-0002-8725-5182 https://orcid.org/0000-0002-8725-5182Falls efficacy is an important self-efficacy concept in older people to prevent and manage falls. However, an adequate understanding of this concept has been lacking. Many falls efficacy instruments have been used to measure fear of falling or balance confidence. This has led to obscurity in the role of falls efficacy in falls prevention and management practice. This commentary aims to present a contemporary understanding of falls efficacy. Translating new insights of falls efficacy into practice promotes new and novel approaches to help older people overcome the threat of falls.https://doi.org/10.3389/fpsyg.2022.1011285pubpu