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

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

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

Development of Stepping On After Stroke fall prevention program in Singapore

The aim of the work was to develop a group-based fall prevention program for community-living stroke survivors by adapting an evidence-based fall prevention program, Stepping On. This thesis comprises of five studies using mixed methodologies. The first study, a systematic review and meta-analysis confirmed that fall risk factors in this studied group are multifactorial and suggested that interventions should be multi-dimensional. In the second study, semi-structured interviews with community-living stroke survivors and caregivers conducted in Singapore identified the common self-perceived fall risk factors post-stroke, main challenges and common safety and coping strategies after a fall post-stroke. The third study, focus groups with therapists trained in Stepping On reported a lack of structured fall prevention programs and suggested adapting the Stepping On with some changes and additional key elements to suit the target population. In the fourth study, building on the earlier work, the key elements of Stepping On After Stroke (SOAS) program were reviewed by international and Singapore experts using a modified Delphi method. The program was further refined based on the review findings. In the final study, the adapted SOAS program was piloted with two groups of stroke survivors and their caregivers in two community centres. The results suggest that it is acceptable and feasible to implement this group-based SOAS program with the target population in Singapore. In summary, the findings from this research have made novel contributions to fall prevention in community-living stroke survivors in Singapore and other countries. The research suggests the need for a structured fall prevention program targeting both stroke survivors and caregivers and focusing on the modifiable fall risk factors with its aim to reduce fall risk and increase community participation. However, further fine-tuning of the program is needed before moving to a larger scale study

Developing a fall prevention program for community-dwelling stroke survivors in Singapore: client and caregiver perspectives

10.1080/09638288.2017.1419293Disability and Rehabilitation4191044-105

Therapists’ perspectives on adapting the Stepping On falls prevention programme for community-dwelling stroke survivors in Singapore

<p><b>Purpose:</b> This study investigates the perspectives of rehabilitation therapists on the implementation of fall prevention programmes with community-dwelling stroke survivors in the Singapore context, and elicits recommendations to adapt the Stepping On programme with stroke survivors.</p> <p><b>Method:</b> Qualitative data were elicited during 4 focus groups with 23 rehabilitation therapists (15 occupational therapists [OTs]; 8 physiotherapists [PTs]) who had received training to deliver the original Stepping On programme, and had experienced delivery of fall-prevention intervention programmes locally. Collected data were analysed using thematic analysis method.</p> <p><b>Results:</b> Three themes emerged from the focus groups describing: (a) limitations of existing falls prevention intervention for stroke clients; (b) the need to adapt the Stepping On programme to use with stroke clients; and (c) challenges in implementing fall prevention programmes in the stroke context. A series of new components were suggested to be included as part of the Stepping On after stroke (SOAS) programme, including involvement of family members and caregivers, and tailored community reintegration sessions (such as taking public transport and shopping).</p> <p><b>Conclusions:</b> Rehabilitation therapists describe challenges in addressing fall prevention within a stroke context, and findings highlight the need for a structured, stroke-specific fall prevention programme rather than a more general approach to education and training. Contextual components identified provide valuable inputs towards the development of a culturally relevant fall prevention programme for stroke survivors in Singapore.Implications for Rehabilitation</p><p>Stroke survivors living in the community are at a high risk of falls.</p><p>A structured and culturally relevant fall prevention programme for community-living stroke survivors is needed.</p><p>Falls prevention for community-living stroke survivors should be multi-dimensional and targeting the modifiable risk factors for falls in this group.</p><p>Both stroke survivors and caregivers should be involved in any fall prevention after stroke programmes.</p><p></p> <p>Stroke survivors living in the community are at a high risk of falls.</p> <p>A structured and culturally relevant fall prevention programme for community-living stroke survivors is needed.</p> <p>Falls prevention for community-living stroke survivors should be multi-dimensional and targeting the modifiable risk factors for falls in this group.</p> <p>Both stroke survivors and caregivers should be involved in any fall prevention after stroke programmes.</p

The Balance Recovery Confidence (BRC) Scale.

From PubMed via Jisc Publications RouterPublication status: aheadofprintFalls efficacy posits an understanding of the perceived ability to prevent and manage falls. There have been no validated self-reported instruments to measure the perceived ability to recover balance in response to destabilizing perturbations. To develop a scale of balance recovery confidence. Stage one had candidate items generated by 12 community-dwelling adults aged 65 and older using the nominal group technique. Stage two had the scale's name, instructions, response options, recall period and the items validated for appropriateness with 28 healthcare professionals and 10 older adults using an e-Delphi technique. Stage three had the scale's psychometric properties evaluated with 84 older adults who had completed self-reported and performance measures. Factor analysis was applied to confirm unidimensionality. The internal structure, reliability and validity of the scale were evaluated using the classical test theory and Rasch measurement theory. The 19-item scale was developed and validated with experts' consensus. The scale is unidimensional with excellent internal structure (Cronbach's α = 0.975) and test-retest reliability with Intraclass Correlation Coefficient (ICC ) = 0.944. Construct validity of the scale was supported by its relationships with the other measures (Activities-specific Balance Confidence scale, Falls Efficacy Scale-International, Late-Life Function and Disability International-Function, handgrip strength dynamometry, 30-second chair stand test, and mini-BESTest). The balance recovery confidence scale is a distinct instrument that measures perceived reactive balance recovery. The scale has good psychometric properties and can be used to complement other measurement instruments to help older adults cope with challenges to balance

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

Falls 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.</p

Pragmatic multicentre stepped-wedge cluster randomised trial to investigate the effectiveness of community-based falls prevention programme for older adults with falls risk in Singapore: a protocol paper

Introduction Falls are an important public health issue with consequences that include injuries, quality of life reduction and high healthcare costs. Studies show that falls prevention strategies are effective in reducing falls rate among community-dwelling older adults. However, the evaluation for effectiveness was usually done in a controlled setting with homogeneous population, and thus may not be generalisable to a wider population. This study aims to evaluate the impact of community falls prevention programmes with group-based strength and balance exercises, on falls risk and health outcomes for older adults with falls risk in Singapore.Methods and analysis This is a pragmatic closed cohort stepped-wedge cluster randomised trial design study, which involves sequential crossover of clusters from the waitlist control condition to the intervention condition, with the sequence of crossover randomly determined. The intervention will be sequentially rolled out to 12 clusters (a minimum of 5 participants/cluster), over 6 time periods with 8-week intervals in Central and North regions of Singapore. The primary analysis will be conducted under the intention-to-treat principle. A general linear mixed model or generalised estimating equation analysis appropriate for a multilevel longitudinal study incorporating an appropriate error distribution and link function will be used. Markov model will be developed to estimate the incremental cost per quality-adjusted life years and incremental cost per fall prevented from the implementation of falls prevention strategies from a societal perspective. Conditional on there being clinically relevant differences in short-term outcomes, we will implement simulation modelling to project the long-term divergence in trajectories for outcomes and costs using the Markov model.Ethics and dissemination Ethics approval has been obtained. Results will be disseminated in publications and other relevant platforms.Trial registration number NCT04788251