Fear of Falling Activity Avoidance Behavior Among Individuals with Parkinson's Disease: A Scoping Review

Abstract

<h3>Objective(s)</h3> To explore existing literature related to fear of falling activity avoidance behavior (FFAB) among individuals with Parkinson's disease (PD). <h3>Data Sources</h3> Databases searched included MEDLINE, Embase, Scopus, APA Psycinfo, CINAHL, Papers First, and ProQuest Dissertations and Theses (1960 - January 8, 2020). <h3>Study Selection</h3> We included studies in English with participants diagnosed with PD who experienced fear of falling (FOF) that impacted activity engagement. Studies were excluded if they only addressed FOF without the behavioral impact of activity avoidance. Two independent reviewers screened the titles, abstracts, and full texts. The initial search resulted in 156 unique hits, 141 were excluded and 15 full texts were retrieved. Nine articles met all criteria. <h3>Data Extraction</h3> Data were extracted by two independent reviewers and included data on the concept, context, participants, study design, measurements, interventions, and key findings. <h3>Data Synthesis</h3> Multiple themes emerged, including the significant impact of FFAB on daily life, how PD-specific symptoms influence FFAB, and the psychological influence on FFAB and its impact. Multiple assessments were identified; however, only two assessments included the behavioral impact of FOF on activity participation: The Survey of Activities and Fear of Falling in the Elderly and the Fear of Falling Avoidance Behavior Questionnaire. Subthalamic deep brain stimulation (DBS) and balance training were identified as potential interventions. <h3>Conclusions</h3> FFAB is associated with psychological, physical, and environmental factors. FFAB is complex, multifaceted, unique to the individual, significantly impacted by PD-specific symptoms, and leads to downstream negative consequences. While DBS and balance training may reduce FFAB among PD, limited research is available. Most recommendations for interventions were based on evidence from the general population or factors shown to be significant predictors of FFAB. <h3>Author(s) Disclosures</h3> No financial disclosures and no conflicts of interest.