Falls Efficacy Scale-International Scores Research Articles

Relationship among Falls, Fear of Falling, and Physical Activity Level in Patients on Hemodialysis.

Patients on hemodialysis are highly susceptible to falls and fractures. Amplified apprehension regarding the fear of falling (FOF) constitutes a risk factor that restricts physical activity and escalates the probability of falls among the elderly population. This study aimed to elucidate the association between falls and FOF and physical activity in patients on hemodialysis. A prospective cohort study was conducted across 9 centers. FOF was assessed using the Falls Efficacy Scale-International (FES-I). Physical activity was assessed using the Japanese version of the International Physical Activity Questionnaire short form. Subsequently, falls were monitored over a duration of 1year. Logistic regression analysis was performed to evaluate the relationship between falls and FOF and physical activity. In addition, in the receiver operating characteristic analysis, the cutoff value of FES-I that predicts falls was determined using the Youden Index. A restricted cubic spline curve was utilized to analyze the nonlinear association between falls and the FES-I. A total of 253 patients on hemodialysis (70.0 [59.0-77.0] years old; 105 female [41.5%]) were included in the analysis. During the 1-year observation period, 90 (35.6%) patients experienced accidental falls. The median FES-I score was 36.0 (24.0-47.0) points, and patients with higher FES-I scores had more falls. Following adjusted logistic regression analysis, FES-I exhibited an independent association with falls (OR = 1.04; 95% CI = 1.01-1.06), but physical activity was not. The area under the receiver operating characteristic curve was 0.70 (95% CI = 0.64-0.77), and the FES-I threshold value for distinguishing fallers from non-fallers was determined as 37.5 points (sensitivity 65.6%, specificity 35.0%). A nonlinear relationship between falls and FES-I was observed. FOF was associated with the incidence of falls in patients on hemodialysis. The evaluation and implementation of interventions targeting the FOF may mitigate the risk of falls.

Cognitive status and sleep quality can explain the fear of falling and fall history in people with Parkinson's disease.

Fear of falling (FOF) is highly prevalent in people with Parkinson's disease (PwPD) and contributes to high fall risk. Studies reporting on the relationship between falls, FOF, and non-motor factors such as cognitive function and sleep quality in Parkinson's disease are limited. This study aimed to investigate (1) the relationship of cognitive function and sleep quality with FOF, and history of falls in PwPD; (2) differences in cognitive function and sleep quality between Parkinson's disease fallers and non-fallers; and (3) a cut-off score for cognitive function and sleep quality to discriminate Parkinson's disease fallers from non-fallers. Fifty PwPD were assessed for FOF [Falls Efficacy Scale-International (FES-I)], cognition [Montréal Cognitive Assessment (MOCA)], sleep quality [Pittsburgh Sleep Quality Index (PSQI)], and falls history. The MOCA is significantly associated with FES-I scores ( R2 = 0.429, P < 0.0001). Both MOCA ( P = 0.012) and PSQI ( P = 0.027) were associated with falls history even after adjusting for confounding factors (age, sex, L-dopa use, Parkinson's disease severity). Both MOCA and PSQI scores were able to distinguish fallers from non-fallers with cut-off scores of 15.5 and 7.5, respectively. Although our findings revealed that both cognitive function and sleep quality are important factors influencing falls and FOF in PwPD, it remains to be determined if addressing cognitive impairments and poor sleep quality may favorably impact balance before integrating such screenings into fall prevention programs.

Fear of Falling Score Is a Predictor of Falls in Community-Dwelling Pre-Frail and Frail Older People.

Identifying frail older people at risk of falling is a priority in order to apply preventive strategies. This cross-sectional study included community-dwelling pre-frail and frail people (Fried's criteria) aged 70 years and older to assess the prevalence of falls and identify screening strategies based on comprehensive geriatric assessments to detect an increased risk of falling and recurrent falling in community-dwelling frail and pre-frail old people. Of the 229 participants, 121 (54.9%) had fallen in the previous 12 months, and 20 of these (16.5%) were recurrent fallers (≥2 falls). A score of 20 points or more on the Falls Efficacy Scale International was predictive of falling (area under the receiver-operating characteristics curve 0.67, 95% confidence interval: 0.61-0.74, p < 0.001) with a sensitivity of 51.7% and a specificity of 73.9%. Polypharmacy, Short Physical Performance Battery score of 8 points or less, and Falls Efficacy Scale International score of 20 points or more show an area under the curve of 0.78 (95% confidence interval: 0.67-0.89, p < 0.001) for recurrent falling.

The relationship of cervicothoracic mobility restrictions to fall risk and fear of falling in ankylosing spondylitis.

The objective of this study is to determine whether restricted cervical mobility in ankylosing spondylitis (AS) is associated with increased fall frequency or fear of falling. A total of 134 AS patients and 199 age- and gender-matched control subjects (CS) with soft-tissue cervicothoracic pain were prospectively evaluated for fall risk. Subjects were divided into non-fallers, single fallers, and multiple fallers. Dynamic cervical rotations and static cervicothoracic axial measurements were compared between the groups. In total, 88 AS patients were reviewed more than once; Kaplan-Meier plots were constructed for fall risk as a function of cervical rotation amplitudes. Falls Efficacy Scale-International (FES-I) questionnaire measured the fear of falling. In total, 34% of AS patients and 29% of CS fell (p = 0.271) in the year prior to evaluation. In AS, static anatomical measurements were unrelated to fall occurrence. The trends of multiple AS fallers to greater flexed forward postures and reduced dynamic cervical rotations were not statistically significant. Cervicothoracic pain (p = 0.0459), BASDAI (p = 0.002), and BASFI (p = 0.003) scores were greater in multiple fallers. FES-I scores were greater in fallers (p = 0.004). Of the 88 AS patients reviewed (or seen) on more than one occasion, 46.5% fell over the 9-year observation period, including all multiple fallers and 71.4% of single fallers. Survival curves showed increased fall risk as cervical rotational amplitudes decreased. In AS, decreased cervical rotations increase fall risk and fear of falling. In multiple fallers, falls were associated with greater disease activity. Cervical muscle stiffness in AS may cause non-veridical proprioceptive inputs and contribute to increased fall frequency similar to individuals with soft-tissue cervicothoracic pain.

Discrepancies in perception of fall risk between patients with subacute stroke and physical therapists in a rehabilitation hospital: a retrospective cohort study.

Objective: Falls are one of the most common complications of a stroke. This study aimed to clarify the discrepancy between the perceived fall risk of hospitalized patients with stroke and the clinical judgment of physical therapists and to examine the changes in discrepancy during hospitalization. Design: Retrospective cohort study. Patients: This study included 426 patients with stroke admitted to a Japanese convalescent rehabilitation hospital between January 2019 and December 2020. Methods: The Falls Efficacy Scale-International was used to assess both patients' and physical therapists' perception of fall risk. The difference in Falls Efficacy Scale-International scores assessed by patients and physical therapists was defined as the discrepancy in fall risk, and its association with the incidence of falls during hospitalization was investigated. Results: Patients had a lower perception of fall risk than physical therapists at admission (p < 0.001), and this trend continued at discharge (p < 0.001). The discrepancy in fall risk perception was reduced at discharge for non-fallers and single fallers (p < 0.001), whereas the difference remained in multiple fallers. Conclusion: Unlike physical therapists, patients underestimated their fall risk, especially patients who experienced multiple falls. These results may be useful for planning measures to prevent falls during hospitalization.

The correlation between falls efficacy and activities of daily living among older adults receiving different types of care: a 2018–2019 cross-sectional study in Shanghai, China

BackgroundFalls in older adults has become a significant public health concern worldwide. Falls-related self-efficacy is closely related to healthy aging. This study investigated older adults receiving different types of care to clarify the correlation between falls efficacy and Activies of Daily Living (ADL), providing a theoretical basis for achieving healthy aging.MethodsAn investigation comparing older adults attending senior day care centers and healthy older adults staying at home in the community was carried out by using structured questionnaires, including individual participants’ data, Falls Efficacy Scale International (FES-I), Patient Health Questionnaire-9, Generalized Anxiety Disorder Scale-7 and Lawton Instrumental Activities of Daily Living Scale (Lawton IADLs).ResultsA total of 336 older adults were enrolled, and 153 (45.5%) older adults attending senior day care centers daily. The FES-I score of all the respondents was 30.65 ± 13.892, while the scores of healthy older adults staying at home in the community and attending senior day care centers were 25.05 ± 10.036 and 37.35 ± 14.894, respectively (p < 0.05). Among healthy older adults staying at home in the community, those using walking aids (OR = 53.595, 95%CI: 8.181, 351.129), with fear of falling (OR = 5.909, 95%CI:1.374, 25.407) and with anxiety symptoms (OR = 23.620, 95%CI: 6.077, 91.802) had low falls efficacy. Among older adults attending senior day care centers daily, those with higher education levels had high falls efficacy (OR = 0.276, 95%CI: 0.088, 0.862), and those with poor sleep quality (OR = 4.469, 95%CI: 0.682, 29.312), comorbidities (OR = 9.820, 95%CI: 1.990, 48.456), and with severe depressive symptoms (OR = 3.680, 95%CI: 1.098, 12.335) had low falls efficacy. The older adults with a higher score of Lawton IADLs had higher falls efficacy.ConclusionsOlder adults attending senior day care centers daily had lower falls efficacy and needed to be paid more attention to in fall prevention. Targeted health promotion activities were necessary for older adults to improve their falls efficacy to achieve healthy aging.

Course of fear of falling after hip fracture: findings from a 12-month inception cohort

ObjectivesTo examine the course of fear of falling (FoF) up to 1 year after hip fracture, including the effect of prefracture FoF on the course.DesignObservational cohort study with assessment of...

Investigation of the relationship between trunk control and balance, gait, functional mobility, and fear of falling in people with Alzheimer's disease.

Optimal trunk control relies on adequate musculoskeletal, motor, and somatosensory systems that are often affected in people with Alzheimer's disease (AD). Therefore, the aim of this study was to compare trunk control between people with AD and healthy older adults, and investigate the relationship between trunk control and balance, gait, functional mobility, and fear of falling in people with AD. The study was completed with 35 people with AD and 33 healthy older adults with matching age and gender. Trunk control was evaluated with Trunk Impairment Scale (TIS); balance with Berg Balance Scale (BBS), Functional Reach Test (FRT), One-Leg Standing Test (OLST) and Five-Repeat Sit-and-Stand Test (5STS); gait with Dynamic Gait Index (DGI); functional mobility with Timed Up and Go (TUG) Test; fear of falling with Falls Efficacy Scale-International (FES-I). BBS, FRT, OLST, and DGI scores were lower and 5STS and TUG Test scores were higher in people with AD compared to healthy older adults (p < 0.05). There was no difference in FES-I score between people with AD and healthy older adults (p > 0.05). TIS was associated with BBS, FRT, OLST, 5STS, DGI, TUG Test, and FES-I (r between - 0.341 and 0.738; p < 0.05 for all). Trunk control is affected and related with balance, gait, functional mobility, and fear of falling in people with AD. For this reason, we think that trunk control should be evaluated in the early period, and applications for trunk control should be included in rehabilitation approaches in order to improve balance, gait, functional mobility, and reduce fear of falling.

Investigation of the Relationship Between BPPV with Anxiety, Sleep Quality and Falls.

To investigate the effects of dizziness on sleep quality and psychological status in patients with benign paroxysmal positional vertigo (BPPV) and to evaluate its relationship with falls. A Demographic Data Form, a Visual Vertigo Analog Scale, the Falls Efficacy Scale - International (FES-I), the Hospital Anxiety and Depression Scale (HADS), and the Pittsburgh Sleep Quality Index (PSQI) were administered in 102 individuals diagnosed with BPPV by videonystagmography test. The same scales were applied to 75 healthy volunteers as the control group, and the two groups were compared. The BPPV group was divided into two groups as posterior canal and lateral canal BPPV. These two groups were compared among themselves and with the control group. A statistically significant difference was found between the BPPV and control groups, the lateral canal BPPV and posterior canal BPPV groups, the lateral canal BPPV and control groups, and the posterior canal BPPV and control groups in terms of total scores of the PSQI, the FES-I, and the HADS (p<0.001). In the regression model, the FES-I score was fully explained by the PSQI and HADS scores (p<0.001). BPPV significantly affects sleep quality, psychological state, and the risk of fall. The negative effects of BPPV restrict daily living activities, affect the prognosis of the disease, and increase the risk of falling. Considering that psychiatric issues and sleep problems increase the risk of falling in individuals with BPPV, counseling services on this issue would reduce the incidence of falls and related injuries.

Clinical Effects of Outpatient Health Education on Fall Prevention and Self-health Management of Elderly Patients with Chronic Diseases.

Background Elderly patients with chronic diseases (CDs) have a higher predilection for falls, with more severe consequences once they fall. Therefore, it is necessary to explore an effective way to prevent falls in elderly patients with CDs. Objective To clarify the clinical effects of outpatient health education on fall prevention and self-health management in elderly patients with CDs. Methods This retrospective study enrolled 102 elderly patients with CDs who received treatment in the School of Medicine, Sir Run Run Shaw Hospital of Zhejiang University, between January 2019 and December 2020. Patients intervened by routine nursing were assigned to the regular group (n = 48), and those additionally treated with outpatient health education were included in the research group (n = 54). Assessment of patients' negative emotions (NEs) adopted the Self-Rating Anxiety/Depression Scale (SAS/SDS), determination of their sense of self-efficacy employed the Falls Efficacy Scale International (FES-I), and their self-care capacity evaluation used the Exercise of Self-Care Agency (ESCA). Patients' falls, hospitalization time, fall prevention knowledge, fall prevention-related health behavior, and nursing satisfaction were recorded. Results After the nursing intervention, lower SAS, SDS, and FES-I scores were determined in the research group versus the regular group; the total ESCA score assessed from various dimensions was higher in the research group; the research group also exhibited a markedly lower incidence of falls, and shorter hospitalization time than the regular group, with better mastery of fall prevention knowledge, fall prevention-related health behavior and nursing satisfaction. Conclusions Outpatient health education intervention can prevent senile patients with CDs from falling, promote their rehabilitation, and enhance their mastery of fall prevention knowledge; moreover, it can improve patients' healthy behaviors to prevent falls, mitigate their NEs, and improve their sense of self-efficacy and self-care ability, which has high clinical application value.

A quantitative assessment of the risk of falls in rheumatoid arthritis patients and determination of the risk factors.

Objectives The aim of this study was to compare the risk of falling in patients with rheumatoid arthritis (RA) to the healthy individuals and to identify the factors affecting the risk of falls. Patients and methods Between December 2015 and August 2016, a total of 100 consecutive patients with RA (16 males, 84 females; mean age: 49.5±11.1 years; range, 21 to 65 years) and 50 healthy controls (11 males, 39 females; mean age: 34.3±12.7 years; range, 19 to 63 years) were included in this prospective study. The fall risk was evaluated using the Tetrax Portable Balance System. The Health Assessment Questionnaire Disability Index (HAQ-DI), RA disease activity (Disease Activity Score 28 [DAS28], Clinical Disease Activity Index [CDAI], and Simple Disease Activity Index [SDAI]), and Falls Efficacy Scale International (FES-I) were applied to all participants. Results The fall risk scores and the FES-I scores were significantly higher in the patients with RA than the control group (p<0.001, p<0.001). A positive significant correlation was found between the Tetrax values of the patients and age, and the scores of the HAQ-DI, FES, DAS28, DAS28-C-reactive protein, CDAI and SDAI. Conclusion Our study results showed higher fall risk scores in patients with RA than healthy individuals an objective computerized technique, and this higher fall risk appeared to be affected by older age, disease activity, and disability.

Effectiveness of autonomous home hazard reduction on fear of falling in community-dwelling older women.

Many falls in older people occur at home, and home hazards (HOHA) are often involved. Fear of falling (FOF) is a frequent and serious consequence of falls. This study aimed to analyze the effectiveness of an autonomous reduction of HOHA on FOF. In this single-blinded, prospective cohort study design, the inclusion criteria were female sex, age ≥60 years, no known dementia, community-dwelling, and written informed consent. Using a 54-item room-by-room checklist, the participants identified and autonomously reduced as many HOHA as possible, within 14 days. The FOF was measured using a dichotomous scale (D-FOF) and the Falls Efficacy Scale International (FES-I). Logistic regression models were used to identify the predictors of a substantial reduction of HOHA (≥50%) and FOF (≥25%). A total of 782 women fulfilled the inclusion criteria, and 431 (60.5%) returned the complete checklist on time. The mean age was 72.5 [SD 7.1] years. 43.8% of participants reduced ≥50% of the HOHA. The D-FOF (odds ratio 22.4 [95% confidence interval 11.0-45.3]), age ≥ 75 years (14.1 [7.5-26.4]), polypharmacy (3.0 [1.4-6.5]), and assumed improvability of housing conditions (2.4 [1.3-4.3]) were identified as predictors for substantially reducing HOHA with an area under the curve of 0.91. The initial FES-I score decreased from 24.5 to 19.5. Prior to the intervention, 53.1% showed a high FOF (>22 FES-I scores). Of these, 70.7% participants reduced their high FOF to low FOF. 29.2% of all participants reduced FOF ≥25% postinterventionally, associated with a substantial reduction in HOHA (3.5 [2.2-5.7]) as the strongest independent factor in the multiple logistic regression analysis. The use of a self-administered checklist led to a substantial reduction of HOHA and subsequently to a clinically relevant reduction of FOF in older community-dwelling women. Autonomous competence of older people should be considered when developing fall prevention strategies.

Exploring the relationship between perceived susceptibility and severity of falling among older adults in Singapore

Introduction Despite extensive research about improving the effectiveness of falls prevention interventions, at-risk individuals are not always willing recipients. Reasons for rejecting treatments are still poorly understood. Applying the health belief model (HBM), if perceived severity and susceptibility can be understood in the context of falling, this might better inform intervention designs. Method Sixty-two participants were recruited from inpatient wards at a local acute hospital. Participants completed two self-report questionnaires, the Staying Independent Checklist (SIC) and the Falls Efficacy Scale – International (FES-I), measuring perceived susceptibility and severity respectively. Results One-way ANOVA analysis revealed a significant association between FES-I total scores and SIC score categories [ F (1,60) = 6.277, p = .015].Stepwise regression with backward elimination also found that falls history (β = .292, p = .033), sex (β = .269, p = .042), and FIM lower body dressing (β = − .286, p = .035) had significant associations with FES-I scores. Conclusion Level of perceived susceptibility and severity of falling should be considered when determining if falls prevention interventions are relevant, regardless of functional ability and physical health status. Future research to determine the underlying mechanisms which drives health behaviours related to falls prevention should be conducted.

Longitudinal Impact of Vision Impairment on Concern About Falling in People With Age-Related Macular Degeneration.

PurposeTo explore the longitudinal impact of central vision loss on concern about falling (CF), over a 12-month period, in people with age-related macular degeneration (AMD).MethodsParticipants included 60 community-dwelling older people (age, 79.7 ± 6.4 years) with central vision impairment due to AMD. Binocular high-contrast visual acuity, contrast sensitivity, and visual fields were assessed at baseline and at 12 months. CF was assessed at both time points using the Falls Efficacy Scale–International (FES-I). Sensorimotor function (sit to stand, knee extension, postural sway, and walking speed) and neuropsychological function (reaction time, symptoms of anxiety and depression) were also assessed at both time points using validated instruments. Falls data were collected using monthly diaries during the 12 months.ResultsCF increased by a small but significant amount over the 12-month follow-up (2.1 units; P = 0.01), with increasing prevalence of high levels of CF (FES-I score ≥ 23), from 48% at baseline to 65% at 12 months. Linear mixed models showed that reduced contrast sensitivity was significantly associated with increased concern about falling (P = 0.004), whereas declines in both visual acuity and contrast sensitivity during the follow-up period were associated with increases in CF over the 12-month follow-up (P = 0.041 and P = 0.054, respectively), independent of age, gender, falls history, or number of comorbidities.ConclusionsHigher levels of CF are common in older people with AMD, and levels increase over time; this increase is associated with declines in both visual acuity and contrast sensitivity. These findings highlight the need for regular assessment of both visual acuity and contrast sensitivity to identify those at greatest risk of developing higher CF.Translational RelevanceRoutine assessment of visual acuity and contrast sensitivity in older people with AMD will assist in identifying those at risk of developing high CF.

Fear of Falls and Related Factors in The Elderly Undergoing Dialysis Referred to Hospitals in Tehran 2021

Background and Objectives: The elderly patients undergoing hemodialysis are at higher risk for falling and its critical outcomes compared with their healthy counterparts. Falls can lead to the individual becoming fearful of experiencing subsequent falls. Yet little is known about the fear of falling in this high risk population. The present study aimed to assess the fear of falling and its contributing factors in the elderly patients with the history of falls undergoing hemodialysis, who referred to the hospitals in Tehran city in 2021 Methods: In this descriptive analytic cross sectional study, which was performed on 197 patients undergoing hemodialysis referring to Tehran city hospitals in 2021. Patients were selected with convenience sampling. The instruments for data collection was demographic characteristics scale, Falls Efficacy Scale-International (FES-I) . Data analysis was done by using descriptive and inferential tests and was shown via SPSS v.21 software. Results: Mean age of participants was 70.02‌±‌8.12 years and (63.5%) were men. Mean Falls Efficacy Scale-International Score was 35.29‌±‌13.54 points, which is consistent with a high fear of falling. There was consistency between adherence to fear of falling and demographic information (P&lt;‌0.05). Conclusion: According to the results, the frequency of fear of falling in the elderly patients with the history of falls undergoing hemodialysis was significantly high. In older hemodialysis patients, fear of falling is a likely contributor to the occurrence of falls. Future researches should explore reducing the fear of falling as a preventive factor for falls in elderly hemodialysis patients.

Effects of Fear of Falling on the Single-Step Threshold for Lateral Balance Recovery in Older Women.

Fear of falling is associated with poor physical health and influences postural stability during whole-body movement. The ability to recover from lateral balance loss is required to prevent falls; however, the relationship between lateral balance recovery and fear of falling has not been established. This study aimed to investigate whether fear of falling is associated with the stepping threshold for lateral balance recovery. This study included 56 ambulatory, community-dwelling women aged 65 years or older. We determined the single-step threshold as the maximum lean magnitude normalized with body weight from which participants could be suddenly released and still recover balance using a single side step. The short-form Falls Efficacy Scale International was used as a measure of fear of falling. The single-step threshold significantly correlated with age ( rs =-0.603) and the short-form Falls Efficacy Scale International score ( rs =-0.439). Ordinal regression analysis revealed that age (odds ratio, 0.826; 95% confidence interval, 0.742-0.920) and the short-form Falls Efficacy Scale International score (odds ratio, 0.811; 95% confidence interval, 0.680-0.966) were significantly associated with the single-step threshold, such that older age and greater fear of falling each independently predicted that failure to recover balance with a single step would occur at a lower percentage of body weight. Greater fear of falling was associated with reduced ability to recover from lateral balance loss in addition to aging. Future studies should explore whether evidence-based interventions to reduce fear of falling combined with perturbation training might lead to improved ability to recover from balance loss.

Evaluation of the Fear of Falling and Related Risk Factors in Elderly People from Hamadan, Iran: a Cross Sectional Study

Background/ purpose: older people are usually afraid of falling. The purpose of this study was to determine the fear of falling and underlying related risk factors among elderly people from Hamadan, Iran. Methods: A total of 321 elderly residents, aged 60 years and older, from 6 district heal th centers and 2 nursing homes were enrolled in this cross -sectional study. Fear of falling was evaluated by the Falls Efficacy Scale - International (FES-I) questionnaire, which contains 16 questions about different daily activities for elderly individuals. The study methods were compliant with the STROBE checklist. Data were analyzed with SPSS16 software. Results: The mean age of participants was 70± 7.46 years. We noted that 70% of participants had positive medical history of chronic diseases of which the most prevalent types were: osteoarthritis (63%), hypertension (42%) and diabetes (19%). The mean FES-I score was 27.83±9.87. The FES-I results indicated that 16.1% of participants had low fear of falling (score: 16-19), 37.6% had moderate fear (score: 20 -27), and 46.3% had severe fear (score: 28 -64). The fear of falling score in the study participants had a significant relationship with age, gender (female), living condition (alone), previous disease history and medication intake (all p values <0.05). Conclusions: The high mean FES-I score (27.83±9.83) alongside high proportion of moderate and severe fear of falling (83.9%) in this study indicates that elderly people from Hamadan, Iran are very concerned about falling. Fear of falling should be specificall y addressed for elderly people and the underlying risk factors should also be investigated.

The frequency and impact of undiagnosed benign paroxysmal positional vertigo in outpatients with high falls risk.

The frequency and impact of undiagnosed benign paroxysmal positional vertigo (BPPV) in people identified with high falls risk has not been investigated. To determine the frequency and impact on key psychosocial measures of undiagnosed BPPV in adult community rehabilitation outpatients identified with a high falls risk. A frequency study with cross-sectional design. A Community Rehabilitation Program in Melbourne, Australia. Adult community rehabilitation outpatients with a Falls Risk for Older People in the Community Screen score of four or higher. BPPV was assessed in 34 consecutive high falls risk rehabilitation outpatients using the Dix-Hallpike test and supine roll test. Participants were assessed for anxiety, depression, fear of falls, social isolation and loneliness using the Hospital Anxiety and Depression Scale, Falls Efficacy Scale-International and De Jong Gierveld 6-Item Loneliness Scale. A total of 18 (53%; 95% confidence interval: 36, 70) participants tested positive for BPPV. There was no significant difference between those who tested positive for BPPV and those who did not for Falls Risk for Older People in the Community Screen scores (P = 0.555), Hospital Anxiety and Depression Scale (Anxiety) scores (P = 0.627), Hospital Anxiety and Depression Scale (Depression) scores (P = 0.368) or Falls Efficacy Scale-International scores (P = 0.481). Higher scores for the De Jong Gierveld 6-Item Loneliness Scale in participants with BPPV did not reach significance (P = 0.056). Undiagnosed BPPV is very common and associated with a trend towards increased loneliness in adult rehabilitation outpatients identified as having a high falls risk.

Factors associated with fear of falling in hemodialysis patients.

Fear of falling (FOF) has important clinical and psychological consequences. This study evaluated the factors associated with FOF in hemodialysis patients and compared with the FOF reported by age-gender matched individuals without chronic kidney disease. This cross sectional study included hemodialysis group (n = 60, 55.4 ± 7.6years, 55.0% male) and control group (n = 40, 55.1 ± 7.5years, 52.5% male). FOF was assessed by the Falls Efficacy Scale International (FES-I). Physical function was evaluated using the Mini-Balance Evaluation Systems Test (Mini-BESTest), Timed Up and Go test, 4-m gait speed, isometric handgrip force and 10-repetition sit-to-stand test. The physical and mental components of quality of life was evaluated by 36-Item Short Form Health Survey. The FES-I score was higher in the hemodialysis group compared to the control group (28.2 ± 9.7 vs. 23.3 ± 5.1, p = 0.020). In addition, the prevalence of individuals with a higher concern about falling was greater in the hemodialysis group (41.7 vs. 17.5%, p = 0.033). Multiple linear regression showed that the FES-I score was associated with the Mini-BESTest score and the physical component summary of quality of life (coefficient of determination of 0.51 and an adjusted coefficient of determination of 0.46). FOF was associated with poor postural balance and reduced physical component of quality of life in patients on hemodialysis and these patients showed higher FOF compared to individuals without chronic kidney disease.

Examining the test-retest reliability and construct validity of the Six-Spot Step Test in older adults with self-reported balance problems

Objective: To evaluate the test-retest reliability and construct validity of the Six-Spot Step Test in older adults. Design: Cross-sectional study. Setting: Outpatient clinics. Subjects: Sixty-six adults aged ⩾65 years with self-reported balance problems. Main measure: The Six-Spot Step Test was completed twice on day 1. Three days later, the Six-Spot Step Test, the Timed “Up and Go” test, Dynamic Gait Index, the Mini-BESTest, and standing balance test were conducted. Reliability and validity were estimated using Bland-Altman statistics, minimal detectable change, Intraclass Correlation Coefficient (ICC), and Spearman’s rank correlation coefficient (ρ). Results: Participants had a mean (SD) age of 75.5 (6.6) years, a median (Q1–Q3) Montreal Cognitive Assessment test score of 26 (24–27), and a median (Q1–Q3) Falls Efficacy Scale International score of 22 (20–26). The study found within-day and between-day limits of agreements of ±15.7% and ±18.1%, respectively. The minimal detectable changes at the 95% level of confidence for within-day and between-day were 17.5% and 21.6%, and the ICCs were 0.96 (CI: 0.92–0.98) and 0.94 (CI: 0.86–0.97), respectively. A learning effect was observed between the first and second Six-Spot Step Test. Moderate to strong correlations were found between the Six-Spot Step Test and Mini-BESTest (ρ = −0.62), Dynamic Gait Index (ρ = −0.55), and the Timed “Up and Go” test (ρ = 0.79). Weak correlations were identified between the Six-Spot Step Test and static standing balance test (ρ < 0.38). Conclusion: The Six-Spot Step Test shows excellent relative consistency and moderate to high construct validity in older adults. A change of 21.6% is a true change in outcome.