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Erschienen in: International Journal of Behavioral Medicine 3/2023

02.06.2022 | Brief Report

A Self-Guided Online Cognitive Behavioural Therapy to Reduce Fear of Falling in Older People: a Randomised Controlled Trial

verfasst von: Mei Ling Lim, Mymy Tran, Kimberley S. van Schooten, Kylie A. Radford, Bridianne O’Dea, Peter Baldwin, Kim Delbaere

Erschienen in: International Journal of Behavioral Medicine | Ausgabe 3/2023

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Abstract

Background

Traditional face-to-face cognitive behavioural therapy (CBT) has been successful at reducing fear of falling (FOF) in older people but can be labour-intensive and costly. Online CBT has been suggested as a cost-effective alternative but has not yet been tested in the context of FOF. This study evaluates the effectiveness of a readily available, self-guided and generalised online CBT program (myCompass) on reducing FOF in older people.

Methods

Fifty community-dwelling older people with FOF received a paper-based health education program, and half were randomly assigned to receive three selected modules from myCompass for 6 weeks. The primary outcome was feared consequences of falling at 6 weeks. Secondary outcomes were concern about falling, balance confidence, activity avoidance, physical activity, exercise self-efficacy, health literacy and mental health at 6/26/52 weeks and falls incidence at 12 months.

Results

All intervention participants completed at least 2-out-of-3 myCompass modules. There was a significant main effect of time on feared consequences of falling (Cohen’s f = 0.55). The group by time interactions for concern about falling (f = 0.28), stress (f = 0.26) and social support for health (health literacy) (f = 0.26) was also significant, favouring the control group. The overall attrition rate at 12 months was 24% (n = 12).

Conclusion

The high program compliance and low attrition rate suggest that online CBT is feasible among older people. However, the myCompass program had no effect at reducing FOF in older people. A more targeted CBT program with a well-integrated psychoeducation module on FOF might be the solution to boost the therapeutic effects of a generalised CBT program at reducing FOF for older people.
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Literatur
1.
Zurück zum Zitat Tinetti ME, Powell L. Fear of falling and low self-efficacy: a case of dependence in elderly persons. J Gerontol. 1993;48:35–8.CrossRefPubMed Tinetti ME, Powell L. Fear of falling and low self-efficacy: a case of dependence in elderly persons. J Gerontol. 1993;48:35–8.CrossRefPubMed
2.
Zurück zum Zitat Delbaere K, Crombez G, van Haastregt JCM, Vlaeyen JWS. Falls and catastrophic thoughts about falls predict mobility restriction in community-dwelling older people: a structural equation modelling approach. Aging Ment Health. 2009;13:587–92.CrossRefPubMed Delbaere K, Crombez G, van Haastregt JCM, Vlaeyen JWS. Falls and catastrophic thoughts about falls predict mobility restriction in community-dwelling older people: a structural equation modelling approach. Aging Ment Health. 2009;13:587–92.CrossRefPubMed
3.
Zurück zum Zitat Zijlstra GAR, van Haastregt JCM, van Eijk JTM, van Rossum E, Stalenhoef PA, Kempen GIJM. Prevalence and correlates of fear of falling, and associated avoidance of activity in the general population of community-living older people. Age Ageing. 2007;36:304–9.CrossRefPubMed Zijlstra GAR, van Haastregt JCM, van Eijk JTM, van Rossum E, Stalenhoef PA, Kempen GIJM. Prevalence and correlates of fear of falling, and associated avoidance of activity in the general population of community-living older people. Age Ageing. 2007;36:304–9.CrossRefPubMed
4.
Zurück zum Zitat Delbaere K, Crombez G, Vanderstraeten G, Willems T, Cambier D. Fear-related avoidance of activities, falls and physical frailty. A prospective community-based cohort study. Age and Ageing. 2004;33:368–73. Delbaere K, Crombez G, Vanderstraeten G, Willems T, Cambier D. Fear-related avoidance of activities, falls and physical frailty. A prospective community-based cohort study. Age and Ageing. 2004;33:368–73.
5.
Zurück zum Zitat Jefferis BJ, Iliffe S, Kendrick D, Kerse N, Trost S, Lennon LT, et al. How are falls and fear of falling associated with objectively measured physical activity in a cohort of community-dwelling older men? BMC geriatrics. 2014;14. Jefferis BJ, Iliffe S, Kendrick D, Kerse N, Trost S, Lennon LT, et al. How are falls and fear of falling associated with objectively measured physical activity in a cohort of community-dwelling older men? BMC geriatrics. 2014;14.
6.
Zurück zum Zitat Scheffer AC, Schuurmans MJ, van Dijk N, van der Hooft T, de Rooij SE. Fear of falling: measurement strategy, prevalence, risk factors and consequences among older persons. Age Ageing. 2008;37:19–24.CrossRefPubMed Scheffer AC, Schuurmans MJ, van Dijk N, van der Hooft T, de Rooij SE. Fear of falling: measurement strategy, prevalence, risk factors and consequences among older persons. Age Ageing. 2008;37:19–24.CrossRefPubMed
7.
Zurück zum Zitat Lim ML, Radford K, van Schooten K, Hadjistavropoulos T, Everett B, Zijlstra R, Delbaere K. Theoretical framework of concern about falling in older people: the role of health literacy. Manuscript submitted for publication. 2022. Lim ML, Radford K, van Schooten K, Hadjistavropoulos T, Everett B, Zijlstra R, Delbaere K. Theoretical framework of concern about falling in older people: the role of health literacy. Manuscript submitted for publication. 2022.
8.
Zurück zum Zitat Delbaere K, Close JCT, Brodaty H, Sachdev P, Lord SR. Determinants of disparities between perceived and physiological risk of falling among elderly people: cohort study. BMJ. 2010;341: c4165.CrossRefPubMedPubMedCentral Delbaere K, Close JCT, Brodaty H, Sachdev P, Lord SR. Determinants of disparities between perceived and physiological risk of falling among elderly people: cohort study. BMJ. 2010;341: c4165.CrossRefPubMedPubMedCentral
9.
Zurück zum Zitat Payette M-C, Bélanger C, Léveillé V, Grenier S. Fall-related psychological concerns and anxiety among community-dwelling older adults: systematic review and meta-analysis. PLoS ONE. 2016;11: e0152848.CrossRefPubMedPubMedCentral Payette M-C, Bélanger C, Léveillé V, Grenier S. Fall-related psychological concerns and anxiety among community-dwelling older adults: systematic review and meta-analysis. PLoS ONE. 2016;11: e0152848.CrossRefPubMedPubMedCentral
10.
Zurück zum Zitat Liu T-W, Ng GYF, Chung RCK, Ng SSM. Cognitive behavioural therapy for fear of falling and balance among older people: a systematic review and meta-analysis. Age Ageing. 2018;47:520–7.CrossRefPubMed Liu T-W, Ng GYF, Chung RCK, Ng SSM. Cognitive behavioural therapy for fear of falling and balance among older people: a systematic review and meta-analysis. Age Ageing. 2018;47:520–7.CrossRefPubMed
11.
Zurück zum Zitat Kendrick D, Kumar A, Carpenter H, Zijlstra GAR, Skelton DA, Cook JR, et al. Exercise for reducing fear of falling in older people living in the community. Cochrane Database Syst Rev. 2014. Kendrick D, Kumar A, Carpenter H, Zijlstra GAR, Skelton DA, Cook JR, et al. Exercise for reducing fear of falling in older people living in the community. Cochrane Database Syst Rev. 2014.
12.
Zurück zum Zitat Dorresteijn TAC, Zijlstra GAR, Ambergen AW, Delbaere K, Vlaeyen JWS, Kempen GIJM. Effectiveness of a home-based cognitive behavioral program to manage concerns about falls in community-dwelling, frail older people: results of a randomized controlled trial. BMC geriatrics. 2016;16:2. Dorresteijn TAC, Zijlstra GAR, Ambergen AW, Delbaere K, Vlaeyen JWS, Kempen GIJM. Effectiveness of a home-based cognitive behavioral program to manage concerns about falls in community-dwelling, frail older people: results of a randomized controlled trial. BMC geriatrics. 2016;16:2.
13.
Zurück zum Zitat Yardley L, Smith H. A prospective study of the relationship between feared consequences of falling and avoidance of activity in community-living older people. Gerontologist. 2002;42:17–23.CrossRefPubMed Yardley L, Smith H. A prospective study of the relationship between feared consequences of falling and avoidance of activity in community-living older people. Gerontologist. 2002;42:17–23.CrossRefPubMed
14.
Zurück zum Zitat Dear BF, Zou JB, Ali S, Lorian CN, Johnston L, Terides MD, et al. Examining self-guided internet-delivered cognitive behavior therapy for older adults with symptoms of anxiety and depression: two feasibility open trials. Internet Interv. 2015;2:17–23.CrossRef Dear BF, Zou JB, Ali S, Lorian CN, Johnston L, Terides MD, et al. Examining self-guided internet-delivered cognitive behavior therapy for older adults with symptoms of anxiety and depression: two feasibility open trials. Internet Interv. 2015;2:17–23.CrossRef
15.
Zurück zum Zitat Hobbs MJ, Joubert AE, Mahoney AEJ, Andrews G. Treating late-life depression: comparing the effects of internet-delivered cognitive behavior therapy across the adult lifespan. J Affect Disord. 2018;226:58–65.CrossRefPubMed Hobbs MJ, Joubert AE, Mahoney AEJ, Andrews G. Treating late-life depression: comparing the effects of internet-delivered cognitive behavior therapy across the adult lifespan. J Affect Disord. 2018;226:58–65.CrossRefPubMed
16.
Zurück zum Zitat Proudfoot J, Clarke J, Birch M-R, Whitton AE, Parker G, Manicavasagar V, et al. Impact of a mobile phone and web program on symptom and functional outcomes for people with mild-to-moderate depression, anxiety and stress: a randomised controlled trial. BMC psychiatry. 2013;13:312. Proudfoot J, Clarke J, Birch M-R, Whitton AE, Parker G, Manicavasagar V, et al. Impact of a mobile phone and web program on symptom and functional outcomes for people with mild-to-moderate depression, anxiety and stress: a randomised controlled trial. BMC psychiatry. 2013;13:312.
17.
Zurück zum Zitat Pfeiffer E. A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients†. J Am Geriatr Soc. 1975;23:433–41.CrossRefPubMed Pfeiffer E. A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients†. J Am Geriatr Soc. 1975;23:433–41.CrossRefPubMed
19.
Zurück zum Zitat Delbaere K, Valenzuela T, Lord SR, Clemson L, Zijlstra GAR, Close JCT, et al. E-health standingtall balance exercise for fall prevention in older people: results of a two year randomised controlled trial. BMJ. 2021;373: n740.CrossRefPubMedPubMedCentral Delbaere K, Valenzuela T, Lord SR, Clemson L, Zijlstra GAR, Close JCT, et al. E-health standingtall balance exercise for fall prevention in older people: results of a two year randomised controlled trial. BMJ. 2021;373: n740.CrossRefPubMedPubMedCentral
20.
Zurück zum Zitat Lord SR, Menz HB, Tiedemann A. A physiological profile approach to falls risk assessment and prevention. Phys Ther. 2003;83:237–52. Lord SR, Menz HB, Tiedemann A. A physiological profile approach to falls risk assessment and prevention. Phys Ther. 2003;83:237–52.
21.
Zurück zum Zitat Lord SR, Ward JA, Williams P. Exercise effect on dynamic stability in older women: a randomized controlled trial. Arch Phys Med Rehabil. 1996;77:232–6. Lord SR, Ward JA, Williams P. Exercise effect on dynamic stability in older women: a randomized controlled trial. Arch Phys Med Rehabil. 1996;77:232–6.
22.
Zurück zum Zitat Reed JC, Reed HBC. The Halstead—Reitan neuropsychological battery. In: Goldstein G, Incagnoli TM, editors. Contemporary approaches to neuropsychological assessment. Boston, MA: Springer, US; 1997. p. 93–129.CrossRef Reed JC, Reed HBC. The Halstead—Reitan neuropsychological battery. In: Goldstein G, Incagnoli TM, editors. Contemporary approaches to neuropsychological assessment. Boston, MA: Springer, US; 1997. p. 93–129.CrossRef
23.
Zurück zum Zitat Costa P, McCrae R. The NEO™ Inventories: NEO™ Five Factor Inventory-3 (NEO™-FFI-3): PAR; 2010. Costa P, McCrae R. The NEO™ Inventories: NEO™ Five Factor Inventory-3 (NEO™-FFI-3): PAR; 2010.
24.
Zurück zum Zitat Delbaere K, T. Smith S, Lord SR. Development and initial validation of the iconographical falls efficacy scale. J Gerontol Series A. 2011;66A:674–80. Delbaere K, T. Smith S, Lord SR. Development and initial validation of the iconographical falls efficacy scale. J Gerontol Series A. 2011;66A:674–80.
25.
Zurück zum Zitat Powell LE, Myers AM. The activities-specific balance confidence (ABC) scale. J Gerontol A Biol Sci Med Sci. 1995;50:M28–34.CrossRef Powell LE, Myers AM. The activities-specific balance confidence (ABC) scale. J Gerontol A Biol Sci Med Sci. 1995;50:M28–34.CrossRef
26.
Zurück zum Zitat Lachman ME, Howland J, Tennstedt S, Jette A, Assmann S, Peterson EW. Fear of falling and activity restriction: the survey of activities and fear of falling in the elderly (SAFE). The Journals of Gerontology: Series B. 1998;53B:P43–50.CrossRef Lachman ME, Howland J, Tennstedt S, Jette A, Assmann S, Peterson EW. Fear of falling and activity restriction: the survey of activities and fear of falling in the elderly (SAFE). The Journals of Gerontology: Series B. 1998;53B:P43–50.CrossRef
27.
Zurück zum Zitat Delbaere K, Hauer K, Lord SR. Evaluation of the incidental and planned activity questionnaire for older people. Br J Sports Med. 2010;44:1029–34.CrossRefPubMed Delbaere K, Hauer K, Lord SR. Evaluation of the incidental and planned activity questionnaire for older people. Br J Sports Med. 2010;44:1029–34.CrossRefPubMed
28.
Zurück zum Zitat Everett B, Salamonson Y, Davidson PM. Bandura’s exercise self-efficacy scale: validation in an Australian cardiac rehabilitation setting. Int J Nurs Stud. 2009;46:824–9.CrossRefPubMed Everett B, Salamonson Y, Davidson PM. Bandura’s exercise self-efficacy scale: validation in an Australian cardiac rehabilitation setting. Int J Nurs Stud. 2009;46:824–9.CrossRefPubMed
29.
Zurück zum Zitat Osborne RH, Batterham RW, Elsworth GR, Hawkins M, Buchbinder R. The grounded psychometric development and initial validation of the health literacy questionnaire (HLQ). BMC Public Health. 2013;13:658.CrossRefPubMedPubMedCentral Osborne RH, Batterham RW, Elsworth GR, Hawkins M, Buchbinder R. The grounded psychometric development and initial validation of the health literacy questionnaire (HLQ). BMC Public Health. 2013;13:658.CrossRefPubMedPubMedCentral
30.
Zurück zum Zitat Lovibond SH, Lovibond PF. Manual for the depression anxiety stress scales. 2nd ed. Sydney: Psychology Foundation of Australia; 1995. Lovibond SH, Lovibond PF. Manual for the depression anxiety stress scales. 2nd ed. Sydney: Psychology Foundation of Australia; 1995.
31.
Zurück zum Zitat van Schooten KS, Rispens SM, Elders PJM, Lips P, van Dieën JH, Pijnappels M. Assessing physical activity in older adults: required days of trunk accelerometer measurements for reliable estimation. J Aging Phys Act. 2015;23:9–17. van Schooten KS, Rispens SM, Elders PJM, Lips P, van Dieën JH, Pijnappels M. Assessing physical activity in older adults: required days of trunk accelerometer measurements for reliable estimation. J Aging Phys Act. 2015;23:9–17.
32.
Zurück zum Zitat Zijlstra GA, van Haastregt JC, Ambergen T, van Rossum E, van Eijk JT, Tennstedt SL, et al. Effects of a multicomponent cognitive behavioral group intervention on fear of falling and activity avoidance in community-dwelling older adults: results of a randomized controlled trial. J Am Geriatr Soc. 2009;57:2020–8.CrossRefPubMed Zijlstra GA, van Haastregt JC, Ambergen T, van Rossum E, van Eijk JT, Tennstedt SL, et al. Effects of a multicomponent cognitive behavioral group intervention on fear of falling and activity avoidance in community-dwelling older adults: results of a randomized controlled trial. J Am Geriatr Soc. 2009;57:2020–8.CrossRefPubMed
33.
Zurück zum Zitat Little RJA. A test of missing completely at random for multivariate data with missing values. J Am Stat Assoc. 1988;83:1198–202.CrossRef Little RJA. A test of missing completely at random for multivariate data with missing values. J Am Stat Assoc. 1988;83:1198–202.CrossRef
34.
Zurück zum Zitat Dempster AP, Laird NM, Rubin DB. Maximum likelihood from incomplete data via the EM algorithm. J Roy Stat Soc: Ser B (Methodol). 1977;39:1–38. Dempster AP, Laird NM, Rubin DB. Maximum likelihood from incomplete data via the EM algorithm. J Roy Stat Soc: Ser B (Methodol). 1977;39:1–38.
35.
Zurück zum Zitat Cohen J. Statistical power analysis for the behavioral sciences. New York: NY: Routledge Academic; 1988. Cohen J. Statistical power analysis for the behavioral sciences. New York: NY: Routledge Academic; 1988.
36.
Zurück zum Zitat Schulz KF, Altman DG, Moher D, the CG. CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. BMC Med. 2010;(8):18. Schulz KF, Altman DG, Moher D, the CG. CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. BMC Med. 2010;(8):18.
37.
Zurück zum Zitat Chua CHM, Jiang Y, Lim DS, et al. Effectiveness of cognitive behaviour therapy-based multicomponent interventions on fear of falling among community-dwelling older adults: a systematic review and meta-analysis. J Adv Nurs. 2019;75:3299–315.CrossRefPubMed Chua CHM, Jiang Y, Lim DS, et al. Effectiveness of cognitive behaviour therapy-based multicomponent interventions on fear of falling among community-dwelling older adults: a systematic review and meta-analysis. J Adv Nurs. 2019;75:3299–315.CrossRefPubMed
38.
Zurück zum Zitat Kruisbrink M, Delbaere K, Kempen GIJM, et al. Intervention characteristics associated with a reduction in fear of falling among community-dwelling older people: a systematic review and meta-analysis of randomized controlled trials. Gerontologist. 2021;61:e269–82.CrossRefPubMed Kruisbrink M, Delbaere K, Kempen GIJM, et al. Intervention characteristics associated with a reduction in fear of falling among community-dwelling older people: a systematic review and meta-analysis of randomized controlled trials. Gerontologist. 2021;61:e269–82.CrossRefPubMed
39.
Zurück zum Zitat Tennstedt S, Howland J, Lachman M, Peterson E, Kasten L, Jette A. A randomized, controlled trial of a group intervention to reduce fear of falling and associated activity restriction in older adults. The Journals of Gerontology: Series B. 1998;53B:P384–92.CrossRef Tennstedt S, Howland J, Lachman M, Peterson E, Kasten L, Jette A. A randomized, controlled trial of a group intervention to reduce fear of falling and associated activity restriction in older adults. The Journals of Gerontology: Series B. 1998;53B:P384–92.CrossRef
40.
Zurück zum Zitat Lim ML, van Schooten KS, Radford KS, Menant J, Lord SR, Sachdev PS, et al. The iconographical falls efficacy scale (IconFES) in community-dwelling older people – a longitudinal validation study. Age Ageing. 2021;50:822–9.CrossRefPubMed Lim ML, van Schooten KS, Radford KS, Menant J, Lord SR, Sachdev PS, et al. The iconographical falls efficacy scale (IconFES) in community-dwelling older people – a longitudinal validation study. Age Ageing. 2021;50:822–9.CrossRefPubMed
41.
Zurück zum Zitat Kazantzis N, Whittington C, Zelencich L, Kyrios M, Norton PJ, Hofmann SG. Quantity and quality of homework compliance: a meta-analysis of relations with outcome in cognitive behavior therapy. Behav Ther. 2016;47:755–72.CrossRefPubMed Kazantzis N, Whittington C, Zelencich L, Kyrios M, Norton PJ, Hofmann SG. Quantity and quality of homework compliance: a meta-analysis of relations with outcome in cognitive behavior therapy. Behav Ther. 2016;47:755–72.CrossRefPubMed
42.
Zurück zum Zitat Mausbach BT, Moore R, Roesch S, Cardenas V, Patterson TL. The relationship between homework compliance and therapy outcomes: an updated meta-analysis. Cogn Ther Res. 2010;34:429–38.CrossRef Mausbach BT, Moore R, Roesch S, Cardenas V, Patterson TL. The relationship between homework compliance and therapy outcomes: an updated meta-analysis. Cogn Ther Res. 2010;34:429–38.CrossRef
43.
Zurück zum Zitat Mennin DS, Ellard KK, Fresco DM, Gross JJ. United we stand: emphasizing commonalities across cognitive-behavioral therapies. Behav Ther. 2013;44:234–48.CrossRefPubMedPubMedCentral Mennin DS, Ellard KK, Fresco DM, Gross JJ. United we stand: emphasizing commonalities across cognitive-behavioral therapies. Behav Ther. 2013;44:234–48.CrossRefPubMedPubMedCentral
Metadaten
Titel
A Self-Guided Online Cognitive Behavioural Therapy to Reduce Fear of Falling in Older People: a Randomised Controlled Trial
verfasst von
Mei Ling Lim
Mymy Tran
Kimberley S. van Schooten
Kylie A. Radford
Bridianne O’Dea
Peter Baldwin
Kim Delbaere
Publikationsdatum
02.06.2022
Verlag
Springer US
Erschienen in
International Journal of Behavioral Medicine / Ausgabe 3/2023
Print ISSN: 1070-5503
Elektronische ISSN: 1532-7558
DOI
https://doi.org/10.1007/s12529-022-10105-6

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