Zijlstra G A Rixt, van Haastregt Jolanda C M, van Rossum Erik, van Eijk Jacques Th M, Yardley Lucy, Kempen Gertrudis I J M
Department of Health Care Studies, Maastricht University, Maastricht, The Netherlands.
J Am Geriatr Soc. 2007 Apr;55(4):603-15. doi: 10.1111/j.1532-5415.2007.01148.x.
The objective was to assess which interventions effectively reduce fear of falling in community-living older people. An extensive search for relevant literature comprised a database search of PubMed, EMBASE, PsycINFO, and the Cochrane Central Register of Controlled Trials; expert consultation; and manually searching reference lists from potentially relevant papers. Randomized, controlled trials that assessed fear of falling in community-living older people were included. Two independent reviewers extracted data from full papers on study characteristics, methodological quality, outcomes, and process characteristics of the intervention. The search identified 599 abstracts, and 19 papers met the inclusion criteria. Seven of those papers were identified using expert consultation. Fifty-five percent of all validity items and 39% of process characteristic items were fulfilled across the 19 trials. Twelve of the 19 papers were of higher methodological quality. In 11 of these trials, fear of falling was lower in the intervention group than in the control group. Interventions that showed effectiveness were fall-related multifactorial programs (n=5), tai chi interventions (n=3), exercise interventions (n=2), and a hip protector intervention (n=1). Three of these interventions explicitly aimed to reduce fear of falling. Several interventions, including interventions not explicitly aimed at fear of falling, resulted in a reduction of fear of falling in community-living older people. Limited but fairly consistent findings in trials of higher methodological quality showed that home-based exercise and fall-related multifactorial programs and community-based tai chi delivered in group format have been effective in reducing fear of falling in community-living older people.
目的是评估哪些干预措施能有效降低社区居住老年人的跌倒恐惧。对相关文献进行广泛检索，包括在PubMed、EMBASE、PsycINFO和Cochrane对照试验中央注册库进行数据库检索；专家咨询；以及手动检索潜在相关论文的参考文献列表。纳入评估社区居住老年人跌倒恐惧的随机对照试验。两名独立评审员从全文中提取有关研究特征、方法学质量、结果和干预措施过程特征的数据。检索共识别出599篇摘要，19篇论文符合纳入标准。其中7篇论文是通过专家咨询确定的。在这19项试验中，所有有效性项目的55%和过程特征项目的39%得到了满足。19篇论文中有12篇方法学质量较高。在其中11项试验中，干预组的跌倒恐惧低于对照组。显示有效的干预措施包括与跌倒相关的多因素项目（n = 5）、太极拳干预（n = 3）、运动干预（n = 2）和髋部保护器干预（n = 1）。其中三项干预措施明确旨在降低跌倒恐惧。包括一些并非明确针对跌倒恐惧的干预措施在内，有几项干预措施使得社区居住老年人的跌倒恐惧有所降低。方法学质量较高的试验中有一些有限但相当一致的研究结果表明，以家庭为基础的运动、与跌倒相关的多因素项目以及以小组形式开展的社区太极拳对降低社区居住老年人的跌倒恐惧有效。
