Parry Steve W, Deary Vincent, Finch Tracy, Bamford Claire, Sabin Neil, McMeekin Peter, O'Brien John, Caldwell Alma, Steen Nick, Whitney Susan L, Macdonald Claire, McColl Elaine
Institute for Ageing and Health, Newcastle University, c/o Falls and Syncope Service, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne NE1 4LP, UK.
Trials. 2014 Jun 6;15:210. doi: 10.1186/1745-6215-15-210.
Around 30% to 62% of older individuals fall each year, with adverse consequences of falls being by no means limited to physical injury and escalating levels of dependence. Many older individuals suffer from a variety of adverse psychosocial difficulties related to falling including fear, anxiety, loss of confidence and subsequent increasing activity avoidance, social isolation and frailty. Such 'fear of falling' is common and disabling, but definitive studies examining the effective management of the syndrome are lacking. Cognitive behavioural therapy has been trialed with some success in a group setting, but there is no adequately powered randomised controlled study of an individually based cognitive behavioural therapy intervention, and none using non-mental health professionals to deliver the intervention.
METHODS/DESIGN: We are conducting a two-phase study examining the role of individual cognitive behavioural therapy delivered by healthcare assistants in improving fear of falling in older adults. In Phase I, the intervention was developed and taught to healthcare assistants, while Phase II is the pragmatic randomised controlled study examining the efficacy of the intervention in improving fear of falling in community-dwelling elders attending falls services. A qualitative process evaluation study informed by Normalization Process Theory is being conducted throughout to examine the potential promoters and inhibitors of introducing such an intervention into routine clinical practice, while a health economic sub-study running alongside the trial is examining the costs and benefits of such an approach to the wider health economy.
Current Controlled Trials ISRCTN78396615.
每年约30%至62%的老年人会跌倒，跌倒的不良后果绝不仅限于身体损伤，还包括依赖性不断增加。许多老年人因跌倒遭受各种不良的心理社会问题，包括恐惧、焦虑、信心丧失以及随后活动回避增加、社会隔离和身体虚弱。这种“跌倒恐惧”很常见且会导致残疾，但缺乏关于该综合征有效管理的权威研究。认知行为疗法在团体环境中进行了试验并取得了一些成功，但尚无足够样本量的基于个体的认知行为疗法干预随机对照研究，也没有使用非心理健康专业人员进行干预的研究。
方法/设计：我们正在开展一项两阶段研究，考察由医疗保健助理提供的个体认知行为疗法在改善老年人跌倒恐惧方面的作用。在第一阶段，开发干预措施并教授给医疗保健助理，而第二阶段是一项实用随机对照研究，考察该干预措施对改善参加跌倒服务的社区居住老年人跌倒恐惧的疗效。同时正在进行一项基于规范化过程理论的定性过程评估研究，以考察将这种干预措施引入常规临床实践的潜在促进因素和抑制因素，而在试验进行的同时开展的一项卫生经济学子研究正在考察这种方法对更广泛卫生经济的成本和效益。
当前受控试验ISRCTN78396615。
