Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, Illinois.
Department of Molecular and Cellular Biology, College of Liberal Arts & Sciences, University of Illinois at Urbana-Champaign, Urbana, Illinois.
Arch Phys Med Rehabil. 2021 Jan;102(1):132-154. doi: 10.1016/j.apmr.2020.06.025. Epub 2020 Jul 31.
To summarize the effectiveness of physical therapy interventions to reduce fear of falling (FOF) among individuals living with neurologic diseases.
PubMed, Physiotherapy Evidence Database, Scopus, Web of Science, PsycINFO, Cumulative Index to Nursing and Allied Health, and SportDiscuss were searched from inception until December 2019.
Clinical trials with either the primary or secondary aim to reduce FOF among adults with neurologic diseases were selected.
Potential articles were screened for eligibility, and data were extracted by 2 independent researchers. Risk of bias was assessed by the Cochrane Risk of Bias tool for randomized controlled trials and the National Institutes of Health Quality Assessment Tool for pre-post studies. A meta-analysis was performed among trials presenting with similar clinical characteristics. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) was used to rate the overall quality of evidence.
Sixty-one trials with 3954 participants were included in the review and 53 trials with 3524 participants in the meta-analysis. The included studies presented, in general, with a low to high risk of bias. A combination of gait and balance training was significantly more effective compared with gait training alone in reducing FOF among individuals with Parkinson disease (PD) (mean difference [MD]=11.80; 95% CI, 8.22-15.38; P<.001). Home-based exercise and leisure exercise demonstrated significant improvement in reducing FOF over usual care in multiple sclerosis (MS) (MD=15.27; 95% CI, 6.15-24.38; P=.001). No statistically significant between-groups differences were reported among individuals with stroke and spinal cord injury. The overall quality of evidence presented in this review ranges from very low to moderate according to the assessment with the GRADE approach.
Gait with lower limb training combined with balance training is effective in reducing FOF in individuals with PD. Also, home-based or leisure exercise is effective among individuals with MS. However, because of several limitations of the included studies, further research is needed to examine the effectiveness of FOF intervention among individuals with neurologic diseases.
总结物理治疗干预措施降低神经疾病患者跌倒恐惧（FOF）的效果。
从建库到 2019 年 12 月，PubMed、Physiotherapy Evidence Database、Scopus、Web of Science、PsycINFO、Cumulative Index to Nursing and Allied Health、SportDiscuss 等数据库均被检索。
选择以降低神经疾病成人 FOF 为主要或次要目标的临床试验。
由 2 名独立研究人员筛选潜在文章以评估其纳入资格，并提取数据。采用 Cochrane 偏倚风险工具评估随机对照试验的偏倚风险，采用 NIH 质量评估工具评估前后研究的偏倚风险。对具有相似临床特征的试验进行荟萃分析。采用推荐分级的评估、制定与评价（GRADE）方法评估证据的总体质量。
纳入 61 项研究，共 3954 名参与者；纳入 53 项研究，共 3524 名参与者。纳入研究的偏倚风险总体较低至较高。与单纯步态训练相比，步态与平衡训练相结合可显著降低帕金森病患者的 FOF（平均差值[MD]=11.80；95%置信区间，8.22-15.38；P<.001）。与常规护理相比，家庭锻炼和休闲锻炼在多发性硬化症患者中可显著降低 FOF（MD=15.27；95%置信区间，6.15-24.38；P=.001）。脑卒中患者和脊髓损伤患者之间未报告组间有统计学差异。采用 GRADE 方法评估，本研究证据的总体质量为低至中。
步态与下肢训练相结合的平衡训练可有效降低 PD 患者的 FOF。此外，家庭或休闲锻炼对多发性硬化症患者有效。然而，由于纳入研究的局限性，还需要进一步研究来检验神经疾病患者跌倒恐惧干预的效果。
