Fear of Falling Avoidance Behavior in Parkinson’s Disease: Most Frequently Avoided Activities

Abstract

Background:

Fear of falling avoidance behavior (FFAB) is common in Parkinson’s disease (PD).

Objectives:

The objectives of the study are to determine what activities are most avoided due to FFAB among people with PD and whether any associations exist with demographic factors or fall history.

Method:

Cross-sectional analysis of 174 individuals with PD using the Modified FFAB Questionnaire.

Results:

Walking in dimly lit, unfamiliar places, and different surfaces, lifting and carrying objects, walking in crowded places, recreational/leisure activities, and going up/downstairs were most avoided. Fallers reported more FFAB (ps < .029). FFAB for certain activities was associated with increased or decreased odds of falling.

Conclusion:

Individuals with PD avoid walking in compromised situations and engaging in recreational/leisure activities due to FFAB. While excessive FFAB may increase the odds of falling, protective forms may be associated with decreased odds. Targeting FFAB among individuals with PD may increase safe participation in meaningful occupations in the home and community.

Keywords

rehabilitation occupational therapy participation community mobility occupational engagement

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References

Allen

N. E.

Schwarzel

A. K.

Canning

C. G.

(2013). Recurrent falls in Parkinson’s disease: A systematic review. Parkinson’s Disease, 2013, 906274. https://doi.org/10.1155/2013/906274

Ashburn

Stack

Ballinger

Fazakarley

Fitton

(2008). The circumstances of falls among people with Parkinson’s disease and the use of falls diaries to facilitate reporting. Disability and Rehabilitation, 30(16), 1205–1212. https://doi.org/10.1080/09638280701828930

Bloem

Hausdorff

Visser

Giladi

(2004). Falls and freezing of gait in Parkinson’s disease: A review of two interconnected, episodic phenomena. Movement Disorders, 19(8), 871–884. https://doi.org/10.1002/mds.20115

Bryant

M. S.

Rintala

D. H.

Hou

J.-G.

Protas

E. J.

(2014). Influence of fear of falling on gait and balance in Parkinson’s disease. Disability and Rehabilitation, 36(9), 744–748. https://doi.org/10.3109/09638288.2013.814722

Dorsey

E. R.

Sherer

Okun

M. S.

Bloem

B. R.

(2018). The emerging evidence of the Parkinson pandemic. Journal of Parkinson’s Disease, 8(s1), S3–S8. https://doi.org/10.3233/jpd-181474

Ellingson

L. D.

Zaman

Stegemöller

E. L.

(2019). Sedentary behavior and quality of life in individuals with Parkinson’s disease. Neurorehabilitation and Neural Repair, 33(8), 595–601. https://doi.org/10.1177/1545968319856893

Foongsathaporn

Panyakaew

Jitkritsadakul

Bhidayasiri

(2016). What daily activities increase the risk of falling in Parkinson patients? An analysis of the utility of the ABC-16 scale. Journal of Neurological Sciences, 364, 183–187. https://doi.org/10.1016/j.jns.2016.03.037

Hoops

Nazem

Siderowf

A. D.

Duda

J. E.

Xie

S. X.

Stern

M. B.

Weintraub

(2009). Validity of the MoCA and MMSE in the detection of MCI and dementia in Parkinson disease. Neurology, 73(21), 1738–1745. https://doi.org/10.1212/WNL.0b013e3181c34b47

Howland

Peterson

E. W.

Levin

W. C.

Fried

Pordon

Bak

(1993). Fear of falling among the community-dwelling elderly. Journal of Aging and Health, 5(2), 229–243. https://doi.org/10.1177/089826439300500205

10.

Jankovic

(2008). Parkinson’s disease: Clinical features and diagnosis. Journal of Neurology, Neurosurgery and Psychiatry, 79(4), 368–376. https://doi.org/10.1136/jnnp.2007.131045

11.

Jonasson

S. B.

Nilsson

M. H.

Lexell

Carlsson

(2018). Experiences of fear of falling in persons with Parkinson’s disease—A qualitative study. BMC Geriatrics, 18(1), Article 44. https://doi.org/10.1186/s12877-018-0735-1

12.

Kader

Iwarsson

Odin

Nilsson

M. H.

(2016). Fall-related activity avoidance in relation to a history of falls or near falls, fear of falling and disease severity in people with Parkinson’s disease. BMC Neurology, 16, Article 84. https://doi.org/10.1186/s12883-016-0612-5

13.

Kelly

V. E.

Eusterbrock

A. J.

Shumway-Cook

(2012). A review of dual-task walking deficits in people with Parkinson’s disease: Motor and cognitive contributions, mechanisms, and clinical implications. Parkinson’s Disease, 2012, 918719. https://doi.org/10.1155/2012/918719

14.

Lachman

M. E.

Howland

Tennstedt

Jette

Assmann

Peterson

E. W.

(1998). Fear of falling and activity restriction: The survey of activities and fear of falling in the elderly (SAFE). The Journals of Gerontology: Series B, Psychological Sciences and Social Sciences, 53B(1), P43–P50. https://doi.org/10.1093/geronb/53b.1.p43

15.

Landers

M. R.

Durand

Powell

D. S.

Dibble

L. E.

Young

D. L.

(2011). Development of a scale to assess avoidance behavior due to a fear of falling: The fear of falling avoidance behavior questionnaire. Physical Therapy, 91(8), 1253–1265. https://doi.org/10.2522/ptj.20100304

16.

Landers

M. R.

Jacobson

K. M.

Matsunami

N. E.

McCarl

H. E.

Regis

M. T.

Longhurst

J. K.

(2021). A vicious cycle of fear of falling avoidance behavior in Parkinson’s disease: A path analysis. Clinical Parkinsonism and Related Disorders, 4, 100089. https://doi.org/10.1016/j.prdoa.2021.100089

17.

Landers

M. R.

Lopker

Newman

(2014). Reliability and validity of the modified fear of falling avoidance behavior questionnaire in Parkinson’s disease. Movement Disorders, 29, S177–S178.

18.

Landers

M. R.

Lopker

Newman

Gourlie

Sorensen

Vong

(2017). A cross-sectional analysis of the characteristics of individuals with Parkinson disease who avoid activities and participation due to fear of falling. Journal of Neurologic Physical Therapy, 41(1), 31–42. https://doi.org/10.1097/NPT.0000000000000162

19.

Landers

M. R.

Nilsson

(2022). A theoretical framework for addressing fear of falling avoidance behavior in Parkinson’s disease. Physiotherapy Theory and Practice. Advance online publication. https://doi.org/10.1080/09593985.2022.2029655

20.

Landers

M. R.

Oscar

Sasaoka

Vaughn

(2015). Balance confidence and fear of falling avoidance behavior are most predictive of falling in older adults: Prospective analysis. Physical Therapy Journal, 96(4), 433–442. https://doi.org/10.2522/ptj.20150184

21.

Lindholm

Hagell

Hansson

Nilsson

M. H.

(2014). Factors associated with fear of falling in people with Parkinson’s disease. BMC Neurology, 14(1), Article 19. https://doi.org/10.1186/1471-2377-14-19

22.

Lindh-Rengifo

Jonasson

S. B.

Mattsson

Ullén

Nilsson

M. H.

(2019). Predictive factors of concerns about falling in people with Parkinson’s disease: A 3-year longitudinal study. Parkinson’s Disease, 2019, 4747320. https://doi.org/10.1155/2019/4747320

23.

Liu

T.-W.

G. Y. F.

Chung

R. C. K.

S. S. M.

(2018). Cognitive behavioural therapy for fear of falling and balance among older people: A systematic review and meta-analysis. Age and Ageing, 47(4), 520–527. https://doi.org/10.1093/ageing/afy010

24.

Longhurst

Rider

Eckard

Hammar

Vukojevic

Campbell

Landers

(2022). Factors predicting fear of falling avoidance behavior in parkinsonisms. NeuroRehabilitation, 50(1), 65–73. https://doi.org/10.3233/NRE-210267

25.

Mantri

Fullard

M. E.

Duda

J. E.

Morley

J. F.

(2018). Physical activity in early Parkinson disease. Journal of Parkinson’s Disease, 8(1), 107–111. https://doi.org/10.3233/JPD-171218

26.

Nilsson

M. H.

Jonasson

S. B.

Zijlstra

G. A. R.

(2020). Predictive factors of fall-related activity avoidance in people with Parkinson disease—A longitudinal study with a 3-year follow-up. Journal of Neurologic Physical Therapy, 44(3), 188–194. https://doi.org/10.1097/npt.0000000000000316

27.

Paul

S. S.

Sherrington

Canning

C. G.

Fung

V. S.

J. C.

Lord

S. R.

(2014). The relative contribution of physical and cognitive fall risk factors in people with Parkinson’s disease: A large prospective cohort study. Neurorehabilitation and Neural Repair, 28(3), 282–290. https://doi.org/10.1177/1545968313508470

28.

Pelicioni

P. H. S.

Menant

J. C.

Latt

M. D.

Lord

S. R.

(2019). Falls in Parkinson’s disease subtypes: Risk factors, locations and circumstances. International Journal of Environmental Research and Public Health, 16(12), 2216. https://doi.org/10.3390/ijerph16122216

29.

Perepezko

Hinkle

J. T.

Shepard

M. D.

Fischer

Broen

M. P. G.

Leentjens

A. F. G.

Gallo

J. J.

Pontone

G. M.

(2019). Social role functioning in Parkinson’s disease: A mixed-methods systematic review. International Journal of Geriatric Psychiatry, 34(8), 1128–1138. https://doi.org/10.1002/gps.5137

30.

Radder

D. L. M.

Sturkenboom

I. H.

van Nimwegen

Keus

S. H.

Bloem

B. R.

de Vries

N. M.

(2017). Physical therapy and occupational therapy in Parkinson’s disease. International Journal of Neuroscience, 127(10), 930–943. https://doi.org/10.1080/00207454.2016.1275617

31.

Rahman

Griffin

H. J.

Quinn

N. P.

Jahanshahi

(2011). On the nature of fear of falling in Parkinson’s disease. Behavioural Neurology, 24(3), 219–228. https://doi.org/10.3233/BEN-2011-0330

32.

Rider

Longhurst

Lekhak

Young

Landers

(2022). Fear of falling avoidance behavior assessment and intervention in Parkinson’s disease: A scoping review. Research and Reviews in Parkinsonism, 2022(6), 1–17. https://doi.org/10.2147/JPRLS.S350890

33.

Salazar

R. D.

Ren

Ellis

T. D.

Toraif

Barthelemy

O. J.

Neargarder

Cronin-Golomb

(2017). Dual tasking in Parkinson’s disease: Cognitive consequences while walking. Neuropsychology, 31(6), 613–623. https://doi.org/10.1037/neu0000331

34.

Stilwell

C. L.

Hutchinson

S. L.

Meisner

B. A.

(2019). “I’ve got Parkinson’s and that makes a difference”: Understanding health and leisure through a Parkinson’s disease diagnosis. Loisir et Société / Society and Leisure, 42(1), 43–55. https://doi.org/10.1080/07053436.2019.1582904

35.

Thordardottir

Nilsson

M. H.

Iwarsson

Haak

(2014). “You plan, but you never know”—participation among people with different levels of severity of Parkinson’s disease. Disability and Rehabilitation, 36(26), 2216–2224. https://doi.org/10.3109/09638288.2014.898807

36.

Wood

B. H.

Bilclough

J. A.

Bowron

Walker

R. W.

(2002). Incidence and prediction of falls in Parkinson’s disease: A prospective multidisciplinary study. Journal of Neurology, Neurosurgery and Psychiatry, 72(6), 721–725. https://doi.org/10.1136/jnnp.72.6.721

37.

Yang

Hamilton

J. L.

Kopil

Beck

J. C.

Tanner

C. M.

Albin

R. L.

Ray Dorsey

Dahodwala

Cintina

Hogan

Thompson

(2020). Current and projected future economic burden of Parkinson’s disease in the U.S. NPJ Parkinson’s Disease, 6, Article 15. https://doi.org/10.1038/s41531-020-0117-1