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Article pour les cliniciens

La thérapie cognitivo-comportementale pour la peur de tomber et l'équilibre chez les personnes âgées: une revue systématique et méta-analyse.



  • Liu TW
  • Ng GYF
  • Chung RCK
  • Ng SSM
Age Ageing. 2018 Jul 1;47(4):520-527. doi: 10.1093/ageing/afy010. (Review)
PMID: 29471428
Lire le résumé Lire résumé des données probantes
Disciplines
  • - Médecine physique et réadaptation
    Relevance - 6/7
    Intérêt médiatique  - 5/7
  • Santé publique
    Relevance - 5/7
    Intérêt médiatique  - 5/7
  • Médecine familiale (MF)/Médecine générale (MG)
    Relevance - 5/7
    Intérêt médiatique  - 4/7
  • Médecine interne générale - Soins primaires
    Relevance - 5/7
    Intérêt médiatique  - 4/7
  • - Gériatrie
    Relevance - 5/7
    Intérêt médiatique  - 4/7

Résumé (en anglais)

BACKGROUND: fear of falling is prevalent among older people and associated with various health outcomes. A growing number of studies have examined the effects of interventions designed to reduce the fear of falling and improve balance among older people, yet our current understanding is restricted to physiological interventions. Psychological interventions such as cognitive behavioural therapy (CBT) have not been reviewed and meta-analysed. OBJECTIVE: to perform a systematic review and meta-analysis evaluating the effects of CBT on reducing fear of falling and enhancing balance in community-dwelling older people. METHOD: randomised controlled trials (RCTs) addressing fear of falling and balance were identified through searches of six electronic databases, concurrent registered clinical trials, forward citation and reference lists of three previous systematic reviews. RESULTS: a total of six trials involving 1,626 participants were identified. Four studies used group-based interventions and two adopted individual intervention. Intervention period ranged from 4 to 20 weeks, and the number and duration of face-to-face contact varied. Core components of the CBT intervention included cognitive restructuring, personal goal setting and promotion of physical activities. The risk of bias was low across the included studies. Our analysis suggests that CBT interventions have significant immediate and retention effects up to 12 months on reducing fear of falling, and 6 months post-intervention effect on enhancing balance. CONCLUSIONS: CBT appears to be effective in reducing fear of falling and improving balance among older people. Future researches to investigate the use of CBT on reducing fear of falling and improving balance are warranted.


Commentaires cliniques (en anglais)

General Internal Medicine-Primary Care(US)

Scarce evidence with probably high risk of performance bias shows a small effect of cognitive behavioral therapy on fear of falling in healthy older adults, with no effect on balance.

General Internal Medicine-Primary Care(US)

It occurs to me that a decent PT program should always have incorporated what is now termed CBT.

Geriatrics

The modalities are likely not widely available and the studies had difficulties. Usual care was the most common control, but I wonder if non-CBT contact of any sort would have been a better control. The effect on balance is not well accounted for physiologically.

Geriatrics

Fear of falling is often more disabling than falling. This review looks at CBT and finds that it can reduce fear of falling. I would like to see how this translated into quality of life, functional activity - but that would need a different study.

Public Health

The effect size is very small and the article fails to account this in its conclusions. I think that from a GP's perspective, it's more important to reduce the risk of falls than the fear of falling.

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