KARNATAKA, BANGALORE
ANNEXURE II
PROFORMA FOR REGISTRATION OF SUBJECT FOR
DISSERTATION1. / Name of the Candidate And
Address
(in block letters): / MALVANKAR NEHA UDAY
401, VAASTU RESIDENCY, NEAR JAIN DERASAR,
BEHIND NANCY COLONY, BORIVALI (EAST) MUMBAI – 400 066, MAHARASHTRA.
2. / Name of the Institute : / LAXMI MEMORIAL COLLEGE OF PHYSIOTHERAPY, MANGALORE.
3. / Course of study and subject : / MASTERS OF PHYSIOTHERAPY (MPT)
2 YEARS DEGREE COURSE
PHYSIOTHERAPY IN NEUROLOGICAL AND PSYCHOSOMATIC DISORDERS
4. / Date of Admission to Course : / 15th MAY 2010.
5. / Title of the topic: / “A STUDY TO EVALUATE THE CORRELATION OF BALANCE CONFIDENCE WITH BALANCE PERFORMANCE IN GERIATRIC POPULATION.”
6. / Brief Resume of the Intended Work:
6.1 NEED FOR THE STUDY:
Balance is a complex neuromusculoskeletal process involving sensory, vestibular, skeletal, and motor component. Significant impairment in balance due to alteration of components can be one of the cause for falls in aging process.
A fall can be defined as an unintentional event resulting in a change in the individuals position from higher to a lower level.1
According to Cunha & Guimaraes (1989) falls can be result of total loss of postural balance , and may be related to a sudden insufficiency of neural and osteoarticular mechanism involved in posture maintenance.1
Falling in elderly persons can lead to disability , hospitalization , and premature death. It may also result in psychological trauma termed as “fear of falling”.2
Fear of falling itself can yield negative consequences by effecting the frequency and intensity of physical activity this can lead to deconditioning and thereby possibly increasing the risk of falling in elderly individuals.3
The fear of falling is referred as a person’s loss of confidence in his or her balance ability. The simple presence or absence of fear of falling was used extensively in early researchbut is limited in its ability to determine whether different degrees of fear exist across different circumstances or have a varying effect on function i.e the balance performance of an elderly individual.4
Furthermore, some researchershave suggested that many people expressing a concern about their balance during functional tasks do not necessarily categorize themselves as “fearful,” even when they have modified their behavior to avoid falling. Consequently, efforts to measure fear of falling have focused on using the concept of “self-efficacy” in place of “fear.”Self-efficacy, a concept based in the field of psychology, refers to an individual's perceived capability within a specific domain of activities.4
Assessing falls-related self-efficacy in performing specific activities or tasks, should reveal the extent to which a person believes he or she is able to participate in specific activities without falling rather, than generalizing it to global fear of falling. 4
In an effort to measure fear of falling based on the concept of self-efficacy “Activity specific balance confidence (ABC) Scale” is used to measure “balance confidence,” this scale measures the construct of perceived balance ability (ie, a person's level of confidence in the ability to maintain balance while performing specific daily activities). 4
Balance performance is assessed using Tinneti POMA (PERFORMANCE ORIENTED MOBILITY ASSESSMENT) which helps in predicting decline in activities of daily living and fall. This scale contains two subscales measuring balance and gait which is one of the major component required while performing activities of daily living.
In rehabilitation of elderly with physical therapy interventions, it is given more focus on improving balance performance with different approaches but “fear of falling” (balance confidence) is not taken into consideration which can be a causative factor for fall in future in elderly without any impairments in components of balance.
This study will help us to better understand the interaction of balance confidence and balance performance. Hence, this will help us in future incorporating balance confidence with balance training during a physical therapy intervention to effectively manage elderly with risk of fall and possibly prevent the spiraling decline of function which is a major problem in elderly.
HYPOTHESES:
NULL HYPOTHESIS (HO):
There may not be a significant correlation of BALANCE CONFIDENCE with BALANCE PERFORMANCE.
ALTERNATE HYPOTHESIS(H1):
There may be a significant correlation of BALANCE CONFIDENCE with BALANCE PERFORMANCE.
6.2 REVIEW OF LITERATURE:
Jenine Hatch, and colleagues did a study on Determinants of balance confidence in community-dwelling elderly people which states that balance impairments are present in people with diminished confidence in their balance ability and it plays an important role in determining balance confidence Future studies should aim at improving our understanding of the interaction between balance confidence and balance performance.4
Jonathan Howland and collegues did a study on Covariates of Fear of Falling and Associated Activity Curtailment, which states that Falls history appears an important contributor to fear of falling, whereas the impact of this fear on activities appears more a function of social support. These findings suggest different strategies for the primary and secondary prevention of fear of falling.3
Kim Delebare and collegues did a study on Fear related falls, activities and Physical frailty, which concluded that fear has negative effect on the physical activities and may also be predictive of future falls.5
Khristine Legsters did a study on fear of falling which says that Fear of falling is claimed to have an average prevalence of 30% or more in older adults who do not have a history of falling, and it is double that in those older adults who have fallen. It has long-term negative consequences to the physical and functional well-being of older adults, to the degree that loss of independence is experienced with normally performed daily activities. 6
Miriam F. Reelick and colleagues did a study on influence of fear of falling on gait and balance in older people, which states that about 30% elderly people have fear of falling who have lower gait velocity than those without. Older people without fear of fall use adaption mechanism optimising balance, rather than slow decreased balance control.7
Cynthia L. Arfken and colleagues found the prevalence and correlates of fear of fall in elderly people living in the community. They observed associations of fear of falling with decreased quality of life and mobility.5
Discrepancies between balance confidence and physical performance among community-dwelling Korean elders: a population-based study by Young-Mi Ko, suggests that enhancing confidence and controlling pain as a means of preventing disability should be emphasized when developing models for maintaining and promoting health in elders.8
Physical Function and Health Status among Seniors with and without a Fear of Falling was studied by Brenda Brouwer, says that The marked deficits in strength and health status found among seniors living independently in the community, who are in good health, but report being fearful of falling underscores the seriousness of Fear of falling as a potential health risk factor in the well elderly. 9
A study by Davide C. and colleagues, confirms the acceptable concurrent validity of activity specific balance confidence.10
A study by Kloon, Anne D confirms the good intra-rater and inter-rater reliability of POMA(performance oriented mobility assessment).11
A study by Deb A Kegelmeyer confirms that POMA(performance oriented mobility assessment) is a valid and reliable tool to assess the mobility status of fall risk patients.12
6.3 AIM OF STUDY:
To study the correlation of balance confidence with balance performance in geriatric population.
7 /
MATERIALS AND METHODS:
7.1 STUDY DESIGN: OBSERVATIONAL STUDY.SOURCES OF DATA: Old age homes in and around Mangalore.
SAMPLE SIZE: 100 Elderly subjects.
STUDY DURATION: 6 months.
7.2 METHOD OF COLLECTION OF DATA
SAMPLING TECHNIQUE:
CLUSTER SAMPLING TECHNIQUE.
Here cluster is old age homes and sampling will be done of elderly individuals for the study.
INCLUSION CRITERIA:
· Elderly subjects 60yrs and above (both male & female)
· Able to follow commands
· Able to walk without any assistance
· Able to see and to do activities.
EXCLUSION CRITERIA:
· History of clinical depression.
· Progressive neurological disorder.
· Lower-extremity fracture or surgery within the past 1 year.
· Lower extremity joint replacement within the past 1 year.
· Cognitive and perceptual deficits.
MATERIALS:
1. Pen
2. Paper
3. A sturdy, armless, straight-back chair.
TECHNIQUE OF APPLICATION:
Method:
· 100 Elderly subjects will be selected randomly on inclusion and exclusion criteria for study and consent will be obtained for the same. Sociodemographic details, Medical history and history about falls if any is recorded.
· Balance confidence is measured with the help of Activities specific balance confidence scale (ABC).
· The same subjects will be assessed for balance performance with help of Tinneti Performance oriented mobility assessment (POMA).
Outcome measures :
· Activities specific balance confidence scale (ABC).
· Tinneti performance oriented mobility assessment (POMA).
STATISTICAL ANALYSIS:
Karl Pearson’s correlation.
RESEARCH QUESTION:
· Is there any correlation of balance confidence with balance performance in geriatric population?
7.3 Does the study require any investigations or interventions to be conducted on
Patients or other humans or animals? If so, please describe briefly.
YES, The subjects will be above 60years of age and will be assessed for balance performance in various activities like sitting, standing, walking on a path etc. using a POMA.
Has ethical clearance been obtained from your institutions
Ethical clearance obtained.
8 / List of References:
1. Moura RN, Santos FC dos, Driemeier M, Santos LM dos, Ramos LR. Quedas em idosos: fatoresde risco associados. Gerontologia 1999;7(2):15-21.
2. American Journal of Public Health, April 1994, vol. 84, no.4, page no. 565-570.
3. The Gerontological Society of America. The Gerontologist 1998,Vol. 38, No. 5, 549-555.
4. APTA 2010 Oct. vol. 90, issue. 10.
5. British Geriatrics Society 2004,Age and Ageing 2004; 33: 368–373 Age and Ageing Vol. 33 No. 4.
6. Physical TherapyMarch 2002vol. 82no. 3264-272.
7. Age and Ageing 2009; 38: 435–440 C the Author 2009. Published by Oxford University Press on behalf of the British Geriatrics Society.
8. International Psychogeriatrics,2009, 21: 738-747 Cambridge University .
9. International Journal of Experimental, Clinical, Behavioral, Regenerative & Technological
Gerontology. Vol.50, no. 3, 2004, 135-141.
10. Disability and Rehabilitation, June 2006; 28(12): 789 – 795.
11. Journal Of Neurological Physical Therapy 2004.
12. Physical TherapyOctober 2007vol. 87no. 101369-1378 .