Effectiveness of cognitive behaviour therapy-based multicomponent interventions on fear of falling among community-dwelling older adults: A systematic review and meta-analysis.

AIMS: To systematically review the evidence and determine the effectiveness of cognitive behaviour therapy-based multicomponent interventions on fear of falling and falls among community-dwelling older adults who are at risk of falling. DESIGN: A systematic review and meta-analysis. DATA SOURCES: Six electronic databases, including CENTRAL, CINAHL, EMBASE, PubMed, PsycInfo and Scopus, were searched. Studies published in English from January 1998-July 2018 were included in this review. REVIEW METHODS: Only randomized controlled trials addressing fear of falling and/or the occurrence of falls using cognitive behaviour therapy-based multicomponent interventions were included. A standard procedure based on the Cochrane Handbook for Systematic Reviews of Interventions was used to assess the risk of bias of the selected studies. A meta-analysis was performed to determine the effectiveness of cognitive behaviour therapy-based multicomponent interventions on fear of falling immediately after the interventions, at ≤6 months and >6 months postinterventions. RESULTS: This review included 15 randomized controlled trials involving 3,165 community-dwelling adults aged 60 years and older. The pooled results showed that the intervention effects, including immediate, short-term (i.e., ≤6 months postintervention) and long-term (i.e., >6 months postintervention) effects, favoured the intervention group. CONCLUSION: Cognitive behaviour therapy-based multicomponent interventions are effective at reducing fear of falling among community-dwelling older adults who are at risk of falling. IMPACT: Fear of falling has been implicated in activity restriction among older adults and fall prevention interventions need to be multifaceted. Understanding and attending to individual psychological needs are as important as exercise training.

The effectiveness of a nurse-led home-based heart failure self-management programme (the HOM-HEMP) for patients with chronic heart failure: A three-arm stratified randomized controlled trial.

BACKGROUND: Although important, heart failure self-care remains a challenge for many patients. This study aimed to evaluate the effect of a nurse-led, home-based self-management psychosocial education intervention (HOM-HEMP). The primary outcome was patient's HF self-care in terms of maintenance, management and confidence. The secondary outcomes were cardiac self-efficacy, psychological wellbeing in terms of perceived social support, health related quality of life and levels of anxiety and depression. The clinical outcomes included New York Heart Association (NYHA) functional class and numbers of unplanned health service visits due to cardiac-related reasons. DESIGN: A three-arm stratified randomized controlled trial was conducted (Clinical trial registration number: NCT03108235). METHODS: A total of 213 participants admitted for heart failure were recruited from the inpatient wards of a tertiary public hospital in Singapore. They were randomly allocated to the control group, the experimental group A or the experimental group B. All participants received the usual care provided by the hospital. Participants in experimental groups A and B received the HOM-HEMP intervention, and those in experimental group B received an additional supplemental smartphone application. Data were collected at baseline, 6 weeks, 3 months and 6 months from baseline. RESULTS: Compared to the control groups, participants in either of the experimental group had significantly higher levels of heart failure self-care maintenance (F = 4.222, p = 0.001), self-care confidence (F = 5.796, p < 0.001) and self-care management (p < 0.05) at 6-week, 3-month and 6-month follow-ups. In addition, both experimental groups had significantly higher levels of cardiac self-efficacy, better health related quality of life and lower depression levels than the control group after the study intervention. A higher proportion of participants in both experimental groups had a better New York Heart Association functional class at 6-week and 3-month follow-ups. Participants in the experimental group B also had significantly fewer cardiac-related unplanned hospital admissions and emergency room visits than the control group at 6-month follow-up. Results on perceived social support were not significant. The study outcomes in experimental group A and B were not significantly different at any of the post intervention follow-up. CONCLUSION: The findings suggested that HOM-HEMP is an effective intervention for patients with heart failure in Singapore.