A mixed-methods study examining perceptions of fear of falling among community-dwelling people who use wheelchairs full-time.

Objective: There is growing evidence that fear of falling (FOF) is common in people who use wheelchairs full-time and negatively influence their performance of daily activities and quality of life. The purpose of this study was to gain an in-depth understanding of perceptions related to FOF among people who use wheelchairs full-time.Methods: Mixed-method analysis was conducted using semi-structured interviews and surveys to gain insight into FOF. Surveys included demographic information; Spinal Cord Injury-Fall Concerns Scale (SCI-FCS); a questionnaire that directly assesses FOF and associated activity curtailment; and Fall Control Scale (FCS).Results: Among 39 participants (age = 43.1 ± 15.6 years, disability duration = 21.2 ± 11.1 years), 27 participants (69%) reported FOF. Participants with less perceived ability to control falls indexed by FCS reported higher SCI-FCS scores, indicating greater FOF (rs = -0.384, p = 0.016). Qualitative findings revealed that participants felt that FOF developed due to sustaining fall-related injuries or limited ability to recover from a fall. Some participants perceived falling as a part of their lives. They believed that it was not the cause of developing FOF.Conclusions: Among people who use wheelchairs full-time, FOF is prevalent and may develop due to fears of sustaining injuries or being unable to get up after falling. Developing an evidenced-based education protocol aimed at managing falls (e.g., establishing a fall recovery strategy and education on techniques to reduce injury during falls) is needed to minimize FOF people who use wheelchairs full-time.

Fear of falling and associated activity curtailment are prevalent among people who use wheelchairs full-time.Fear of falling often develops as a result of prior fall-related injuries or the inability to recover from a fall independently.Evidence-based education protocols to reduce fear of falling among people who use wheelchairs full-time should contain content related to fall recovery and injury prevention.

Factors associated with fear of falling and fall-related injuries among people who use wheelchairs and motorized mobility scooters: a cross-sectional study.

PURPOSE: To identify the factors associated with the fear of falling (FOF) and fall-related injuries (FRI) among full-time wheelchair and motorized mobility scooter (WC/S) users with various health conditions. METHODS: This cross-sectional study included participants (≥18 years old) who used WC/S for at least one year for ≥ 75% of mobility and had a history of ≥ 1 fall in the past three years. Logistic regression models identified factors associated with FOF (yes/no) and FRI (yes/no) during the past year. Data on demographics, prior falls, mental health, environmental accessibility, and WC/S usage were used as independent variables. RESULTS: Among 156 participants, 96% reported at least one fall within the past year, among whom 94.6% reported FOF, and 74% reported FRI within the same period. FOF was associated with fall incidence in the past year (OR = 17.75, p = 0.001). FRI was associated with higher levels of anxiety (OR = 1.15, p = 0.003) and fewer hours of WC/S use per week (OR = 0.98, p = 0.012). CONCLUSION: This study highlights the high prevalence of FOF and FRI among WC/S users who had falls. The findings emphasized the relation between prior fall experiences and FOF and underscored the significance of addressing anxiety symptoms and WC/S usage in relation to FRI.

Among individuals with a variety of health conditions who use wheelchairs and motorized mobility scooters full-time for most of their mobility and have experienced at least one fall incident within the past year, the prevalence of psychosocial and physical consequences of falls (fear of falling and fall-related injuries) is relatively high.Given the significant association between an individual's previous fall experiences and the likelihood of fear of falling, continuous screening for falls is a crucial step toward fall prevention for people who use wheelchairs and motorized mobility scooters full-time.Recognizing the importance of the unique needs of individuals who use wheelchairs and motorized mobility scooters and tailoring interventions like wheelchair skills and anxiety management education may enhance overall rehabilitation outcomes.

Development, reliability, and validity assessment of a fall concerns scale for people who use wheelchairs and scooters (FCS-WC/S).

PURPOSE: To evaluate the psychometric properties of a Fall Concerns Scale for people who use Wheelchairs and Scooters (FCS-WC/S). MATERIALS AND METHODS: Developed by fall prevention experts, FCS-WC/S underwent refinement through interdisciplinary reviews and focus groups with researchers, clinicians, and individuals who use WC/S full-time. The psychometric evaluation involved adults who used WC/S for ≥1 year and had ≥1 fall in the previous 3 years, recruited between April and September 2022. RESULTS: The FCS-WC/S evaluates fall concerns among people with various health conditions who use WC/S full-time across 33 daily activities. One hundred and twenty-four participants responded to the baseline survey. A subgroup of 63 people repeated the FCS-WC/S a week later. The FCS-WC/S demonstrated excellent internal and good test-retest reliability (α ≥ 0.90, ICC = 0.86-0.9), as well as concurrent validity (Spearman's rho = 0.72) with the Spinal Cord Injury Falls Concern Scale (SCI-FCS). It effectively differentiated fear of falling levels from an established measure (ORs 4.1, 25.8, 46.7). Factor and parallel analysis revealed three factors, two of which were retained for further analysis. CONCLUSIONS: Preliminary findings support FCS-WC/S validity and reliability for assessing fall concerns among individuals with various conditions who use WC/S. Further scale construction analysis is recommended.

Measuring concerns about falling among full-time wheelchair and scooter users is crucial due to its potential negative impact on activity curtailment, which in turn may affect community participation and quality of life.Most validated tools, except for the Spinal Cord Injury-Falls Concern Scale, designed for manual wheelchair users with spinal cord injury, are primarily tailored for individuals who ambulate, highlighting the need for assessment tools specifically designed for full-time wheelchair and scooter users.Using the Spinal Cord Injury-Falls Concern Scale as a foundation, the Fall Concerns Scale for people who use Wheelchairs and Scooters was developed to measure fall concerns among full-time wheelchair and scooter users, irrespective of their specific health conditions.The Fall Concerns Scale for people who use Wheelchairs and Scooters has a good potential to offer clinicians a valid and reliable tool to systematically screen fall concerns across various health conditions, with further large-scale studies needed to validate the tool across a wider range of health conditions.

Disrupted executive cerebro-cerebellar functional connectivity in alcohol use disorder.

BACKGROUND: Alcohol use disorder (AUD) affects 283 million people worldwide and its prevalence is increasing. Despite the role of the cerebellum in executive control and its sensitivity to alcohol, few studies have assessed its involvement in AUD-relevant functional networks. The goal of this study is to compare resting-state functional connectivity (FC) patterns in abstinent adults with a history of AUD and controls (CTL). We hypothesized that group differences in cerebro-cerebellar FC would be present, particularly within the frontoparietal/executive control network (FPN). METHODS: Twenty-eight participants completed a resting-state functional magnetic resonance imaging (rsfMRI) study. CTL participants had no history of AUD, comorbid psychological conditions, or recent heavy drinking and/or drug use. AUD participants had a history of AUD, with sobriety for at least 30 days prior to data collection. Multivariate pattern analysis, an agnostic, whole-brain approach, was used to identify regions with significant differences in FC between groups. Seed-based analyses were then conducted to determine the directionality and extent of these FC differences. Associations between FC strength and executive function were assessed using correlations with Wisconsin Card Sorting Test (WCST) performance. RESULTS: There were significant group differences in FC in nodes of the FPN, ventral attention network, and default mode network. Post hoc analyses predominantly identified FC differences within the cerebro-cerebellar FPN, with AUD showing significantly less FC within the FPN. In AUD, FC strength between FPN clusters identified in the multivariate pattern analysis (MVPA) analysis (Left Crus II, Right Frontal Cortex) was positively associated with performance on the WCST. CONCLUSIONS: Our results show less engagement of the FPN in individuals with AUD than in CTL. FC strength within this network was positively associated with performance on the WCST. These findings suggest that long-term heavy drinking alters cerebro-cerebellar FC, particularly within networks that are involved in executive function.