Systematic Review of the Effects of Cognitive and Behavioural Interventions on Fall-Related Psychological Concerns in Older Adults.

This systematic review aims to evaluate the efficacy of cognitive and behavioural interventions for improving falls-related psychological concerns. A systematic search yielded 8 randomised controlled trials eligible for inclusion. All studies compared a cognitive and behavioural intervention to a control. Meta-analysis showed that cognitive and behavioural treatments had beneficial effects on fear of falling outcomes [lower score better] immediately after treatment [random effects standardised mean difference (SMD): -0.3 (95% CI: -0.50 to -0.10)] and at longer term follow up [random effects SMD: -0.29 (95% CI: -0.49 to -0.09)]. Cognitive and behavioural treatments also showed a positive effect on falls efficacy outcomes [higher score better] immediately after treatment [fixed effects SMD: 0.19 (95% CI: 0.04 to 0.34)] and over the longer term [fixed effects SMD: 0.13 (95% CI:-0.00 to 0.25)]. However the clinical significance of these effects on fear of falling and falls efficacy was unclear. Further work is required with best-practice comparators over a longer follow-up period.