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Participation Restriction, Not Fear of Falling, Predicts Actual Balance and Mobility Abilities in Rural Community-Dwelling Older Adults

Allison, Leslie K. PT, PhD; Painter, Jane A. EdD, OTR/L, FAOTA; Emory, Amanda DPT; Whitehurst, Patricia DPT; Raby, Amanda DPT

Journal of Geriatric Physical Therapy: January/March 2013 - Volume 36 - Issue 1 - p 13–23
doi: 10.1519/JPT.0b013e3182493d20
Research Reports

Background and Purpose: Fear of falling (FOF) has been correlated with an increased risk for falls, self-restriction of physical activity, and subsequent decrease in quality of life in older adults. The relationship between perceived FOF, participation restriction, and balance and mobility abilities is unclear, as results from prior studies are inconsistent. Few studies have used the Survey of Activities and Fear of Falling in the Elderly (SAFE) as a standard measure of FOF, although this survey provides both a measure of FOF and participation restriction. Only one study has explored the relationship of individual items from the SAFE with balance and mobility tests that predict fall risk. The primary purpose of this study was to investigate the relationships between FOF and participation restriction as measured by the SAFE and actual balance and mobility abilities in a diverse group of older adults.

Participants: Eighty-two community-dwelling older adults (17 men) with a mean age of 74 (SD = 8.8; range = 55–91) participated in this study. The sample comprised 45% African Americans and 54% whites.

Methods: Fear of falling and participation restriction were assessed using the SAFE, a self-assessment survey. The SAFE assesses information about participation in 11 functional activities as well as the extent to which fear is a source of participation restriction. Balance and functional mobility were measured using the Berg Balance Scale (BBS) and Timed Get Up & Go Test (TUG), respectively. Participants were categorized as low (N = 36), mixed (N = 19), or high (N = 24) risk for future falls based on their past fall history and results on the BBS and the TUG. Data analysis included χ2 and Spearman correlation and 2 regression analyses.

Results: Both SAFE FOF and participation restriction scores were significantly correlated with BBS and TUG scores. However, SAFE participation restriction scores, but not SAFE FOF scores, predicted BBS and TUG scores. SAFE FOF scores could discriminate older adults at high risk for falls from those at mixed and low risk but could not discriminate between the mixed- and low-risk groups.

Discussion/Conclusion: The relationship between self-reported participation restriction and objectively measured balance and mobility abilities is stronger than the relationship between self-reported FOF and objectively measured balance and mobility abilities. These findings lend support to the argument that participation restriction may be the critical mediating factor between FOF, balance and mobility limitations, and fall risk. Evaluation of and intervention for FOF and fall risk without direct and specific attention to participation restriction may not yield optimal results. Older adults whose goals include both reduction in fall risk and increase in participation level may need combined treatment approaches.

1Physical Therapy Department, College of Allied Health Sciences, East Carolina University, Greenville, North Carolina.

2Occupational Therapy Department, College of Allied Health Sciences, East Carolina University, Greenville, North Carolina.

Address correspondence to: Leslie K. Allison, PT, PhD, Physical Therapy Department, College of Allied Health Sciences, East Carolina University, 3305 F Health Sciences Bldg, Greenville, NC 27858 (

Preliminary results from this study were presented as a poster at the APTA Combined Sections Meeting in Las Vegas, Nevada, February 11, 2009.

This study was supported in part by Pitt Partners for Health, Older Adult Health Subcommittee, funded through Pitt Memorial Hospital Foundation.

The authors declare no conflict of interest.

© 2013 Academy of Geriatric Physical Therapy, APTA
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