Fear of Falling Avoidance Behavior Assessment and Intervention in Parkinson’s Disease: A Scoping Review

Abstract

Falling and fear of falling (FOF) are significant concerns for people with Parkinson’s disease (PD). FOF can lead to activity avoidance behavior, a risk factor for increased falls and further functional decline. The significant implications of fear of falling avoidance behavior (FFAB) among PD warrant a literature review. The objective of this review was to explore existing literature on FFAB and identify what is known about this phenomenon in people with PD. This scoping review considered studies including adults 18 years and older diagnosed with PD experiencing FFAB. Using Joanna Briggs Institute methodology and the PRISMA extension for scoping reviews, we performed a scoping review searching MEDLINE, Embase, Scopus, APA PsycInfo, CINAHL, Papers First, and ProQuest Dissertations and Theses for studies examining FFAB among people with PD with no limit on publication date. A three-step search strategy was followed and data extraction was performed by two independent reviewers. A total of 9 articles met eligibility criteria. Seven studies were quantitative and two were qualitative. The results identified that FFAB has a significant impact on daily life and is associated with downstream consequences of physical and psychological decline. The symptoms and severity of PD uniquely influence FFAB. Multiple assessments were utilized, but only two measured the impact of FOF and how this fear translates into avoidance behavior. There is a paucity of literature on interventions targeting FFAB among PD. In summary, this review demonstrated that FFAB is complex, multifactorial, and significantly impacts everyday life for people with PD. Evaluation and treatment should begin in the early stages of the disease. PD adds disease-specific symptoms and progression that directly impact FFAB, possibly in a bidirectional or cyclical manner. Further research is required to explore assessment and interventions for FFAB among people with PD.

Keywords:

• anxiety
• activity restriction
• catastrophizing
• rehabilitation
• sedentary behavior
• participation

Acknowledgment

Jason Fetty, MLIS, AHIP, for assistance in the development of search strategies of database systems.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors report no disclosures or conflicts of interest in this work. No specific funding was received for this scoping review. This review was conducted in accordance with an a priori protocol published in JBI Evidence Synthesis.³⁹ An abstract of this paper was presented at the 2021 American Congress of Rehabilitation Medicine Annual Conference as a poster presentation with interim findings. The poster’s abstract was published in “Systematic/Meta-Analytic Review Posters” in the Archives of Physical Medicine and Rehabilitation: https://doi.org/10.1016/j.apmr.2021.07.485.