Fall-related concerns, balance and gait in older adults with osteoporosis

Aim: The overall aim of this thesis was to evaluate the short- and long-term effects of a specific and progressive balance-training programme, focusing on dual- and multi-task exercises, with respect to fall-related concerns, gait, balance performance and physical function in older adults with osteoporosis. Furthermore, to evaluate the reliability and validity of the Falls Efficacy Scale-International questionnaire, and to explore perceptions of fall-related concerns and balance after participating in the balance-training programme.

Methods: In a methodological study the relative and absolute reliability and convergent validity of the Falls Efficacy Scale –International (FES-I) for older adults with or without osteoporosis and an increased risk of falling was evaluated. In a randomized controlled trial including 3 groups (Training, Training + physical activity and Control), both the short- and long-term effects of a balance-training programme, focusing on dual- and multi-task exercises, for older adults with osteoporosis were evaluated with respect to fall-related concerns, walking speed with or without a supplemental cognitive task, balance performance, and physical function. Inductive qualitative content analysis was used to explore how older women with osteoporosis perceive fall-related concerns and balance in daily life after participating in the balance-training programme.

Results: The Swedish version of the FES-I showed acceptable values for relative and absolute reliability in older Swedish individuals with increased risk of falling. Moreover, the results showed low convergent validity for FES-I in correlation with balance performance and health-related quality of life in older women with osteoporosis and increased risk of falling. The balance-training programme had positive effects on fall-related concerns, gait, balance, and physical function. Both training groups showed positive effects from the balance-training intervention at the first follow-up. However, at 9 months follow-up, the effects for the Training + physical activity group had regressed to baseline values, and were even lower at the 15 months follow-up, one year after the end of the intervention. This was in contrast to the participants in the Training group, who maintained improved positive effects throughout the study period. After the balance-training the participants described perceived fall-related concerns and balance in daily life under the categories of empowerment, safety and menace, with an underlying theme of ‘internalised risk perception related to experience of bodily fragility’ that always was present. The analysis also identified a dynamic process, in which seasonal, environmental and personal factors influenced how participants perceived their fall-related concerns and balance.

Conclusion: The FES-I is a reliable questionnaire for older individuals with increased fall risk, but it has low convergent validity with balance performance tests and health-related quality of life among older women with osteoporosis. The specific and progressive balance-training programme, focusing on dual- and multi-tasks, positively influenced fall-related concerns, gait speed, and physical function in older adults with osteoporosis in both a short- and long-term perspective. To cope with the fragility caused by osteoporosis, the participants experience an internalised risk perception that protects against possible threats and harm. The participants improved their empowerment and self-efficacy, resumed activities, and became more active after participation in balance-training programme.

List of scientific papers

I. Halvarsson A, Franzén E, Ståhle A. Assessing the relative and absolute reliability of the Falls Efficacy Scale-International questionnaire in elderly individuals with increased fall risk and the questionnaire´s convergent validity in elderly women with osteoporosis. Osteoporosis International. 2013;24:1853-1858.
https://doi.org/10.1007/s00198-012-2197-1

II. Halvarsson A, Franzén E, Ståhle A. Balance training with multi-task exercises improves fall-related self-efficacy, gait, balance performance and physical function in older adults with osteoporosis: a randomized controlled trial. Clinical Rehabilitation. 2014 August 20.
https://doi.org/10.1177/0269215514544983

III. Halvarsson A, Oddsson L, Franzén E, Ståhle A. Long-term effects of a progressive and specific balance-training programme with multi-task exercises for older adults with osteoporosis – a randomized controlled study. [Submitted]

IV. Halvarsson A, Ståhle A. Halén C, Roaldsen KS. ‘Better safe than sorry’ – a qualitative analysis of participants perspective of balance and fall-related concerns in older women with osteoporosis. [Submitted]