Citation

Soh SLH. Front. Sports Act. Living 2022; 4: e1025026.

Copyright

(Copyright © 2022, Frontiers Media)

DOI

10.3389/fspor.2022.1025026

PMID

36311214

PMCID

PMC9596795

Abstract

There is a growing interest in using perturbation-based balance training (PBT) to reduce falls (1). PBT is a skill training intervention that aims to improve reactive balance control in response to destabilizing perturbations in a safe and controlled environment (2). Studies have often posited that the training mechanisms of PBT improve physical abilities, such as generating more effective recovery step response and trunk movement to arrest falls in the face of a slip, trip or a loss of balance caused by volitional movement (3). This explanation has also been offered for studies employing a single PBT session (4, 5). PBT is likely to influence psychological factors. However, the impact on this aspect remains unclear. Psychological factors are well-established predictors of falls and play a role in determining performance, such as balance and gait (6). Yet, several studies have reported a limited influence of PBT on falls efficacy or balance confidence (7, 8). PBT could affect other self-efficacies, such as balance recovery confidence, safe landing confidence, or fall recovery confidence, but there are scarce studies on them. Since falls are a complex phenomenon, the concepts of the different falls-related self-efficacy (falls efficacy) constructs must be clarified. Having better clarity allows appropriate measures to be selected to elucidate the impact of PBT on the perceived ability to deal with falls.

Deciphering falls efficacy has not been easy because several falls-related psychological factors have been used interchangeably in the literature. Falls efficacy is closely related to fear of falling or balance confidence, but it is necessary to recognize that these constructs are distinct (9, 10). While some research papers have presented falls efficacy and balance confidence as isomorphic (11), this paper will consider balance confidence to be a subdomain of falls efficacy. A recent methodological quality review of the content development of falls efficacy-related measurement instruments reported that falls efficacy has been viewed as a self-efficacy construct that covers different perceived abilities needed to prevent and manage falls (12). Rooted in Bandura's self-efficacy theory (13, 14), falls efficacy refers to the general belief in capabilities required to overcome various falls-related situations. This belief incorporates different self-efficacies presented across four stages surrounding falls (Figure 1) (15). In the pre-fall stage, balance confidence refers to the perceived ability to perform activities without losing balance. In the near-fall stage, balance recovery confidence focuses on the perceived ability to arrest a fall in response to destabilizing perturbations. These two stages surround the perceived capability to prevent falls (16). In the fall-landing stage, safe landing confidence relates to the perceived ability to fall safely on the ground when the balance is irrecoverable. In the post-fall stage, fall recovery confidence refers to the perceived ability to get up from the floor independently. The latter two stages surround the perceived capability to manage falls...

Language: en

Keywords

fear of falling; falls prevention; balance confidence; balance recovery confidence; falls efficacy; falls management; perturbation-based training; self-efficacy