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Impact of the backward chaining method on physical and psychological outcome measures in older adults at risk of falling: a systematic review

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Abstract

Background

Being unable to “get up from the floor” is a risk factor and predictor of serious fall-related injuries in older age; however, floor-rise training (FRT) is not widely used. The backward chaining method (BCM) is a success-oriented, step-by-step form of FRT. This systematic review aimed to evaluate the impact of BCM on physical and psychological outcome measures, and its clinical application.

Methods

Studies were identified through systematic searching of five databases. Criteria for inclusion were: use of BCM as a treatment method, outcome measures related to falls, and participants aged 60 + years. Study quality was evaluated using the Mixed Methods Appraisal Tool and PEDro scale, if applicable.

Results

Seven studies with a total of 446 participants (mean age 82.4 ± 5.3 years) were identified. Emerging evidence shows that BCM significantly improves the ability to get up unassisted from the floor, as well as mobility with reduced fall incidence in older people. Furthermore, it can potentially reduce fear of falling. Reporting on feasibility and acceptance of BCM was limited. Study quality varied widely.

Conclusions

BCM provides a promising intervention in fall-related recovery strategies for older adults and is most effective when offered to older adults at risk of falling. Considering the small number of included studies and the varying methodological quality, these findings should be evaluated accordingly. The growing evidence regarding the benefits of BCM, yet the lack of adoption into standard care, highlights the need for further research and clinical application of this intervention approach.

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Funding

RL salary is funded by the Robert-Bosch-Hospital and this work is a continuation of her Bac. No funding grants were used for this review.

Author information

Author notes

  1. A. Stefanie Mikolaizak

    Present address: Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Barker Street, Randwick, NSW, Australia

Authors and Affiliations

  1. Department of Clinical Gerontology and Geriatric Rehabilitation, Robert-Bosch-Hospital, Auerbachstr. 110, 70376, Stuttgart, Germany

    Rebekka Leonhardt, Clemens Becker, Michaela Groß & A. Stefanie Mikolaizak

  2. Faculty of Health Sciences, The University of Sydney, Camperdown, Australia

    A. Stefanie Mikolaizak

Authors
  1. Rebekka Leonhardt
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  2. Clemens Becker
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  3. Michaela Groß
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  4. A. Stefanie Mikolaizak
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Contributions

RL undertook the literature search; RL and ASM completed title, abstract and full-text screening as well as data extraction. The manuscript was prepared by RL, ASM, MG and CB.

Corresponding author

Correspondence to Rebekka Leonhardt.

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The authors declare that they have no conflict of interest regarding the publication of this paper.

Human and animal rights statement

This review does not contain any experiments involving human participants or animals performed by any of the authors.

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Appendix

Appendix

Example Search Strategy for Medline:

1. “Accidental Falls”[Mesh] OR Fall* [tiab] OR Slip* [tiab]

AND

2. “Backward Chaining” [tiab] OR (Rise [tiab] AND Floor* [tiab]) OR “Get up” [tiab] OR “Stand up” [tiab] OR Lie-to-stand* [tiab]

NOT

3. (Infant [mh] OR Child [mh] OR Adolescent [mh] OR “Young Adult” [mh] OR “Middle Aged” [mh]) NOT aged [mh]

Search date: September 15th 2019

Number of hits on that date: 248

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Leonhardt, R., Becker, C., Groß, M. et al. Impact of the backward chaining method on physical and psychological outcome measures in older adults at risk of falling: a systematic review. Aging Clin Exp Res 32, 985–997 (2020). https://doi.org/10.1007/s40520-019-01459-1

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