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.
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.
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.
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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The authors declare that they have no conflict of interest regarding the publication of this paper.
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Example Search Strategy for Medline:
1. “Accidental Falls”[Mesh] OR Fall* [tiab] OR Slip* [tiab]
2. “Backward Chaining” [tiab] OR (Rise [tiab] AND Floor* [tiab]) OR “Get up” [tiab] OR “Stand up” [tiab] OR Lie-to-stand* [tiab]
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
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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 (2020) doi:10.1007/s40520-019-01459-1
- Fall prevention
- Backward chaining method
- Older adults
- Floor rise training