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Open Access Study protocol

The STRIDE (Strategies to Increase confidence, InDependence and Energy) study: cognitive behavioural therapy-based intervention to reduce fear of falling in older fallers living in the community - study protocol for a randomised controlled trial

Steve W Parry1*, Vincent Deary2, Tracy Finch3, Claire Bamford3, Neil Sabin4, Peter McMeekin3, John O’Brien5, Alma Caldwell6, Nick Steen3, Susan L Whitney7, Claire Macdonald3 and Elaine McColl3

Author Affiliations

1 Institute for Ageing and Health, Newcastle University, c/o Falls and Syncope Service, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne NE1 4LP, UK

2 Department of Psychology, Northumbria University, Northumberland Road, Newcastle upon Tyne NE1 8ST, UK

3 Institute of Health and Society, Newcastle University, Baddiley Clark Building, Richardson Road, Newcastle upon Tyne NE2 4AX, UK

4 Newcastle University, c/o STRIDE Office, 3-4 Claremont Road, Newcastle upon Tyne NE2 4AE, UK

5 Department of Psychiatry, University of Cambridge School of Clinical Medicine, Bradbury Centre, Level E4 Cambridge Biomedical Campus, Cambridge CB2 0SP, UK

6 Age UK North Shields, 13 Saville Street West, North Shields NE29 6QP, UK

7 University of Pittsburgh, 6035 Forbes Tower, Pittsburgh, PA 15260, USA

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Trials 2014, 15:210  doi:10.1186/1745-6215-15-210

Published: 6 June 2014

Abstract

Background

Around 30% to 62% of older individuals fall each year, with adverse consequences of falls being by no means limited to physical injury and escalating levels of dependence. Many older individuals suffer from a variety of adverse psychosocial difficulties related to falling including fear, anxiety, loss of confidence and subsequent increasing activity avoidance, social isolation and frailty. Such ‘fear of falling’ is common and disabling, but definitive studies examining the effective management of the syndrome are lacking. Cognitive behavioural therapy has been trialed with some success in a group setting, but there is no adequately powered randomised controlled study of an individually based cognitive behavioural therapy intervention, and none using non-mental health professionals to deliver the intervention.

Methods/Design

We are conducting a two-phase study examining the role of individual cognitive behavioural therapy delivered by healthcare assistants in improving fear of falling in older adults. In Phase I, the intervention was developed and taught to healthcare assistants, while Phase II is the pragmatic randomised controlled study examining the efficacy of the intervention in improving fear of falling in community-dwelling elders attending falls services. A qualitative process evaluation study informed by Normalization Process Theory is being conducted throughout to examine the potential promoters and inhibitors of introducing such an intervention into routine clinical practice, while a health economic sub-study running alongside the trial is examining the costs and benefits of such an approach to the wider health economy.

Trial registration

Current Controlled Trials ISRCTN78396615

Keywords:
Fear of falling; Falls; Elders; Community; Randomised controlled trial; Cognitive behavioural therapy; Complex intervention; Normalization process theory