Reactive Balance Training for Fall Reduction
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Questions and Answers

What is the primary purpose of assessing funnel plot asymmetry in a meta-analysis?

  • To examine potential bias in the meta-analysis results. (correct)
  • To determine the statistical power of the included studies.
  • To evaluate the severity of adverse events reported in the studies.
  • To calculate the overall effect size of the interventions.

In a study evaluating falls, which of the following adverse events would be classified as 'moderate'?

  • An event resulting in permanent harm.
  • An event that is mild and self-resolving.
  • An event that is life-threatening.
  • An event requiring hospitalization. (correct)

When assessing risk of bias, what action is typically taken when two independent reviewers disagree?

  • The higher risk of bias assessment is automatically used.
  • The reviewers average their risk of bias assessments.
  • The study is excluded from the meta-analysis.
  • A third, independent reviewer is consulted to resolve the disagreement. (correct)

Which of the following factors can contribute to asymmetry in funnel plots?

<p>Selective nonreporting of findings. (C)</p> Signup and view all the answers

Why is it important to contact the authors of included studies during a systematic review?

<p>To obtain missing data and additional details about their studies. (B)</p> Signup and view all the answers

What is the potential consequence of poor methodological quality in studies included in a meta-analysis?

<p>Inflated effect sizes. (B)</p> Signup and view all the answers

When assessing falls after an intervention, what outcome measures are considered?

<p>The number of falls and the nature, frequency, and severity of adverse events. (A)</p> Signup and view all the answers

What does 'true heterogeneity' refer to in the context of studies included in a meta-analysis?

<p>Real differences between study populations or interventions. (D)</p> Signup and view all the answers

In a systematic review, what is the primary reason for having two independent reviewers assess study quality and extract data?

<p>To reduce potential bias and errors during data extraction and quality assessment. (C)</p> Signup and view all the answers

When independent reviewers disagree on the PEDro score of a study, what is the recommended procedure for resolving the discrepancy?

<p>Resolve by consensus after discussion, or involve a third reviewer. (A)</p> Signup and view all the answers

According to the PEDro scale classification, what range of scores is typically considered to represent 'fair' methodological quality?

<p>4-5 (C)</p> Signup and view all the answers

What is the primary purpose of using the Cochrane Risk of Bias Tool in a systematic review?

<p>To identify potential sources of bias within individual studies. (A)</p> Signup and view all the answers

According to the criteria described, when is a study rated as having a 'high risk' of bias when using the Cochrane Risk of Bias Tool?

<p>When at least one of the five domains is rated as high risk. (A)</p> Signup and view all the answers

What are the five domains assessed by the revised Cochrane Risk of Bias tool?

<p>Risk of bias arising from the randomization process, risk of bias due to deviations from the intended interventions, missing outcome data, risk of bias in measurement of the outcome, and risk of bias in selection of the reported results. (D)</p> Signup and view all the answers

What is the purpose of GRADEpro GDT software in the context of systematic reviews?

<p>To conduct certainty assessments and prepare summary of findings tables. (B)</p> Signup and view all the answers

According to GRADE, which label corresponds to 'moderate' certainty of evidence for randomized controlled studies?

<p>Serious (A)</p> Signup and view all the answers

Which of the following is NOT a typical source of bias that should be assessed when performing a meta-analysis?

<p>Researcher bias, where researchers always aim to ensure the quality of included studies. (A)</p> Signup and view all the answers

When using the GRADE approach, what factors are considered when assessing the certainty of evidence?

<p>Risk of bias, inconsistency, indirectness, imprecision, and publication bias. (D)</p> Signup and view all the answers

In the context of meta-analysis, what does 'indirectness' refer to as a threat to the certainty of evidence?

<p>The extent to which the included studies are not directly applicable to the population, intervention, or outcome of interest. (B)</p> Signup and view all the answers

What is the purpose of using tools like ROBINS-I in the context of meta-analysis?

<p>To assess the risk of bias in non-randomized studies included in the meta-analysis. (B)</p> Signup and view all the answers

Which of the following actions would be LEAST effective in minimizing the risk of bias during data extraction for a meta-analysis?

<p>Relying on the study authors' interpretations of their own data, as they have the most insight. (D)</p> Signup and view all the answers

In the context of assessing publication bias, what does a funnel plot asymmetry typically suggest?

<p>The presence of publication bias, where smaller studies with statistically non-significant results are less likely to be published. (D)</p> Signup and view all the answers

How does the consideration of 'values and preferences' relate to the assessment of certainty of evidence in the GRADE approach?

<p>Values and preferences are considered when assessing the importance of outcomes and may influence the interpretation of evidence. (C)</p> Signup and view all the answers

What distinguishes a 'systematic review' from a 'meta-analysis'?

<p>A meta-analysis involves the statistical synthesis of data, while a systematic review focuses on a qualitative assessment of the research. (D)</p> Signup and view all the answers

Flashcards

PEDro Scale

A tool to assess the methodological quality of clinical trials. Scores range from 0-10.

PEDro Score Classification

Classifies PEDro scores: Good (6-10), Fair (4-5), Poor (Less than 3).

Cochrane Risk of Bias Tool

A tool used to assess the risk of bias in studies.

Cochrane Risk of Bias Domains

Randomization, deviations, missing data, outcome measurement, and result selection.

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GRADE

Assesses the quality of evidence using five domains.

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GRADE Domains

Risk of bias, inconsistency, indirectness, imprecision, and other considerations.

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GRADE Certainty Levels

Not serious, serious, and very serious (High, Moderate, Low certainty).

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GRADEpro GDT

Software used to create 'Summary of Findings' tables.

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Severe Adverse Events

Events that are life-threatening or result in permanent harm.

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Moderate Adverse Events

Events requiring hospitalization or leading to withdrawal from the intervention.

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Mild Adverse Events

Adverse events that do not require hospitalization.

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Funnel Plot Asymmetry

A visual tool to examine bias in meta-analysis results.

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Reporting Bias

Bias from selective non-reporting or non-publication of study findings.

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True Heterogeneity

Differences in study characteristics that can distort meta-analysis results.

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Sampling Variation

Variance due to limited samples in the included studies.

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Random Chance

The chance that study findings vary randomly.

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Bias Assessment

Bias assessment in meta-analysis evaluates potential systematic errors in the included studies.

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Reactive Balance Training

Reactive balance training aims to improve balance by challenging participants to respond to unexpected disturbances.

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Graphical Test

Graphical tests visually represent data, making it easier to detect patterns or outliers such as bias.

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ROBINS-I

ROBINS-I is a tool for assessing the risk of bias in non-randomized studies.

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Indirectness (GRADE)

Indirectness considers whether the study populations, interventions, comparators, and outcomes are directly applicable to the review question.

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Inconsistency (GRADE)

Inconsistency refers to unexplained heterogeneity or variability in the results across different studies included in a meta-analysis.

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Imprecision (GRADE)

Imprecision relates to the uncertainty around the estimate of effect, often due to wide confidence intervals or small sample sizes.

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Other Considerations (GRADE)

Other considerations in GRADE involve factors such as publication bias, large magnitude of effect, and dose-response gradient.

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Study Notes

  • Reactive balance training (RBT) is an emerging approach to reducing falls risk in people with balance impairments.

Objective

  • Determine the effect of RBT on falls in daily life among individuals at increased risk of falls
  • Document associated adverse events

Methods

  • Databases searched were Ovid MEDLINE (1946 to March 2022), Embase Classic and Embase (1947 to March 2022), Cochrane Central Register of Controlled Trials (2014 to March 2022), and Physiotherapy Evidence Database (PEDro; searched on 22 March 2022).
  • Randomized controlled trials of RBT were included and the literature search was limited to the English language.
  • Records were screened by 2 investigators separately
  • Outcome measures were number of participants who reported falls after training, number of falls reported after training, and the nature, frequency, and severity of adverse events
  • Authors of included studies were contacted to obtain additional information.

Results

  • Twenty-nine trials were included, of which 17 reported falls and 21 monitored adverse events
  • Participants assigned to RBT groups were less likely to fall compared with control groups
  • The fall risk ratio = 0.76; 95% CI =0.63–0.92; I2 = 32%
  • Reported fewer falls than control groups (rate ratio = 0.61; 95% CI = 0.45–0.83; /2 = 81%).
  • Prevalence of adverse events was higher in RBT (29%) compared with control groups (20%).

Conclusion

  • RBT reduced likelihood of falls in daily life for older adults and people with balance impairments
  • More adverse events were reported in RBT than control groups
  • Balance training that evokes balance reactions can reduce falls among people at increased risk of falls
  • Older adults and individuals with balance problems were less likely to fall in daily life after participating in RBT compared with traditional balance training
  • Physical therapists may prescribe reactive balance training rather than traditional balance training in order to reduce the likelihood of falling in daily life for older adults and/or those with balance problems

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Related Documents

The Effect of Reactive Balance Training on Falls in Daily Life PDF

Description

This study investigates the effectiveness of Reactive Balance Training (RBT) in reducing falls among individuals at high risk. It analyzes randomized controlled trials to determine RBT's impact on fall incidence and documents any adverse events associated with the training.

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