Date of Award

12-9-2024

Document Type

Thesis

School

School of Chemical & Biotechnology

Programme

Ph.D.-Doctoral of Philosophy

First Advisor

Anuradha Narayanan

Second Advisor

K.Uma Maheswari

Keywords

Falls Prevention, Visual Impairment, Behavior Change Models, SMART Intervention Strategy, Glaucoma and Retinitis Pigmentosa

Abstract

Falls are the second leading cause of unintentional injuries and extensively studied among the elderly. Hence, intervention studies for falls prevention are restricted to the elderly with or without visual impairment (VI). Even among studies with VI, strategies for treatable VI are widely explored. Hence this study aimed to understand falls and interventions that may reduce falls in all the age groups especially among those with untreatable VI.

This mixed methods study included identification of subjects aged ≥ 18 years with VI from clinical records of Medical Research Foundation, Chennai and details of previous history of falls were enquired over telephone. In-depth interviews were conducted for a subset of subjects to understand perspectives of falls considering reduction of falls as behavior. Theoretical Domains Framework, Behavior Change Wheel and Socio- Ecological Model were used to analyse the results.

Effectiveness of proposed strategy was tested for subset of subjects with untreatable VI and history of falls. Falls rate was considered as primary outcome and fear of falling, visual reaction time, balance assessment, temporal gait parameters, obstacle foot placement were considered as secondary outcome measures. Out of 888 subjects, 18.0% (n=160) reported having fallen at least once and among them, 45.6% (n=73) had multiple falls.

Overall, fallers were more among ‘young’ (21.1%) than ‘middle-aged’ (16.0%) and ‘elderly’ (17.3%). Increased severity of VI, Side vision difficulty, diseases such retinitis pigmentosa and glaucoma showed increased risk of falls. Overall ‘Fear of falling’ was reported by 11.3% (n=100), out of which 30.0% (n=48) were by fallers. SMART intervention strategy (S-Support from caregivers/assistive devices, M-Monitoring of falls, A-Awareness about falls, R- Reduction of home hazards, T-Training-Training orientation and mobility, balance exercises and yoga therapy) was proposed from in-depth interviews which showed reduction of falls rate by 62% with incidence rate 0.381 (95% CI 0.240-0.606, p< 0.001) for cases.

Fear of falling score, visual reaction time, indoor walking speed, indoor and outdoor walking steps per minutes improved in cases compared to controls after intervention. This mixed methods study concluded that the SMART strategy identified used behavior change models is effective in reducing falls among adults with untreatable VI in India.

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