ORCID Profile
0000-0002-9969-8976
Current Organisation
Singapore Institute of Technology
Does something not look right? The information on this page has been harvested from data sources that may not be up to date. We continue to work with information providers to improve coverage and quality. To report an issue, use the Feedback Form.
Publisher: Elsevier BV
Date: 03-2018
DOI: 10.1016/J.APMR.2017.06.032
Abstract: To identify the risk factors for falls in community stroke survivors. A comprehensive search for articles indexed in MEDLINE, Embase, CINAHL, PsycINFO, Cochrane Library, and Web of Science databases was conducted. Prospective studies investigating fall risk factors in community stroke survivors were included. Reviewers in pair independently screened the articles and determined inclusion through consensus. Studies meeting acceptable quality rating using the Q-Coh tool were included in the meta-analysis. Data extraction was done in duplicate by 4 reviewers using a standardized data extraction sheet and confirmed by another independent reviewer for completeness and accuracy. Twenty-one articles met the minimum criteria for inclusion risk factors investigated by ≥3 studies (n=16) were included in the meta-analysis. The following risk factors had a strong association with all fallers: impaired mobility (odds ratio [OR], 4.36 95% confidence interval [CI], 2.68-7.10) reduced balance (OR, 3.87 95% CI, 2.39-6.26) use of sedative or psychotropic medications (OR, 3.19 95% CI, 1.36-7.48) disability in self-care (OR, 2.30 95% CI, 1.51-3.49) depression (OR, 2.11 95% CI, 1.18-3.75) cognitive impairment (OR, 1.75 95% CI, 1.02-2.99) and history of fall (OR, 1.67 95% CI, 1.03-2.72). A history of fall (OR, 4.19 95% CI, 2.05-7.01) had a stronger association with recurrent fallers. This study confirms that balance and mobility problems, assisted self-care, taking sedative or psychotropic medications, cognitive impairment, depression, and history of falling are associated with falls in community stroke survivors. We recommend that any future research into fall prevention programs should consider addressing these modifiable risk factors. Because the risk factors for falls in community stroke survivors are multifactorial, interventions should be multidimensional.
Publisher: Informa UK Limited
Date: 25-12-2019
DOI: 10.1080/09638288.2017.1419293
Abstract: Drawing on the perspectives of stroke survivors, family members and domestic helpers, this study explores participants' experiences of self-perceived fall risk factors after stroke, common fall prevention strategies used, and challenges to community participation after a fall. Semi-structured interviews were conducted in Singapore with community-dwelling stroke survivors with a previous fall (n = 9), family caregivers (n = 4), and domestic helpers (n = 4) who have cared for a stroke survivor with a previous fall. Purposive s ling was used for recruitment all interviews were audio-recorded with permission and transcribed. Thematic analysis was conducted using NVivo (v10) software. All participants shared their self-perceived intrinsic and extrinsic fall risk factors and main challenges after a fall. For stroke participants and family caregivers, motivational factors in developing safety strategies after a previous fall(s) include social connectedness, independent living and community participation. For family caregivers and domestic helpers, the stroke survivor's safety is their top priority, however this can also lead to over-protective behavior outside of the rehabilitation process. Reducing the risk of falls in community-dwelling stroke survivors seems to be more important than promoting community participation among caregivers. The study findings highlight that a structured and client-centered fall prevention program targeting stroke survivors and caregivers is needed in Singapore. Implications for rehabilitation Falls after stroke can lead to functional decline in gait and mobility and restricted self-care activities. Community-dwelling stroke survivors develop adaptive safety strategies after a fall and want to be socially connected. However, caregivers see the safety of the stroke survivors as their top priority and demonstrate over-protective behaviors. Fall prevention programs for community-dwelling stroke survivors should target both stroke survivors and their caregivers. A structured and client-centered fall prevention program targeting at multiple risk factors post-stroke is needed for community-living stroke survivors.
Publisher: Human Kinetics
Date: 10-2023
Abstract: Frailty in later life is often associated with functional declines and reduced quality of life. A multicomponent frailty management program (mFMP) is lacking in Singapore. This study aimed to determine the feasibility and effects of an mFMP in reducing frailty and increasing participation among frail community-living older adults. Pre- and postassessments at three time points were conducted to compare the differences in body functions between the mFMP (experimental group [EG]) and a fitness program (control group [CG]). Recruitment, dropouts, and fall data were collected. Weekly field notes and semistructured interviews postintervention were thematically analyzed. Sixteen out of 23 participants (EG: eight CG: eight) completed the 12-week interventions with reduced frailty immediately postintervention. At 3-month postintervention, 10 participants (EG: five CG: five) being followed up had a sustained level of frailty ( p .05). The EG and CG reported zero and two falls, respectively. The mFMP demonstrated its feasibility and exhibited a trend to facilitate personal behavioral changes postintervention.
Publisher: Springer Science and Business Media LLC
Date: 22-09-2023
Publisher: Springer International Publishing
Date: 2021
Publisher: Informa UK Limited
Date: 18-06-2021
Publisher: Wiley
Date: 25-05-2022
Abstract: Disruptions caused by the COVID‐19 pandemic have not only restricted people from performing occupations but also adversely affected their health and quality of life. However, the impact of the pandemic on Singaporean adults at different life stages remains unclear. This study aimed to understand the impact of COVID‐19 on a range of community‐living age groups' occupations and sense of well‐being. Community‐living adults in Singapore were invited to participate in this qualitative descriptive study. Thematic analysis was conducted to generate themes and identify common patterns (e.g. impacts on different occupations) in different age groups. Twenty‐nine semi‐structured interviews (young adults: 10, middle‐aged adults: 10, older adults: 9) were conducted and thematically analysed, revealing three main themes: (1) impact on occupations, (2) impacts on personal well‐being, and (3) responses to COVID‐19 situation. Participants from all age groups experienced both positive and negative impacts across various occupations, such as productivity (work and study), leisure, and self‐care activities. Young and middle‐aged adults were less affected as they were more proficient in using technology to make adequate adaptations. Older adults were least equipped with coping strategies and thus the most compromised. In response to the impacts of the pandemic on occupations and well‐being, participants from different age groups adjusted differently (e.g. adopting a sedentary lifestyle and developing different coping strategies). This study identified the impacts of COVID‐19 on the daily occupations of Singaporean adults and how it is intricately linked with their well‐being. Findings also revealed the significant role of technology in adapting to the COVID‐19 situation. The younger Singaporean adults were more agile to make occupational changes and adaptations. More can be done by occupational therapists to assist community‐living older adults to enable continued participation in meaningful occupations during pandemics.
Publisher: Institution of Engineering and Technology (IET)
Date: 02-2015
Publisher: SAGE Publications
Date: 03-09-2021
Abstract: Intervention studies to date have shown limited evidence of falls reduction in community-dwelling stroke survivors. This study tests the acceptability and feasibility of the Stepping On after Stroke programme in Singapore. A pre–post-intervention study design was used over a 6-month period. Falls incidence was the main outcome measure, with the recruitment process and attendance rate recorded to test feasibility. Data analysis from evaluation questionnaires (descriptive statistics) and interviews (content analysis) were applied to determine acceptability. Eight stroke participants and seven caregivers completed the programme at two community sites facilitated by two programme leaders. Stroke participants achieved full attendance over the 7-week programme but family caregivers did not (38%). All participants highlighted their acceptability of the group-based falls-prevention programme. Both programme leaders achieved 92% fidelity in session delivery. Four stroke participants fell during the study period. Stroke participants demonstrated clinically meaningful improvements in community participation at 1 month post-intervention. Family caregivers reported no changes in pre–post evaluations. The Stepping On after Stroke programme appears feasible and acceptable to therapists and service users in Singapore however, caregivers’ participation was limited. Findings can be used to further improve the programme and its methodology before testing its effectiveness in a larger-scale trial.
Publisher: Oxford University Press (OUP)
Date: 20-07-2023
Abstract: Falls among older adults are a significant health problem globally. Studies of multicomponent fall prevention programmes in randomised controlled trials demonstrate effectiveness in reducing falls, however, the translation of research into the community remains challenging. While there is an increasing interest to understand the factors contributing to implementation barriers, the dynamic relationships between factors are less well examined. Furthermore, evidence on implementation barriers from Asia is lacking as most of these studies originate from the West. As such, this study aims to engage stakeholders in uncovering the factors that facilitate or inhibit implementing community-based fall prevention programmes in Singapore, with a focus on the inter-relationship between those factors. Healthcare professionals familiar with fall prevention programmes were invited to discuss the enablers and challenges to the implementation. This effort was facilitated using a systems modelling methodology of Group Model Building (GMB), to share ideas and to create a common conceptual model of the challenges. The GMB employs various engagement techniques to draw on the experiences and perceptions of all stakeholders involved. This process led to the development of a Causal Loop Diagram (CLD), a qualitative conceptual model of the dynamic relationships between the barriers and facilitators of implementing fall prevention programmes. Results from the CLD show that implementation is influenced by two main drivers: healthcare provider factors that influenced referrals, and patient factors that influenced referral acceptance and long-term adherence. Key leverage points for potential interventions were identified as well. The overall recommendation emphasised closer coordination and collaboration across providers to ensure sustainable and effective community-based fall prevention programmes. This has to be supported by a national effort, involving a multidisciplinary stakeholder advisory group. These findings generated would be promising to guide future approaches to fall prevention.
Publisher: ACM
Date: 20-03-2017
Publisher: Informa UK Limited
Date: 19-10-2022
DOI: 10.1080/09593985.2022.2135420
Abstract: Falls efficacy posits an understanding of the perceived ability to prevent and manage falls. There have been no validated self-reported instruments to measure the perceived ability to recover balance in response to destabilizing perturbations. To develop a scale of balance recovery confidence. Stage one had candidate items generated by 12 community-dwelling adults aged 65 and older using the nominal group technique. Stage two had the scale's name, instructions, response options, recall period and the items validated for appropriateness with 28 healthcare professionals and 10 older adults using an e-Delphi technique. Stage three had the scale's psychometric properties evaluated with 84 older adults who had completed self-reported and performance measures. Factor analysis was applied to confirm unidimensionality. The internal structure, reliability and validity of the scale were evaluated using the classical test theory and Rasch measurement theory. The 19-item scale was developed and validated with experts' consensus. The scale is unidimensional with excellent internal structure (Cronbach's α = 0.975) and test-retest reliability with Intraclass Correlation Coefficient (ICC The balance recovery confidence scale is a distinct instrument that measures perceived reactive balance recovery. The scale has good psychometric properties and can be used to complement other measurement instruments to help older adults cope with challenges to balance.
Publisher: BMJ
Date: 06-2023
DOI: 10.1136/BMJOPEN-2023-072029
Abstract: Falls are an important public health issue with consequences that include injuries, quality of life reduction and high healthcare costs. Studies show that falls prevention strategies are effective in reducing falls rate among community-dwelling older adults. However, the evaluation for effectiveness was usually done in a controlled setting with homogeneous population, and thus may not be generalisable to a wider population. This study aims to evaluate the impact of community falls prevention programmes with group-based strength and balance exercises, on falls risk and health outcomes for older adults with falls risk in Singapore. This is a pragmatic closed cohort stepped-wedge cluster randomised trial design study, which involves sequential crossover of clusters from the waitlist control condition to the intervention condition, with the sequence of crossover randomly determined. The intervention will be sequentially rolled out to 12 clusters (a minimum of 5 participants/cluster), over 6 time periods with 8-week intervals in Central and North regions of Singapore. The primary analysis will be conducted under the intention-to-treat principle. A general linear mixed model or generalised estimating equation analysis appropriate for a multilevel longitudinal study incorporating an appropriate error distribution and link function will be used. Markov model will be developed to estimate the incremental cost per quality-adjusted life years and incremental cost per fall prevented from the implementation of falls prevention strategies from a societal perspective. Conditional on there being clinically relevant differences in short-term outcomes, we will implement simulation modelling to project the long-term ergence in trajectories for outcomes and costs using the Markov model. Ethics approval has been obtained. Results will be disseminated in publications and other relevant platforms. NCT04788251 .
Publisher: Institute of Electrical and Electronics Engineers (IEEE)
Date: 11-2014
Publisher: Informa UK Limited
Date: 15-09-2022
DOI: 10.1080/17483107.2022.2121008
Abstract: With an ageing population, the use of mobility scooters by community-dwelling older adults with mobility limitations has been increasingly prevalent in Singapore. Their experiences in using mobility scooters remain unclear. This study aimed to explore the impact of mobility scooters on occupational performance and engagement among elderly Singaporeans. Mobility scooter users were recruited Twelve eligible participants (mean age: 75 years) completed the interviews. They were predominantly female Chinese with 7 receiving training from occupational therapists (OT). Four main themes emerged from the interviews describing their experiences of using mobility scooters: factors of decision-making in getting a mobility scooter, enhanced occupational participation with the use of the mobility scooter, enablers for community participation and barriers to community participation. Despite having barriers, older adults with mobility limitations generally still had positive experiences to continue using mobility scooters to perform occupations in the community. This study highlights the benefits of mobility scooters in supporting users' occupational performance and engagement in the community. Continual efforts are required from all stakeholders to provide an accessible environment and improve societal attitudes to further support the mobility scooter users.IMPLICATIONS FOR REHABILITATIONMobility scooter users can be deterred from performing their preferred occupations if they had a prior negative encounter and they mainly rely on self-developed coping strategies to overcome possible barriers in the community.Occupational therapists should identify and address the potential barriers when prescribing mobility scooters to older adult users.Occupational therapists should work collaboratively with other key stakeholders, such as external vendors and government agencies, to co-create a universal guideline to support and safeguard mobility scooter users.
Publisher: Informa UK Limited
Date: 18-05-2019
No related grants have been discovered for Tianma Xu.