title: Fear of falling and gait variability in older adults: a systematic review and meta-analysis.
abstract: BACKGROUND
  Fear of falling (FOF) and increased gait variability are both independent markers of gait instability. There is a complex interplay between both entities. The purposes of this study were (1) to perform a qualitative analysis of all published studies on FOF-related changes in gait variability through a systematic review, and (2) to quantitatively synthesize FOF-related changes in gait variability.
  
  
  METHODS
  A systematic Medline literature search was conducted in May 2014 using the Medical Subject Heading (MeSH) terms "Fear" OR "fear of falling" combined with "Accidental Falls" AND "Gait" OR "Gait Apraxia" OR "Gait Ataxia" OR "Gait disorders, Neurologic" OR "Gait assessment" OR "Functional gait assessment" AND "Self efficacy" OR "Self confidence" AND "Aged" OR "Aged, 80 and over." Systematic review and fixed-effects meta-analysis using an inverse-variance method were performed.
  
  
  RESULTS
  Of the 2184 selected studies, 10 observational studies (including 5 cross-sectional studies, 4 prospective cohort studies, and 1 case-control study) met the selection criteria. All were of good quality. The number of participants ranged from 52 to 1307 older community-dwellers (26.2%-85.0% women). The meta-analysis was performed on 10 studies with a total of 999 cases and 4502 controls. In one study, the higher limits of the effect size's confidence interval (CI) were lower than zero. In the remaining studies, the higher limits of the CI were positive. The summary random effect size of 0.29 (95% CI 0.13-0.45) was significant albeit of small magnitude, and indicated that gait variability was overall 0.29 SD higher in FOF cases compared with controls.
  
  
  CONCLUSIONS
  Our findings show that FOF is associated with a statistically significant, albeit of small magnitude, increase in gait variability.
authors.affiliation: Department of Neuroscience, Division of Geriatric Medicine, Angers University Hospital, Angers, France; UPRES EA 4638, UNAM, Angers University Hospital, Angers, France.
authors.forename: Farah
authors.initials: F
authors.lastname: Ayoubi
authors.affiliation: Department of Neuroscience, Division of Geriatric Medicine, Angers University Hospital, Angers, France.
authors.forename: Cyrille P
authors.initials: CP
authors.lastname: Launay
authors.affiliation: Department of Neuroscience, Division of Geriatric Medicine, Angers University Hospital, Angers, France; Robarts Research Institute, Department of Medical Biophysics, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, Canada.
authors.forename: Cédric
authors.initials: C
authors.lastname: Annweiler
authors.affiliation: Department of Neuroscience, Division of Geriatric Medicine, Angers University Hospital, Angers, France. Electronic address: olbeauchet@chu-angers.fr.
authors.forename: Olivier
authors.initials: O
authors.lastname: Beauchet
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control*; D000368:Aged; D005239:Fear / Q000523:psychology*; D020233:Gait Disorders, Neurologic / Q000503:physiopathology* / Q000523:psychology*; D006801:Humans
keywords: Fear of falling; falls; gait variability; motor control; older adults