1 Research Critique Huang, T.-T., Yang., L.-H.,& Liu, C.-Y. (2011).

Reducing the fear of falling among communitydwelling elderly adults through cognitive-behavioral strategies and intense tai chi exercise: a randomized controlled trial. Journal of Advanced Nursing, 67(5), 961971. Evaluation of the appropriateness of the title The title of this article is appropriate because it accurately describes the purpose of the research study. These key words returned this article on a library database search: fear of falling, fall prevention, cognitive behavioral, elderly adults, and tai chi exercise. Identification of the research problem, purpose, and question The authors of this article strongly believe on the importance of developing a robust plan to use in reducing fear of fallingamongst the elderly population. They identify fear of falling as a major problem amongstthe elderly over the age of sixty. Therefore, the purpose of this study was, to examine the effectiveness of cognitive- behavioral strategies with /without intense tai chi exercise in reducing fear of falling among community-dwelling elderly adults (Huang,Yang, and Liu, 2011).There was no direct research question posed by the authors but one could infer from reading this article that the question addressed is: how effective is cognitive-behavioral strategies with or without tai chi exercise in reducing the fear of falling among elderly adults (Huang et al., 2011)? Critique of the literature review The literature review of this study was introduced by first discussing the prevalence of falls and its associated problems among older adults in a community-dwelling. The major problem identified in this literature was the fear of falling and the impact it had on the physical and mental well-being of older adults typically over the age of 65. The authors stated facts from previous research that were of relevance to the purpose of their study.A study done in 2005

2 found that elders exhibiting a certain level of fear of falling were able to cope more effectively in fall prevention but that having too much fear, compromise mental and physical well-being.There were other studies examined that dated between 2006and 2009; the findings from those studies indicated that interventions focusing on exercise and education were effective in reducing fear of falling in the elderly. According to (Huang et al., 2011), there was no study found that combined tai chi exercise with cognitive-behavioral strategy in reducing fear of falling amongst communitydwelling older adults. The study was accepted for publication 13 November 2010 and the benefit of this combination therapy is still of relevance in enhancing the mobility and quality of life of the elderly practitioners. Ethical consideration Participation in this study was voluntary; those that accepted the invitation were assured of their confidentiality and had the option to withdraw at any time. It was documented in theliterature that each participant gave a written informed consent and the authors university was the institution oversight board that approved the study.Invitation to participate in the study was based on the absence of the use of prosthetic legs amongst the subjects thereby observing the principle of non-maleficence. Analysis of the research design and methodology The authors employed a randomized controlled design in conducting this study.The first author used a computer-developed program to randomly select and placed subjects in three groups respectively (control, cognitive-behavioral and tai chi with cognitive behavioral). The second author was blind to the selection process. The aim of this design selection was to eliminate bias usually associated with non-experimental design.

3 The population of interest for this study was older adult residing in rural area of northeastern Taiwan. The sample was obtained by probability sampling from the abovementioned population.Originally, 186 older adults over the age of 60 were randomly drawn from a sample consisting of 660 community dwellers but after screening using different parameters, and voluntary withdrawal of some subjects, the final sample was down to a 176 (73male and 103female) participants.Even though the sample for this experiment was obtained from a certain geographic location, it is fairly representative of older community dwellers. The main concept of interest in this study was the ways to reduce fear of falling and this was operationalized by applying different interventions to the subjects in the control group, the cognitive-behavioral group and the tai chi with cognitive-behavioral group.No measurement was applied to the control group. The cognitive behavioral group was measured using a management model. This model describes and explains how community-dwelling elders think and act when confronted with fear of falling (Huang et al., 2011). Fear of falling in the cognitivebehavioral with tai chi group wasmeasured using the Geriatric Fear of Falling Measure (GFFM) and the Fall Efficacy Scale (FES). Responses on these scale ranges from 1 to 10, and with a higher score indicating positive response to the intervention. The various data collected from performing this experiment were analyzed using SPSS 15.0. The significance level of P < 0.05 was also considered. Analysis of chi-square and variance statistics was used to test for the effects of the intervention on the 3 study group. Cronbachs alpha test was used to examine internal consistency. The results of the data analysis of the three groups differ significantly in both measures of fear of falling (F=30.33, P < 0.001; F=6.09, P < 0.001) and mobility (F < 0.05 and F=6.35, P < 0.001). The analysis of the scores from this study indicates that subjects in the tai chi with cognitive-behavioral group had lower fear of falling scores (P , 0.001) and higher mobility (P

4 <0.001), quality of life (P < 0.001) and social support satisfaction than those of the cognitivebehavioral alone and control groups (Huang et al., 2011). The authors of this study confirmed that there was significant improvement in the health of community-dwelling adults who participated in the combined therapy. Evaluation According to (Huang et al., 2011), this study did have several limitations. They acknowledged that the subjects recruited where from only one community thus making it difficult to approximate the findings to a different community. There was no inclusion of a tai chi only groupin the study and lastly, subjects were followed over a short period; long-term management would have been more beneficial. The implication of this study for nursing is to seek better outcomes for older adults by implementing the results of this research to improve their mobility.