Backward Chaining Method for Teaching Long-Term Care Residents to Stand Up from the Floor: A Pilot Randomized Controlled Trial.
Seven weeks of backward chaining lowered fear and widened life-space for long-term care residents even though strength stayed the same.
01Research in Context
What this study did
ABelteki et al. (2025) tested backward chaining to teach long-term care residents how to stand up from the floor. Half the residents got seven weeks of BCM lessons. The other half kept their normal routine.
Trainers broke the stand-up sequence into small steps. They taught the last step first, then added earlier steps one by one. Each week they tracked fear of falling, life-space mobility, and basic strength scores.
What they found
The BCM group felt less afraid of falling and moved around more areas of the home. Their strength and standard mobility scores did not change.
The usual-care group stayed the same on every measure. The fear drop and life-space gain were large enough to matter in daily life.
How this fits with other research
Blanchard et al. (1979) used the same backward chaining tactic forty-six years earlier. Four adults with profound disabilities learned to walk to school alone. Both studies show BCM works in residential settings for adults with intellectual disabilities.
Krentz et al. (2016) boosted walking with a simple token economy. AZ et al. boosted moving around with BCM. Different tools, same goal: get adults with ID to move more.
Robertson et al. (2013) paired walkers with microswitches to increase steps. AZ et al. taught floor-rise with no tech. Both raised adaptive mobility, but AZ focused on safety after a fall, not distance walked.
Why it matters
You can cut fear of falling even when strength stays flat. Start BCM at the final step: standing upright. Add earlier steps each session. Track life-space with a simple map of where the resident goes. Less fear means more willingness to leave the room, join meals, and take part in activities. Try a short weekly block—seven weeks fit most facility calendars.
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02At a glance
03Original abstract
<b>Objectives</b>: Older adults who worry about not being able to stand up from the floor after a fall, reduce their physical activity, which leads to a higher risk of falling. The Backward Chaining Method (BCM) was developed specifically for this population to safely teach and practice the movement sequence required to stand up from the floor. Our aim is to evaluate the effectiveness of using the BCM to teach older adults how to stand up from the floor, and to determine whether this training has an impact on functional mobility, muscle strength, fear of falling, and life-space mobility. <b>Methods</b>: A total of 26 residents of a long-term care facility were randomly allocated to two groups. Residents in the intervention group (IG, <i>n</i> = 13) participated in a seven-week training program to learn how to stand up from the floor with BCM, in addition to the usual care generally offered in long-term care facilities. The participants in the control group (CG, <i>n</i> = 13) received the usual care alone. The primary outcome measure was functional mobility, assessed by the Timed Up and Go test. Secondary outcome measures included functional lower limb strength, grip strength, fear of falling, and life-space mobility. The outcomes were measured at baseline and after the seven-week intervention period. <b>Results</b>: We found no significant between-group differences in functional mobility, lower limb strength and grip strength; however, IG subjects demonstrated significantly lower fear of falling scores, and significantly higher life-space mobility and independent life-space mobility scores compared to CG subjects after the training program. <b>Conclusions</b>: This study demonstrates that the Backward Chaining Method is a feasible, well-tolerated intervention in a long-term care setting and it may have meaningful benefits, particularly in lessening fear of falling and improving life-space mobility and independent life-space mobility when incorporated into the usual physiotherapy interventions.
, 2025 · doi:10.3390/jcm14155293