1
|
Rahimi S, Khankeh HR, Ebadi A, Mohammadian B, Eghbali M, habibzadeh F. Developing a fall prevention program in an inpatient spinal cord injury rehabilitation unit: A participatory action research study. PLoS One 2024; 19:e0304320. [PMID: 38985738 PMCID: PMC11236094 DOI: 10.1371/journal.pone.0304320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Accepted: 05/10/2024] [Indexed: 07/12/2024] Open
Abstract
IMPORTANCE Spinal cord injury is a lifelong disability necessitating early management of falls during inpatient admissions. However, there is a paucity of research on fall prevention and management in Spinal cord injury rehabilitation. OBJECTIVE(S) This study aimed at developing a fall prevention program in an inpatient rehabilitation Spinal cord injury unit. METHOD A participatory action research approach utilizing a before-and-after, mixed-method design was employed for this study. The study was performed at Rofaydeh Rehabilitation Hospital in Tehran, Iran, from 2021 to 2022. the study implemented Cohen's four-stage model, encompassing the design of a change program, action, observation and evaluation, and feedback stages. A purposeful sampling method was utilized to select 19 nurses and members of the rehabilitation team from the hospital, ensuring maximum diversity. Data collection involved semi-structured interviews, focus groups, and a checklist for fall prevention measures. Qualitative content analysis, alongside descriptive (frequency, mean, and standard deviation) and inferential statistics (paired t-tests and Chi-square tests), were employed for data analysis. The study adhered to COREQ guidelines. RESULTS Falls were most common among patients aged fifty years or older (P = 0.026). Throughout the study period, men were more likely to experience falls than women (P = 0.01). Preventive interventions have led to significant improvements in indicators of patient monitoring and care, patient education, and environmental safety, as demonstrated by a paired-sample t-test (P<0.001). Moreover, factors contributing to patients' falls included "shortcomings in fall prevention policies" and "lack of knowledge and participation among patients and caregivers." Changes implemented in the Spinal Cord Injury unit involved enhancing interprofessional interactions, conducting educational workshops for patients and their companions, and identifying high-risk patients. These findings indicate a significant decrease in the incidence of falls following the intervention (P = 0.02). CONCLUSIONS The study found that a multifaceted intervention can increase knowledge about fall risks and substantially reduce both falls and associated minor injuries.
Collapse
Affiliation(s)
- Shoeleh Rahimi
- PhD in Nursing, University of Social Welfare and Rehabilitation Sciences (USWR), Tehran, IR Iran
- Nurse of Javadalaimeh Hospital in Kharameh, Shiraz University of Medical Sciences, Shiraz, Fars, Iran
| | - Hamid Reza Khankeh
- Health in Emergency and Disaster Research Center, Social Health Research Institute, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Abbas Ebadi
- Behavioral Sciences Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
- Faculty of Nursing, Baqiyatallah University of Medical Sciences, Teheran, Iran
| | - Batol Mohammadian
- Department of Operating Room, School of Allied Medical Sciences, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Mohammad Eghbali
- Department of Nursing, school of Nursing and Midwifery, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
| | - Fatemeh habibzadeh
- MSC of Critical Care Nursing Tehran University of Medical Science, Tehran, Iran
| |
Collapse
|
2
|
Ong RHS, Nurjono M, Oh HC, Lien CTC, Jumala J, Teo RCC, Gan P, Kan KLM, Rosle LF, Wee MK, Low SL. Factors Influencing the Implementation of a Fall Prevention Exercise Program for Community-Dwelling Older Adults: A Qualitative Study Guided by the PRECEDE-PROCEED Model. Clin Interv Aging 2024; 19:857-871. [PMID: 38770185 PMCID: PMC11104366 DOI: 10.2147/cia.s454043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 04/27/2024] [Indexed: 05/22/2024] Open
Abstract
Purpose Multiple falls preventions exercise programs have been rolled out globally, however, few studies have explored the factors necessary for their implementation. This study aimed to investigate the factors influencing the implementation of "Steady Feet" (SF), a 12-week community fall prevention exercise intervention, for older adults living in Singapore. Material and Methods This study utilized purposive sampling to recruit two participant groups: (i) older adults who declined or withdrew from the program and (ii) providers of the program (eg, instructors). We conducted 22 semi-structured interviews, recordings were transcribed and translated, followed by thematic analysis. Data collection and analysis were informed by the PRECEDE-PROCEED framework, focusing on predisposing, enabling, and reinforcing factors. Results Findings revealed two predisposing, four enabling, and two reinforcing themes. Predisposing themes encompassed (i) knowledge, attitudes, and practices of older adults towards exercises and falls prevention, and (ii) perceptions and attitudes of providers towards SF. Both older adults and providers identified several enabling elements in implementing SF, emphasizing the significance of (i) accessibility, availability, and affordability. Providers highlighted (ii) tools and structural support for continual engagement, (iii) minimizing variations in capabilities through a competency development program, and (iv) fostering synergistic partnerships. Positive reinforcement included (i) the role of providers in engaging and promoting participation, (ii) family support, social networks, and (iii) incentives for older adults. Conversely, both groups highlighted negative reinforcements, including (iv) communication issues and (v) repetitive exercises, while providers specifically identified (vi) labor constraints as a deterrent for implementation. Conclusion Findings indicate that effective implementation necessitates a multifaceted approach. Promoting participation involves engaging instructors, emphasizing social bonds and family involvement, offering incentives, and providing subsidized or free classes. A competency development program proved effective in reducing variations in providers' capabilities. Strengthening community partnerships, with management support, was crucial for ensuring the availability and accessibility of falls prevention programs.
Collapse
Affiliation(s)
| | | | - Hong Choon Oh
- Health Services Research, Changi General Hospital, Singapore
- Centre for Population Health Research and Implementation, Singapore Health Services, Singapore
- Health Services & Systems Research, Duke-NUS Medical School, Singapore
| | | | - Junisha Jumala
- Rehabilitative Services, Changi General Hospital, Singapore
| | | | - Peiying Gan
- Community Nursing, Changi General Hospital, Singapore
| | | | | | - Moi Kim Wee
- Community and Mental Health, Changi General Hospital, Singapore
| | - Shou Lin Low
- Geriatric Medicine, Changi General Hospital, Singapore
| |
Collapse
|
3
|
Maximos M, Dal Bello-Haas V, Tang A, Stratford P, Kalu M, Virag O, Kaasalainen S, Gafni A. Barriers and Facilitators of a Community-Based, Slow-Stream Rehabilitation, Hospital-to-Home Transition Program for Older Adults: Perspectives of a Multidisciplinary Care Team. Can J Aging 2024; 43:124-140. [PMID: 37665030 DOI: 10.1017/s0714980823000442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023] Open
Abstract
The purpose of this study was to examine the perspectives of support staff, health care professionals, and care coordinators working in or referring to a community-based, slow-stream rehabilitation, hospital-to-home transition program regarding gaps in services, and barriers and facilitators related to implementation and functioning of the program. This was a qualitative descriptive study. Recruitment was conducted through purposive sampling, and 23 individuals participated in a focus groups or individual semi-structured interview. Transcripts were analyzed by six researchers using inductive thematic analysis. Themes that emerged were organized based on a socio-ecological framework. Themes were categorized as: (1) macro level, meaning gaps while waiting for program, limited program capacity, and gaps in service post-program completion; (2) meso level, meaning lack of knowledge and awareness of the program, lack of specific referral process and procedures, lack of specific eligibility criteria, and need for enhanced communication among care settings; or (3) micro level, meaning services provided, program participant benefits, person-centred communication, program structure constraints, need for use of outcome measures, and follow-up or lack of follow-up. Implementation of seamless patient information sharing, documentation, use of specific referral criteria, and use of standardized outcome measures may reduce the number of unsuitable referrals and provide useful information for referral and program staff.
Collapse
Affiliation(s)
- Melody Maximos
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Institute of Applied Health Science, Hamilton, ON, Canada
| | - Vanina Dal Bello-Haas
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Institute of Applied Health Science, Hamilton, ON, Canada
| | - Ada Tang
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Institute of Applied Health Science, Hamilton, ON, Canada
| | - Paul Stratford
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Institute of Applied Health Science, Hamilton, ON, Canada
| | - Michael Kalu
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Institute of Applied Health Science, Hamilton, ON, Canada
| | - Olivia Virag
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Institute of Applied Health Science, Hamilton, ON, Canada
| | - Sharon Kaasalainen
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Institute of Applied Health Science, Hamilton, ON, Canada
| | - Amiram Gafni
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Institute of Applied Health Science, Hamilton, ON, Canada
| |
Collapse
|
4
|
Arnold C, Lanovaz J, Banman D. Is it a Macho Thing? Older Adults' Perceptions of Gender Differences inFall Prevention Class Participation. J Appl Gerontol 2022; 41:1952-1959. [PMID: 35543184 PMCID: PMC9364234 DOI: 10.1177/07334648221095623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Perceptions that women are in greater need of fall prevention might impact their
participation in programs. This study aimed to understand gender differences in motivating
factors and experiences in a fall prevention program. Thirty-four adults (18 men and 16
women) aged 60 years or older participated in focus groups after 12 weeks of fall
prevention exercises and education. Six main themes emerged. It might be a macho
thing represented an overarching theme of why men might not participate in fall
prevention as readily as women. Personal experience as a motivator,
Get my balance back, and Challenges/Successes were
common themes for men and women. Both genders realized the benefits of the program;
however, men emphasized the importance of personal outcomes (Being part of
something bigger), whereas women highlighted group outcomes
(Socialization). These findings can guide the future messaging and
marketing of fall prevention programs for older adults.
Collapse
Affiliation(s)
- Catherine Arnold
- School of Rehabilitation Science, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Joel Lanovaz
- College of Kinesiology, University of Saskatchewan, Saskatoon, SK, Canada
| | - Danelle Banman
- Saskatchewan and College of Kinesiology, University of Saskatchewan, Saskatoon, SK, Canada
| |
Collapse
|
5
|
Bell T, Pope C, Fazeli P, Crowe M, Ball K. The Association of Persistent Low Back Pain With Older Adult Falls and Collisions: A Longitudinal Analysis. J Appl Gerontol 2020; 40:1455-1464. [PMID: 33095077 DOI: 10.1177/0733464820966517] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Mobility-related injuries associate with reduced quality of life, greater functional dependence, and quicker mortality in older adults-warranting prevention efforts. One factor elevating injury risk may be persistent low back pain, which can negatively affect cognitive and physical functions essential for safe mobility. Among older adults obtaining license renewal (n = 1,127), this study examined the association between persistent low back pain and incidence of falls and motor vehicle collisions (MVCs) for up to 15 years. Overall, older adults with persistent low back pain were more likely to have a fall (odds ratio [OR] = 1.54, 95% confidence interval [CI] = [1.34, 1.77]) or MVC (OR = 1.38, 95% CI = [1.07, 1.77]) than those without back pain. Furthermore, the number of falls and MVCs was lower for people with better lower limb and visuospatial function, respectively. Ameliorating pain and functioning in persistent lower back pain might contribute to improved mobility and a reduction of injury-related risk in later life.
Collapse
|
6
|
Szanton SL, Clemson L, Liu M, Gitlin LN, Hladek MD, LaFave SE, Roth DL, Marx KA, Felix C, Okoye SM, Zhang X, Bautista S, Granbom M. Pilot Outcomes of a Multicomponent Fall Risk Program Integrated Into Daily Lives of Community-Dwelling Older Adults. J Appl Gerontol 2020; 40:320-327. [PMID: 32193981 DOI: 10.1177/0733464820912664] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objectives: To evaluate whether a fall prevention intervention reduces fall risk in older adults who have previously fallen. Design: Randomized controlled pilot trial. Setting: Participants' homes. Intervention: LIVE-LiFE, adapted from Lifestyle-Intervention Functional Exercise (LiFE) integrates strength and balance training into daily habits in eight visits over 12 weeks. The adaptations to LiFE were to also provide (a) US$500 in home safety changes, (b) vision contrast screening and referral, and (c) medication recommendations. Control condition consisted of fall prevention materials and individualized fall risk summary. Measurement: Timed Up and Go (TUG) and Tandem stand. Falls efficacy, feasibility, and acceptability of the intervention. Results: Sample (N = 37) was 65% female, 65% White, and average 77 years. Compared with the control group, each outcome improved in the intervention. The LIVE-LiFE intervention had a large effect (1.1) for tandem stand, moderate (0.5) in falls efficacy, and small (0.1) in the TUG. Conclusion: Simultaneously addressing preventable fall risk factors is feasible.
Collapse
Affiliation(s)
- Sarah L Szanton
- Johns Hopkins School of Nursing, Baltimore, MD, USA.,Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lindy Clemson
- The University of Sydney, New South Wales, Australia
| | - Minhui Liu
- Johns Hopkins School of Nursing, Baltimore, MD, USA
| | | | | | | | | | | | - Cynthia Felix
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Safiyyah M Okoye
- Johns Hopkins School of Nursing, Baltimore, MD, USA.,Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Xuan Zhang
- Johns Hopkins School of Nursing, Baltimore, MD, USA
| | | | | |
Collapse
|