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DeWalt NC, Stahorsky KA, Sturges S, Bena JF, Morrison SL, Drobnich Sulak L, Szczepinski L, Albert NM. Simulation Versus Written Fall Prevention Education in Older Hospitalized Adults: A Randomized Controlled Study. Clin Nurs Res 2023; 32:278-287. [PMID: 35291853 DOI: 10.1177/10547738221082192] [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: 02/01/2023]
Abstract
Using a randomized controlled, non-blinded, two-group design, differences in fall risk assessment, post-discharge sustainable fall risk changes, fall events and re-hospitalization were examined in 77 older adults who received a simulation (n = 36) or written (n = 41) education intervention. Between-group differences and changes in pre- versus post-fall risk assessment scores were examined using Pearson's chi-square, Wilcoxon rank sum or Fisher's exact tests (categorical variables) and two-sample t-tests (continuous variables). There were no statistically significant differences between groups in demographic characteristics. Patients who received simulation education had higher fall risk post-assessment scores than the written education group, p = .022. Change in fall risk assessment scores (post-vs.-pre; 95% confidence intervals) were higher in the simulation group compared to the written education group, 1.43 (0.37, 2.50), p = .009. At each post-discharge assessment, fall events were numerically fewer but not significantly different among simulation and education group participants. There were no statistically significant between-group differences in re-hospitalization.
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Affiliation(s)
- Nancy C DeWalt
- Cleveland Clinic Hillcrest Hospital, Mayfield Heights, OH, USA
| | | | - Susan Sturges
- Cleveland Clinic Hillcrest Hospital, Mayfield Heights, OH, USA
| | - James F Bena
- Cleveland Clinic Hillcrest Hospital, Mayfield Heights, OH, USA
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Brach JS, Juarez G, Perera S, Cameron K, Vincenzo JL, Tripken J. Dissemination and Implementation of Evidence-Based Falls Prevention Programs: Reach and Effectiveness. J Gerontol A Biol Sci Med Sci 2022; 77:164-171. [PMID: 34244780 PMCID: PMC8751789 DOI: 10.1093/gerona/glab197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Using the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework, we describe the implementation of evidence-based fall prevention programs (EBFPPs) by Administration for Community Living grantees during 2014-2019. METHOD Forty-four grantees contributed to the national data repository. Data components include workshop information, participant information, attendance records, and organizational data. Data were collected before and after implementation of the EBFPPs. RESULTS Ten different programs were offered in 35 states with the most common settings being senior centers (25.3%), residential facilities (16.8%), health care organizations (12.5%), and faith-based organizations (11.1%). Individuals who participated in the programs (N = 85 848) had an age of 75.5 ± 9.7 years and were primarily female (79.7%), and the majority (86.2%) reported at least some fear of falling. At the postprogram assessment, 31.8% reported less fear of falling, 21.6% reported fewer falls, and 10.1% reported fewer injurious falls (all p < .0001). CONCLUSIONS EBFPPs implemented by Administration for Community Living grantees reached over 85 000 older adults. Participation in the EBFPPs resulted in improved confidence, decreased fear of falling, and fewer falls and injurious falls. Future efforts should focus on reaching specific underserved minorities and examining the effectiveness of individual programs.
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Affiliation(s)
- Jennifer S Brach
- Department of Physical Therapy, University of Pittsburgh, Pennsylvania, USA
| | - Gardenia Juarez
- Department of Physical Therapy, University of Pittsburgh, Pennsylvania, USA
| | - Subashan Perera
- Department of Medicine, University of Pittsburgh, Pennsylvania, USA
- Department of Biostatistics, University of Pittsburgh, Pennsylvania, USA
| | - Kathleen Cameron
- National Council on Aging Center for Healthy Aging, Arlington, Virginia, USA
| | - Jennifer L Vincenzo
- Department of Physical Therapy, University of Arkansas Medical Sciences, Fayetteville, USA
| | - Jennifer Tripken
- National Council on Aging Center for Healthy Aging, Arlington, Virginia, USA
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Balance Measurement Using Microsoft Kinect v2: Towards Remote Evaluation of Patient with the Functional Reach Test. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11136073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
To prevent falls, it is important to measure periodically the balance ability of an individual using reliable clinical tests. As Red Green Blue Depth (RGBD) devices have been increasingly used for balance rehabilitation at home, they may also be used to assess objectively the balance ability and determine the effectiveness of a therapy. For this, we developed a system based on the Microsoft Kinect v2 for measuring the Functional Reach Test (FRT); one of the most used balance clinical tools to predict falls. Two experiments were conducted to compare the FRT measures computed by our system using the Microsoft Kinect v2 with those obtained by the standard method, i.e., manually. In terms of validity, we found a very strong correlation between the two methods (r = 0.97 and r = 0.99 (p < 0.05), for experiments 1 and 2, respectively). However, we needed to correct the measurements using a linear model to fit the data obtained by the Kinect system. Consequently, a linear regression model has been applied and examining the regression assumptions showed that the model works well for the data. Applying the paired t-test to the data after correction indicated that there is no statistically significant difference between the measurements obtained by both methods. As for the reliability of the test, we obtained good to excellent within repeatability of the FRT measurements tracked by Kinect (ICC = 0.86 and ICC = 0.99, for experiments 1 and 2, respectively). These results suggested that the Microsoft Kinect v2 device is reliable and adequate to calculate the standard FRT.
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Yoshikawa A, Ramirez G, Smith ML, Lee S, Ory MG. Systematic review and meta-analysis of fear of falling and fall-related efficacy in a widely disseminated community-based fall prevention program. Arch Gerontol Geriatr 2020; 91:104235. [PMID: 32911232 DOI: 10.1016/j.archger.2020.104235] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 07/29/2020] [Accepted: 08/12/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Fear of falling restricts mobility and increases fall risk among older adults. Fall-related efficacy (i.e. the confidence to perform activities without falling), a construct related to fear of falling, has also been associated with active living and fall prevention. This study statistically synthesized the program effects of A Matter of Balance Volunteer Lay Leader (AMOB/VLL) model, designed to improve fall-related efficacy and promote daily activities among community-dwelling older adults. METHODS Research articles and doctoral dissertations that examined the effect of the AMOB/VLL on fear of falling and fall-related efficacy were searched from multiple databases. A random effects model was used to compute mean weighted effect sizes, 95 % CIs, and heterogeneity (I2). Bias was examined through a funnel plot and Egger's test. Factors associated with heterogeneity were also explored. RESULTS Seventeen AMOB/VLL studies involving 3,860 participants were identified. The pooled effects of the 13 studies with sufficient information for effect size calculation, were -0.29 (95 % CI: -0.40, -0.19) for fear of falling and 0.51 (95 % CI: 0.42, 0.60) for fall-related efficacy. Effect sizes differed partially due to outcome measures of fall-related efficacy. Covariate adjustment and study quality were not associated with differences in effect sizes. No substantial evidence of asymmetry and publication bias was found. CONCLUSION This study provides evidence supporting AMOB/VLL as an effective intervention for reducing fear of falling and improving fall-related efficacy. A greater consistency in outcome measures is needed to optimally capture changes in fear of falling and fall-related efficacy among community-dwelling older adults.
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Affiliation(s)
- Aya Yoshikawa
- Center for Population Health and Aging, Texas A&M University, College Station, TX 77843, USA.
| | - Gilbert Ramirez
- Center for Population Health and Aging, Texas A&M University, College Station, TX 77843, USA; Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station, TX 77843, USA.
| | - Matthew Lee Smith
- Center for Population Health and Aging, Texas A&M University, College Station, TX 77843, USA; Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, College Station, TX 77843, USA; Department of Health Promotion and Behavior, College of Public Health, The University of Georgia, Athens, GA 30602, USA.
| | - Shinduk Lee
- Center for Population Health and Aging, Texas A&M University, College Station, TX 77843, USA.
| | - Marcia G Ory
- Center for Population Health and Aging, Texas A&M University, College Station, TX 77843, USA; Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, College Station, TX 77843, USA.
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Mahoney JE, Pinzon MM, Myers S, Renken J, Eggert E, Palmer W. The Community-Academic Aging Research Network: A Pipeline for Dissemination. J Am Geriatr Soc 2020; 68:1325-1333. [PMID: 32039476 DOI: 10.1111/jgs.16363] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 12/17/2019] [Accepted: 01/16/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND/OBJECTIVES The Community-Academic Aging Research Network (CAARN) was created to increase the capacity and effectiveness of Wisconsin's Aging Network and the University of Wisconsin to conduct community-based research related to aging. The purpose of this article is to describe CAARN's infrastructure, outcomes, and lessons learned. DESIGN Using principles of community-based participatory research, CAARN engages stakeholders to participate in the design, development, and testing of older adult health interventions that address community needs, are sustainable, and improve health equity. SETTING Academic healthcare and community organizations. PARTICIPANTS Researchers, community members, and community organizations. INTERVENTION CAARN matches academic and community partners to develop and test evidence-based programs to be distributed by a dissemination partner. MEASUREMENTS Number of partnerships and funding received. RESULTS CAARN has facilitated 33 projects since its inception in 2010 (30 including rural populations), involving 46 academic investigators, 52 Wisconsin counties, and 1 tribe. These projects have garnered 52 grants totaling $20 million in extramural and $3 million in intramural funding. Four proven interventions are being prepared for national dissemination by the Wisconsin Institute for Healthy Aging: one to improve physical activity; one to reduce bowel and bladder incontinence; one to reduce sedentary behavior; and one to reduce falls risk among Latinx older adults. Additionally, one intervention to improve balance using a modified tai chi program is being disseminated by another organization. CONCLUSION CAARN's innovative structure creates a pipeline to dissemination by designing for real-world settings through inclusion of stakeholders in the early stages of design and by packaging community-based health interventions for older adults so they can be disseminated after the research has been completed. These interventions provide opportunities for clinicians to engage with community organizations to improve the health of their patients through self-management. J Am Geriatr Soc 68:1325-1333, 2020.
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Affiliation(s)
- Jane E Mahoney
- Division of Geriatrics and Gerontology, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Maria Mora Pinzon
- Division of Geriatrics and Gerontology, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Shannon Myers
- Wisconsin Institute for Health Aging, Madison, Wisconsin
| | - Jill Renken
- Wisconsin Institute for Health Aging, Madison, Wisconsin
| | - Erin Eggert
- Wisconsin Institute for Health Aging, Madison, Wisconsin
| | - Will Palmer
- Division of Geriatrics and Gerontology, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
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Sacino A, Rosenblatt K. Early Management of Acute Spinal Cord Injury-Part I: Initial Injury to Surgery. JOURNAL OF NEUROANAESTHESIOLOGY AND CRITICAL CARE 2019; 6:213-221. [PMID: 34012997 DOI: 10.1055/s-0039-1694688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Acute spinal cord injury is a devastating event associated with substantial morbidity worldwide. The pathophysiology of spinal cord injury involves the initial mechanical trauma and the subsequent inflammatory response, which may worsen the severity of neurologic dysfunction. Interventions have been studied to reduce the extent of primary injury to the spinal cord through preventive measures and to mitigate secondary insult through early specialized care. Management, therefore, is multifold, interdisciplinary, and begins immediately at the time of injury. It includes the trauma triage, acute management of the circulatory and respiratory systems, and definitive treatment, mainly with surgical decompression and stabilization.
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Affiliation(s)
- Amanda Sacino
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Kathryn Rosenblatt
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States.,Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
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