1
|
Groos SS, Linn AJ, Kuiper JI, van Schoor NM, van der Velde N, van Weert JCM. Combining user-centered design and behavioral theory to enhance health technologies: A personas-based approach for a primary-care based multifactorial falls risk assessment tool. Int J Med Inform 2024; 186:105420. [PMID: 38518678 DOI: 10.1016/j.ijmedinf.2024.105420] [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] [Received: 12/13/2023] [Revised: 03/11/2024] [Accepted: 03/18/2024] [Indexed: 03/24/2024]
Abstract
INTRODUCTION Multifactorial falls risk assessment tools (FRATs) can be an effective falls prevention method for older adults, but are often underutilized by health care professionals (HCPs). This study aims to enhance the use and implementation of multifactorial FRATs by combining behavioral theory with the user-centered design (UCD) method of personas construction. Specifically, the study aimed to (1) construct personas that are based on external (i.e., needs, preferences) and intrinsic user characteristics (i.e., behavioral determinants); and (2) use these insights to inform requirements for optimizing an existing Dutch multifactorial FRAT (i.e., the 'Valanalyse'). METHODS Survey data from HCPs (n = 31) was used to construct personas of the 'Valanalyse.' To examine differences between clusters on 68 clustering variables, a multivariate cluster analysis technique with non-parametric analyses and computational methods was used. The aggregated external and intrinsic user characteristics of personas were used to inform key design and implementation requirements for the 'Valanalyse,' respectively, whereby intrinsic user characteristics were matched with appropriate behavior change techniques to guide implementation. RESULTS Significant differences between clusters were observed in 20 clustering variables (e.g., behavioral beliefs, situations for use). These variables were used to construct six personas representing users of each cluster. Together, the six personas helped operationalize four key design requirements (e.g., guide treatment-related decision making) and 14 implementation strategies (e.g., planning coping responses) for optimizing the 'Valanalyse' in Dutch geriatric, primary care settings. CONCLUSION The findings suggest that theory- and evidence-based personas that encompass both external and intrinsic user characteristics are a useful method for understanding how the use and implementation of multifactorial FRATs can be optimized with and for HCPs, providing important implications for developers and eHealth interventions with regards to encouraging technology adoption.
Collapse
Affiliation(s)
- Sara S Groos
- Department of Internal Medicine/Geriatrics, Amsterdam University Medical Centers, Location University of Amsterdam, Amsterdam, The Netherlands; Amsterdam Public Health Research Institute, Aging and Later Life, Amsterdam, The Netherlands.
| | - Annemiek J Linn
- Amsterdam School of Communication Research/ASCoR, University of Amsterdam, The Netherlands
| | | | - Natasja M van Schoor
- Amsterdam Public Health Research Institute, Aging and Later Life, Amsterdam, The Netherlands; Department of Epidemiology and Data Science, Amsterdam University Medical Centers, Location Vrije University, Amsterdam, The Netherlands
| | - Nathalie van der Velde
- Department of Internal Medicine/Geriatrics, Amsterdam University Medical Centers, Location University of Amsterdam, Amsterdam, The Netherlands; Amsterdam Public Health Research Institute, Aging and Later Life, Amsterdam, The Netherlands
| | - Julia C M van Weert
- Amsterdam School of Communication Research/ASCoR, University of Amsterdam, The Netherlands
| |
Collapse
|
2
|
Takase M, Kisanuki N, Nakayoshi Y, Uemura C, Sato Y, Yamamoto M. Exploring nurses' clinical judgment concerning the relative importance of fall risk factors: A mixed method approach using the Q Methodology. Int J Nurs Stud 2024; 153:104720. [PMID: 38408403 DOI: 10.1016/j.ijnurstu.2024.104720] [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] [Received: 10/06/2023] [Revised: 02/04/2024] [Accepted: 02/08/2024] [Indexed: 02/28/2024]
Abstract
BACKGROUND Nurses are pivotal in averting patient falls through their assessment of cues presented by patients and their environments, rendering clinical judgments regarding the risk of falling, and implementing tailored interventions. Despite the intricate cognitive processes entailed in nurses' judgment, no prior studies have explored their approach to assessing the risk of falling. OBJECTIVE This study aimed to examine how nurses judge the risk of falling among patients with different conditions, whether there are differences in the importance of risk factors as judged by nurses, how they justify their judgments, and what attributes of the nurses influence their judgments. DESIGN A mixed method approach using the Q Methodology was employed. SETTING(S) Three public and private hospitals in Japan. PARTICIPANTS Eighteen nurses participated in the study. METHODS Participants were tasked with ranking 36 patient scenarios, each featuring a distinct set of fall risk factors. Subsequently, post-sorting interviews were conducted to gather insights into their typical approach to assessing fall risk and the rationale behind their ranking decisions. A by-person principal component factor extraction was employed to examine differences in the rankings of the scenarios. The interview data were analyzed descriptively to elucidate the reasons behind these discrepancies. RESULTS Nurses engage in complex cognitive manipulations when evaluating the risk of patient falls, drawing extensively from their wealth of experience while utilizing assessment tools to support their judgments. In essence, nurses identify patients' tendency to act alone without calling a nurse, impaired gait and cognition, sedative use, drains, and limited information sharing among healthcare professionals as key fall risks. In addition, nurses vary in the importance they attribute to certain risk factors, leading to the discrimination of three distinct judgment profiles. One group of nurses judges patients with cognitive impairment and acting alone as high risk. Another group of nurses considers patients with unstable gait and acting alone as high risk. The last group of nurses sees patients wearing slippers as high risk. The post-sorting interviews revealed that their judgments are closely related to the healthcare context and patient population. CONCLUSIONS Nurses operate within diverse contexts, wherein they interact with patients of varying characteristics, collaborate with professionals from diverse disciplines, and have access to varying levels of human and physical resources. This nuanced understanding empowers the formulation of judgments that are finely attuned to the specific context at hand. STUDY REGISTRATION Not registered.
Collapse
Affiliation(s)
- Miyuki Takase
- School of Nursing, Yasuda Women's University, Hiroshima, Japan.
| | - Naomi Kisanuki
- School of Nursing, Yasuda Women's University, Hiroshima, Japan
| | - Yoko Nakayoshi
- School of Nursing, Yasuda Women's University, Hiroshima, Japan
| | - Chizuru Uemura
- School of Nursing, Yasuda Women's University, Hiroshima, Japan
| | - Yoko Sato
- Division of Nursing, Hiroshima University Hospital, Hiroshima, Japan
| | - Masako Yamamoto
- School of Nursing, Yasuda Women's University, Hiroshima, Japan
| |
Collapse
|
3
|
Carter EL, Hallen SAM, Welch GW, Gordon EN, Parker MG. Exploring attitudinal barriers to participation in inpatient fall risk assessment using the Theoretical Domains Framework: A survey of providers. Health Sci Rep 2024; 7:e2000. [PMID: 38605726 PMCID: PMC11006990 DOI: 10.1002/hsr2.2000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 02/27/2024] [Accepted: 03/07/2024] [Indexed: 04/13/2024] Open
Abstract
Background and Aims Lack of provider (physicians and advanced practice providers) participation in fall risk assessment was theorized to be contributing to rising rates of falls with injury at our institution. This project sought to identify if attitudinal barriers to inpatient provider participation in fall risk assessment were similar to those identified in other clinical settings. Methods Barriers to provider participation in fall risk assessment were identified in the literature. These were mapped to the Theoretical Domains Framework (TDF) domains to assist with interpretation of the data. A 10-item survey using a 5-point Likert scale (strongly agree to strongly disagree) with two open-ended questions was developed using these barriers. The survey was distributed via email to all providers on the Medical Staff in July 2021. Results The response rate was 9.1% (188/2062). 72.6% (95% confidence interval [CI]: 65.6, 78.5) of providers at our institution did agree that fall risk assessment was within their role and 72% (95% CI: 66.1, 78.5) agreed that assessment can prevent falls. Nearly half felt that they lacked formal training in fall risk assessment (48.1% [95% CI: 41.1, 55.1]) and 52.2% (95% CI: 44.6, 58.6) agreed that other aspects of patient care took priority over falls assessment. These barriers correlated best with the TDF domains of Beliefs about Capabilities and Beliefs about Consequences. Conclusions Survey results indicate that interventions focused on increasing provider motivation and capability regarding fall risk assessment and helping providers prioritize fall risk assessment are potential targets for future quality improvement projects.
Collapse
Affiliation(s)
- Emily L. Carter
- Division of Geriatric MedicineMaine Medical CenterPortlandMaineUSA
| | | | - Gavin W. Welch
- Department of Quality and Patient SafetyMaineHealthPortlandMaineUSA
| | - Erin N. Gordon
- Department of Family MedicineMaine Medical CenterPortlandMaineUSA
| | - Mark G. Parker
- Department of Quality and Patient SafetyMaineHealthPortlandMaineUSA
- Division of Nephrology and TransplantationMaine Medical CenterPortlandMaineUSA
| |
Collapse
|
4
|
Kehrer-Dunlap AL, Bollinger RM, Holden B, Ances BM, Stark S. Examining the impact of a health report card on follow through with fall risk recommendations: an observational study. BMC Geriatr 2024; 24:166. [PMID: 38365585 PMCID: PMC10873987 DOI: 10.1186/s12877-024-04686-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 01/09/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Increasing older adults' awareness of their personal fall risk factors may increase their engagement in fall prevention. The purpose of this study was to explore the impact of and participant satisfaction with a comprehensive occupational therapy fall risk screening and recommendations for evidence-based fall prevention strategies based on personalized fall risk results for community-dwelling older adults. METHODS Cognitively normal participants (Clinical Dementia Rating = 0) were recruited from an ongoing longitudinal study of memory and aging. Participants completed 2 annual in-home visits, fall risk questionnaires, and 12 months of fall monitoring between visits. Participants received a health report card with their fall risks and tailored recommendations in 6 domains. Participants completed follow-up questions at their next annual in-home visit about the fall risk recommendations and their satisfaction with receiving their fall risk results. RESULTS Two hundred five participants completed 2 annual visits and 12 months of fall monitoring. Of the 6 domains of recommendations provided, participants were most likely to follow through with getting an annual eye exam and reviewing their medications with their doctor or pharmacist. Older adults who fell were significantly more likely to receive recommendations for finding fall prevention classes (p = 0.01) and having a doctor or pharmacist review their medications (p = 0.004). The majority of participants were satisfied receiving their fall risk results (92%) and believed it to be beneficial (90%), though few participants shared their results with their doctor (20%). CONCLUSIONS An occupational therapy fall risk screening and tailored recommendations were not sufficient to encourage follow through with fall risk recommendations. Older adults may benefit from additional support and encouragement to reduce their fall risk. Additional research is needed to examine awareness of fall risks and follow through with fall risk recommendations among community-dwelling older adults.
Collapse
Affiliation(s)
- Abigail L Kehrer-Dunlap
- Program in Occupational Therapy, Washington University School of Medicine, 4444 Forest Park Ave, 63110, St Louis, MO, Box 8505, USA
| | - Rebecca M Bollinger
- Program in Occupational Therapy, Washington University School of Medicine, 4444 Forest Park Ave, 63110, St Louis, MO, Box 8505, USA
| | - Brianna Holden
- Program in Occupational Therapy, Washington University School of Medicine, 4444 Forest Park Ave, 63110, St Louis, MO, Box 8505, USA
| | - Beau M Ances
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Susan Stark
- Program in Occupational Therapy, Washington University School of Medicine, 4444 Forest Park Ave, 63110, St Louis, MO, Box 8505, USA.
| |
Collapse
|
5
|
Bjerk M, Flottorp SA, Pripp AH, Øien H, Hansen TM, Foy R, Close J, Linnerud S, Brovold T, Solli R, Olsen NR, Skelton DA, Rydwik E, Helbostad JL, Idland G, Kvæl L, Vieira E, Taraldsen K. Tailored implementation of national recommendations on fall prevention among older adults in municipalities in Norway (FALLPREVENT trial): a study protocol for a cluster-randomised trial. Implement Sci 2024; 19:5. [PMID: 38273325 PMCID: PMC10811923 DOI: 10.1186/s13012-024-01334-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 01/02/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Despite substantial research evidence indicating the effectiveness of a range of interventions to prevent falls, uptake into routine clinical practice has been limited by several implementation challenges. The complexity of fall prevention in municipality health care underlines the importance of flexible implementation strategies tailored both to general determinants of fall prevention and to local contexts. This cluster-randomised trial (RCT) investigates the effectiveness of a tailored intervention to implement national recommendations on fall prevention among older home-dwelling adults compared to usual practice on adherence to the recommendations in health professionals. METHODS Twenty-five municipalities from four regions in Norway will be randomised to intervention or control arms. Each municipality cluster will recruit up to 30 health professionals to participate in the study as responders. The tailored implementation intervention comprises four components: (1) identifying local structures for implementation, (2) establishing a resource team from different professions and levels, (3) promoting knowledge on implementation and fall prevention and (4) supporting the implementation process. Each of these components includes several implementation activities. The Consolidated Framework for Implementation Research (CFIR) will be used to categorise determinants of the implementation process and the Expert Recommendations for Implementing Change (ERIC) will guide the matching of barriers to implementation strategies. The primary outcome measure for the study will be health professionals' adherence to the national recommendations on fall prevention measured by a questionnaire. Secondary outcomes include injurious falls, the feasibility of the intervention, the experiences of the implementation process and intervention costs. Measurements will be carried out at baseline in August 2023, post-intervention in May 2024 and at a follow-up in November 2024. DISCUSSION This study will provide evidence on the effectiveness, intervention costs and underlying processes of change of tailored implementation of evidence-based fall prevention recommendations. TRIAL REGISTRATION The trial is registered in the Open Science Registry: https://doi.org/10.17605/OSF.IO/JQ9T5 . Registered: March 03, 2023.
Collapse
Affiliation(s)
- Maria Bjerk
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, Oslo Metropolitan University (OsloMet), Oslo, Norway.
- Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway.
| | - Signe A Flottorp
- Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Are Hugo Pripp
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, Oslo Metropolitan University (OsloMet), Oslo, Norway
- Oslo Centre of Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Henning Øien
- Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Tonya Moen Hansen
- Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | | | - Jacqueline Close
- Neuroscience Research Australia, Randwick, NSW, Australia
- Prince of Wales Hospital, SESLHD, Randwick, NSW, Australia
| | - Siv Linnerud
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, Oslo Metropolitan University (OsloMet), Oslo, Norway
| | - Therese Brovold
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, Oslo Metropolitan University (OsloMet), Oslo, Norway
| | - Rune Solli
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, Oslo Metropolitan University (OsloMet), Oslo, Norway
| | - Nina Rydland Olsen
- Department of Health and Functioning, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Dawn A Skelton
- Research Centre for Health (ReaCH), Department of Physiotherapy and Paramedicine, School of Health & Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Elisabeth Rydwik
- Women's Health and Allied Health Professionals Theme, Medical Unit Occupational Therapy and Physiotherapy, Karolinska University Hospital, Solna, Sweden
| | - Jorunn L Helbostad
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health, NTNU, Trondheim, Norway
| | - Gro Idland
- Agency for Health, Municipality of Oslo, Oslo, Norway
| | - Linda Kvæl
- Department of Housing and Ageing Research, Norwegian Social Research - NOVA, Oslo Metropolitan University (OsloMet), Oslo, Norway
| | - Edgar Vieira
- Department of Physical Therapy, Florida International University, Miami, FL, USA
| | - Kristin Taraldsen
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, Oslo Metropolitan University (OsloMet), Oslo, Norway
| |
Collapse
|
6
|
Kakara RS, Lee R, Eckstrom EN. Cause-Specific Mortality Among Adults Aged ≥65 Years in the United States, 1999 Through 2020. Public Health Rep 2024; 139:54-58. [PMID: 36905313 PMCID: PMC10905760 DOI: 10.1177/00333549231155869] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023] Open
Abstract
OBJECTIVE Reports on recent mortality trends among adults aged ≥65 years are lacking. We examined trends in the leading causes of death from 1999 through 2020 among US adults aged ≥65 years. METHODS We used data from the National Vital Statistics System mortality files to identify the 10 leading causes of death among adults aged ≥65 years. We calculated overall and cause-specific age-adjusted death rates and then calculated the average annual percentage change (AAPC) in death rates from 1999 through 2020. RESULTS The overall age-adjusted death rate decreased on average by 0.5% (95% CI, -1.0% to -0.1%) per year from 1999 through 2020. Although rates for 7 of the top 10 causes of death decreased significantly, the rates of death from Alzheimer disease (AAPC = 3.0%; 95% CI, 1.5% to 4.5%) and from unintentional injuries (AAPC = 1.2%; 95% CI, 1.0% to 1.4%), notably falls (AAPC = 4.1%; 95% CI, 3.9% to 4.3%) and poisoning (AAPC = 6.6%; 95% CI, 6.0% to 7.2%), increased significantly. CONCLUSION Public health prevention strategies and improved chronic disease management may have contributed to decreased rates in the leading causes of death. However, longer survival with comorbidities may have contributed to increased rates of death from Alzheimer disease and unintentional falls.
Collapse
Affiliation(s)
- Ramakrishna S. Kakara
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Robin Lee
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Elizabeth N. Eckstrom
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| |
Collapse
|
7
|
Linnerud S, Kvael LAH, Graverholt B, Idland G, Taraldsen K, Brovold T. Stakeholder development of an implementation strategy for fall prevention in Norwegian home care - a qualitative co-creation approach. BMC Health Serv Res 2023; 23:1390. [PMID: 38082278 PMCID: PMC10714538 DOI: 10.1186/s12913-023-10394-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 11/29/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND The uptake of fall prevention evidence has been slow and limited in home care services. Involving stakeholders in the implementation process is suggested as a method to successfully tailor implementation strategies. The aim of this study was to develop an implementation strategy for fall prevention, targeting healthcare providers working in home care services. METHODS This study used an explorative qualitative approach in a five-step co-creation process to involve researchers, service users, and healthcare providers. The first two steps consisted of workshops. This was followed by focus group interviews and individual interviews with key informants as steps three and four. Data from the first four steps were analyzed using reflexive thematic analysis. The fifth and final step was a workshop finalizing a strategy for implementing fall prevention evidence in home health services. RESULTS Overall, our findings, resulted in an implementation strategy for fall prevention with four components: (1) Empower leaders to facilitate implementation, operationalized through what managers pay attention to regularly, resource priorities, and time spent on fall prevention, (2) Establish implementation teams, consisting of multidisciplinary healthcare providers from different levels of the organization, with formalized responsibility for implementation, (3) Tailor dual competence improvement, reflecting the need for knowledge and skills for fall prevention and implementation among healthcare providers and users, and (4) Provide implementation support, representing guidance through the implementation process. CONCLUSIONS This study advances our understanding of implementation in home care services. Implementation of fall prevention requires an implementation strategy involving a blend of essential components targeting leaders, competent healthcare providers and users, and establishing structures enhancing the implementation process.
Collapse
Affiliation(s)
- Siv Linnerud
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, P.O. Box 4, St. Olavs plass, Oslo, N-0130, Norway.
| | - Linda Aimee Hartford Kvael
- Department of Housing and Ageing Research, Norwegian Social Science, OsloMet - Oslo Metropolitan University, P.O. Box 4, St. Olavs plass, Oslo, N-0130, Norway
| | - Birgitte Graverholt
- Department of Health and Functioning, Western Norway University of Applied Sciences, P.O. Box 7030, N-5020, Bergen, Norway
| | - Gro Idland
- Agency of Health, The municipality of Oslo, N-0130, Oslo, Norway
| | - Kristin Taraldsen
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, P.O. Box 4, St. Olavs plass, Oslo, N-0130, Norway
| | - Therese Brovold
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, P.O. Box 4, St. Olavs plass, Oslo, N-0130, Norway
| |
Collapse
|
8
|
Koh VJW, Matchar DB, Chan AWM, Lee JML, Lai WX, Rosario D, George A, Ho V, Ismail NHB, Lien CTC, Merchant RA, Tan SM, Wong CH, Xu T. Reducing Falls Among Community-Dwelling Older Adults From Clinicians' Perspectives: A Systems Modeling Approach. Innov Aging 2023; 7:igad077. [PMID: 37694132 PMCID: PMC10484166 DOI: 10.1093/geroni/igad077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Indexed: 09/12/2023] Open
Abstract
Background and Objectives Falls among older adults are a significant health problem globally. Studies of multicomponent fall prevention programs in randomized controlled trials demonstrate effectiveness in reducing falls; however, the translation of research into the community remains challenging. Although there is an increasing interest to understand the factors contributing to implementation barriers, the dynamic relationships between factors are less well examined. Furthermore, evidence on implementation barriers from Asia is lacking as most of these studies originate from the West. As such, this study aims to engage stakeholders in uncovering the factors that facilitate or inhibit implementing community-based fall prevention programs in Singapore, with a focus on the interrelationship between those factors. Research Design and Methods Health care professionals familiar with fall prevention programs were invited to discuss the enablers and challenges to the implementation. This effort was facilitated using a systems modeling methodology of Group Model Building (GMB) to share ideas and create a common conceptual model of the challenges. The GMB employs various engagement techniques to draw on the experiences and perceptions of all stakeholders involved. Results This process led to the development of a Causal Loop Diagram (CLD), a qualitative conceptual model of the dynamic relationships between the barriers and facilitators of implementing fall prevention programs. Results from the CLD show that implementation is influenced by two main drivers: health care provider factors that influenced referrals, and patient factors that influenced referral acceptance and long-term adherence. Key leverage points for potential interventions were identified as well. Discussion and Implications The overall recommendation emphasized closer coordination and collaboration across providers to ensure sustainable and effective community-based fall prevention programs. This has to be supported by a national effort, involving a multidisciplinary stakeholder advisory group. These findings generated would be promising to guide future approaches to fall prevention.
Collapse
Affiliation(s)
- Vanessa Jean Wen Koh
- Programme in Health Services and Systems Research (HSSR), Duke-NUS Medical School, Singapore, Singapore
- Centre for Ageing Research and Education (CARE), Duke-NUS Medical School, Singapore, Singapore
| | - David B Matchar
- Programme in Health Services and Systems Research (HSSR), Duke-NUS Medical School, Singapore, Singapore
- Department of Medicine (General Internal Medicine), Duke University Medical Center, Durham, North Carolina, USA
| | - Angelique Wei-Ming Chan
- Programme in Health Services and Systems Research (HSSR), Duke-NUS Medical School, Singapore, Singapore
- Centre for Ageing Research and Education (CARE), Duke-NUS Medical School, Singapore, Singapore
| | - June May-Ling Lee
- Centre for Ageing Research and Education (CARE), Duke-NUS Medical School, Singapore, Singapore
| | - Wei Xuan Lai
- Programme in Health Services and Systems Research (HSSR), Duke-NUS Medical School, Singapore, Singapore
| | - Dulcie Rosario
- Centre for Ageing Research and Education (CARE), Duke-NUS Medical School, Singapore, Singapore
| | - Anne George
- Rehabilitation Services, Changi General Hospital, Singapore, Singapore
| | - Vanda Ho
- Department of Geriatric Medicine, National University Hospital, Singapore, Singapore
| | | | | | - Reshma A Merchant
- Division of Geriatric Medicine, Department of Medicine, National University Hospital, Singapore, Singapore
| | | | - Chek Hooi Wong
- Programme in Health Services and Systems Research (HSSR), Duke-NUS Medical School, Singapore, Singapore
| | - Tianma Xu
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore, Singapore
| |
Collapse
|
9
|
Vincenzo JL, Brach JS, Bean J, Curran GM. Developing and Testing Implementation Strategies to support the Centers for Disease Control and Prevention's Initiative for Falls Risk Management in Outpatient Physical Therapy: A Protocol. Arch Rehabil Res Clin Transl 2023; 5:100268. [PMID: 37312984 PMCID: PMC10258383 DOI: 10.1016/j.arrct.2023.100268] [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: 06/15/2023] Open
Abstract
Objectives To develop and test implementation strategies to support implementing the Centers for Disease Control and Preventions' Stopping Elderly Accidents, Deaths, and Injuries (STEADI) initiative for falls prevention and falls risk management in a novel setting, outpatient physical therapy. Design A feasibility implementation study engaging key partners involved in or affected by the implementation throughout the study. Setting Five outpatient physical therapy clinics embedded in a health system. Participants Key partners (physical therapists, physical therapist assistants, referring physicians, administrative clinic staff, older adults, and caregivers) involved in or affected by the implementation (N=48) will participate in surveys and interviews to identify barriers and facilitators prior to implementation and post implementation. Twelve key partners representing at least 1 of each group will participate in evidence-based quality improvement panels to identify which barriers and facilitators are most important and feasible to address and to assist in choosing and designing implementation strategies to support the uptake of STEADI in outpatient rehabilitation. STEADI will be implemented in 5 outpatient physical therapy clinics as a standard of care for the ∼1200 older adults attending those clinics annually. Outcomes Primary outcomes include clinic- and provider-level (physical therapists and physical therapist assistant) adoption and fidelity to STEADI screening, multifactorial assessment, and falls risk interventions for older adults (65 years or older) attending outpatient physical therapy. Key partners' perceived feasibility, acceptability, and appropriateness of STEADI in outpatient physical therapy will also be measured using validated implementation science questionnaires. Exploratory clinical outcomes of older adults' falls risk pre- and post rehabilitation will be investigated.
Collapse
Affiliation(s)
- Jennifer L. Vincenzo
- Department of Physical Therapy, University of Arkansas for Medical Sciences, Fayetteville, Arkansas
| | - Jennifer S. Brach
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jonathan Bean
- New England Geriatric Research, Education and Clinical Center, VA Boston Healthcare System, Boston, Massachusetts
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Cambridge, Massachusetts
| | - Geoffrey M. Curran
- Center for Implementation Research, University of Arkansas for Medical Sciences, Little Rock, Arkansas
- Department of Pharmacy Practice, University of Arkansas for Medical Sciences, Little Rock, Arkansas
- Central Arkansas Veterans Healthcare System, Little Rock, Arkansas
| |
Collapse
|
10
|
Gemmeke M, Koster ES, van der Velde N, Taxis K, Bouvy ML. Patients' experience with a community pharmacy fall prevention service. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2023; 9:100223. [PMID: 36785796 PMCID: PMC9918784 DOI: 10.1016/j.rcsop.2023.100223] [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] [Received: 08/31/2022] [Revised: 12/27/2022] [Accepted: 01/14/2023] [Indexed: 01/22/2023] Open
Abstract
Background Pharmacists can contribute to fall prevention, by offering services such as fall risk screenings, counselling, and medication reviews. Patient acceptance of the role of pharmacists in fall prevention is crucial. Objectives The aim of this study was to explore patients' experience with a community pharmacy fall prevention service. Methods Interviews were conducted with patients one month after they participated in a pharmacy fall prevention service, in the Netherlands. Patient inclusion criteria for the service were: age ≥ 70 years, use of ≥5 drugs including ≥1 fall risk-increasing drug. The service included a fall risk screening followed by counselling and a medication review. The semi-structured interview guide was based on the consolidated framework for implementation research and included the following topics: outcomes, patient's motivation, and contact with the pharmacy technician. Results Of the 91 participants of the fall prevention service, 87 patients were interviewed with a median age of 78.0 years (first quartile [Q1] - third quartile [Q3]: 74.0-84.75) and 46.3% were female. Many patients expressed positive feedback about receiving a medication review. Most patients whose medication was deprescribed expressed to be positive about this. Others were reassured about the appropriateness of their medication use. Patients reported that the service enhanced their awareness about fall prevention. Only a few patients were motivated to adapt their lifestyle. Patients appreciated the attention and contact. Conclusions Patients see a potential benefit for a community pharmacy falls prevention service, including a medication review. Patient education appeared to enhance their fall risk awareness.
Collapse
Affiliation(s)
- Marle Gemmeke
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Faculty of Science, Utrecht University, Utrecht, the Netherlands
- Corresponding author at: Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, PO Box 80082, 3508 TB Utrecht, the Netherlands.
| | - Ellen S. Koster
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Faculty of Science, Utrecht University, Utrecht, the Netherlands
| | - Nathalie van der Velde
- Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Katja Taxis
- Department of Pharmacotherapy, Pharmacoepidemiology and Pharmacoeconomics (PTEE), Faculty of Science and Engineering, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, the Netherlands
| | - Marcel L. Bouvy
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Faculty of Science, Utrecht University, Utrecht, the Netherlands
| |
Collapse
|
11
|
Binns E, Bright F, Parsons J, Peri K, Taylor L, Kerse N, Taylor D. "It's all about the money": an interpretive description of embedding physical therapy-led falls prevention group exercise in long-term care. BMC Geriatr 2023; 23:14. [PMID: 36631743 PMCID: PMC9832407 DOI: 10.1186/s12877-022-03722-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 12/28/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Falls prevention interventions are effective for community dwelling older adults however, the same cannot be said for older adults living in long-term care (LTC). The Staying UpRight (SUp) randomized controlled trial was designed to test the effectiveness of a progressive strength and balance group exercise program delivered to LTC residents. This paper explores the factors impacting LTC providers' decisions to continue the program on completion of the funded trial period. METHODS A qualitative study using an Interpretive Description approach. Semi-structured interviews and focus groups were conducted with 15 LTC staff involved in the randomized controlled trial. Data were analysed using conventional content analysis. RESULTS Practice change occurred following participation in the trial with some facilities starting exercise groups, some increasing the number of exercise groups offered and physical therapists selecting elements of the program to adopt into their practice. Decisions about continuing with SUp as designed were constrained by organizational decisions regarding funding and resources. Three factors were identified which informed decision-making: business models and philosophies, requirements for evidence, and valuing physical therapy. CONCLUSIONS Managers and facilitators adapted SUp by selecting and delivering components of the program in response to the changes they had observed in participating residents. However, our findings highlight that while SUp was valued, the tight financial environment created by the current funding model in New Zealand did not support funding physical therapist delivered falls prevention exercise programs in LTC. This study may provide policy makers with important information on changes needed to support falls prevention service delivery in LTC. TRIAL REGISTRATION This study is a sub-study of a randomized controlled trial which was registered to the Australian New Zealand Clinical Trials Registry ACTRN12618001827224 on 09/11/2018. Universal trial number U1111-1217-7148.
Collapse
Affiliation(s)
- Elizabeth Binns
- grid.252547.30000 0001 0705 7067Physiotherapy Department, Auckland University of Technology, Wellesley Campus, Private Bag 92006, 1142 Auckland, New Zealand ,grid.252547.30000 0001 0705 7067Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
| | - Felicity Bright
- grid.252547.30000 0001 0705 7067Physiotherapy Department, Auckland University of Technology, Wellesley Campus, Private Bag 92006, 1142 Auckland, New Zealand ,grid.252547.30000 0001 0705 7067Centre for Person Centred Research, Auckland University of Technology, Auckland, New Zealand
| | - John Parsons
- grid.9654.e0000 0004 0372 3343School of Nursing, University of Auckland, Auckland, New Zealand ,grid.9654.e0000 0004 0372 3343Department of Exercise Sciences, University of Auckland, Auckland, New Zealand
| | - Kathy Peri
- grid.9654.e0000 0004 0372 3343School of Nursing, University of Auckland, Auckland, New Zealand
| | - Lynne Taylor
- grid.9654.e0000 0004 0372 3343School of Population Health, University of Auckland, Auckland, New Zealand
| | - Ngaire Kerse
- grid.9654.e0000 0004 0372 3343School of Population Health, University of Auckland, Auckland, New Zealand
| | - Denise Taylor
- grid.252547.30000 0001 0705 7067Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand ,New Zealand Dizziness & Balance Centre, Auckland, New Zealand
| |
Collapse
|
12
|
Lach HW, Berg-Weger M, Washington S, Malmstrom TK, Morley JE. Falls across Health Care Settings: Findings from a Geriatric Screening Program. J Appl Gerontol 2023; 42:67-75. [PMID: 36121797 DOI: 10.1177/07334648221124912] [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: 12/14/2022] Open
Abstract
Falls are a major public health problem for older adults, resulting in injuries and mortality. Screening is recommended to identify the multifactorial fall risks that can be addressed with interventions to prevent future falls. This study examined the utility of using the Rapid Geriatric Assessment (RGA) tool to identify fall risks across multiple settings. RGA data was collected at primary care sites, hospitals, long-term care settings, and community events (n = 8686, 65% female, mean age 77.6). Multinomial logistic regression was used to determine predictors of falls using the RGA. The FRAIL, SARC-F, Rapid Cognitive Screen and SNAQ measures all significantly predicted history of falls. The RGA provides a brief screening that can be used in any setting by multiple providers to identify fall risk.
Collapse
Affiliation(s)
- Helen W Lach
- Trudy Busch Valentine School of Nursing40272 Saint Louis University, Saint Louis, MO, USA
| | - Marla Berg-Weger
- School of Social Work, 40272Saint Louis University, Saint Louis, MO, USA
| | - Selena Washington
- Doisy College of Health Sciences, of Occupational Science and Occupational Therapy, 40272Saint Louis University, Saint Louis, MO, USA
| | | | - John E Morley
- School of Medicine, 40272Saint Louis University, Saint Louis, MO, USA
| |
Collapse
|
13
|
Duah-Owusu White M, Kelly F, Vassallo M, Nyman SR. Using a systems perspective to understand hospital falls among patients with dementia. AGING AND HEALTH RESEARCH 2022. [DOI: 10.1016/j.ahr.2022.100109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
14
|
Gemmeke M, Koster ES, van der Velde N, Taxis K, Bouvy ML. Establishing a community pharmacy-based fall prevention service - An implementation study. Res Social Adm Pharm 2022; 19:155-166. [PMID: 35995694 DOI: 10.1016/j.sapharm.2022.07.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 07/18/2022] [Accepted: 07/24/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND Community pharmacists are in the position to contribute to fall prevention, but this is not yet common practice. OBJECTIVE The aim of this study was to evaluate the implementation of a community pharmacy-based fall prevention service. METHODS A fall prevention service, consisting of a fall risk screening and assessment including a medication review, was implemented in pharmacies during three months. A preparative online training was provided to the pharmacy team to enhance adoption of the service. Included patients were aged ≥70 years, using ≥5 drugs of which ≥1 fall risk-increasing drug. The implementation process was quantitively assessed by registering medication adaptations, recommendations, and referrals. Changes in patient scores on the Short Fall Efficacy Scale-International (FES-I) and a fall prevention knowledge test were documented at one month follow-up. Implementation was qualitatively evaluated by conducting semi-structured interviews with pharmacists before and after the project, based on the consolidated framework of implementation research. RESULTS The service was implemented in nine pharmacies and 91 consultations were performed. Medication was adapted of 32 patients. Patients' short FES-I scores were significantly higher at follow-up (p = 0.047) and patients' knowledge test scores did not differ (p = 0.86). Pharmacists experienced the following barriers: lack of time, absence of staff, and limited multidisciplinary collaboration. Facilitators were training, motivated staff, patient engagement, and project scheduling. CONCLUSION The service resulted in a substantial number of medication adaptations and lifestyle recommendations, but many barriers were identified that hamper the sustained implementation of the service.
Collapse
Affiliation(s)
- Marle Gemmeke
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Faculty of Science, Utrecht University, Utrecht, the Netherlands
| | - Ellen S Koster
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Faculty of Science, Utrecht University, Utrecht, the Netherlands.
| | - Nathalie van der Velde
- Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Katja Taxis
- Department of Pharmacotherapy, Pharmacoepidemiology and Pharmacoeconomics (PTEE), Faculty of Science and Engineering, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, the Netherlands
| | - Marcel L Bouvy
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Faculty of Science, Utrecht University, Utrecht, the Netherlands
| |
Collapse
|
15
|
Burns ER, Lee R, Hodge SE, Pineau VJ, Welch B, Zhu M. Validation and comparison of fall screening tools for predicting future falls among older adults. Arch Gerontol Geriatr 2022; 101:104713. [PMID: 35526339 PMCID: PMC10543920 DOI: 10.1016/j.archger.2022.104713] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 04/27/2022] [Accepted: 04/29/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND Falls are the leading cause of injuries among older adults in the United States (US). Falls are preventable and clinicians are advised to screen for fall risk yearly. There are many falls screening tools and not all have been validated for their ability to predict future falls. METHODS We enrolled 1905 community-dwelling older adults into a 13-month study using a probability-based representative panel of the US population recruited from NORC at the University of Chicago's National Frame. Respondents completed a baseline survey, 11 monthly fall calendars, and a final survey. The baseline survey included six falls screening tools (the Stay Independent, Three Key Questions (3KQ), a modified American Geriatric/British Geriatric tool, the short Falls Efficacy-1[FES-I]) and two single screening questions ("I have fallen in the past year" and "How many times did you fall in the past 12 months?"). The baseline and final survey collected demographic and health information, including falls. Sensitivity, specificity, positive and negative likelihood ratios, and corresponding 95% confidence intervals were calculated in SAS using weighted proportions. RESULTS There were 1563 respondents who completed the final survey (completion rate 82%). Sensitivity estimates ranged from 22.5% for the short FES-I to 68.7% for the 3KQ. Specificity estimates ranged from 57.9% for the 3KQ to 89.4% for the short FES-I. CONCLUSIONS Falls screening tools have varying sensitivity and specificity for predicting the occurrence of a fall in the following 12 months.
Collapse
Affiliation(s)
- Elizabeth R Burns
- Division of Injury Prevention, National Center of Injury Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Atlanta, GA 30341, United States.
| | - Robin Lee
- Division of Injury Prevention, National Center of Injury Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Atlanta, GA 30341, United States
| | | | | | - Bess Welch
- NORC at the University of Chicago, United States
| | - Meimeizi Zhu
- NORC at the University of Chicago, United States
| |
Collapse
|
16
|
Perspectives of primary care providers on multidisciplinary collaboration to prevent medication-related falls. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2022; 6:100149. [PMID: 35755717 PMCID: PMC9218163 DOI: 10.1016/j.rcsop.2022.100149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 04/14/2022] [Accepted: 06/03/2022] [Indexed: 11/23/2022] Open
Abstract
Background The causes of falls are often multifactorial. The prevention of falls benefits from a multidisciplinary approach. As people who fall are generally older and users of polypharmacy who frequently visit pharmacies, pharmacists may contribute to fall prevention. Objective(s) This study aims to explore the perceptions of primary care providers on multidisciplinary collaboration in fall prevention especially with pharmacists. Methods Two focus groups were held with each of the following health disciplines: physiotherapists, home care nurses, and practice nurses. A topic list was developed based on the capability opportunity motivation – behaviour (COM-B) model and the theoretical domains framework (TDF). Focus groups were audiotaped and transcribed verbatim. Data were collected in the Netherlands between March and June 2021. Results Six online focus groups were held with 17 physiotherapists, 14 home care nurses, and 15 practice nurses. Participants reported to collaborate multidisciplinary to prevent falls, but they had very limited collaboration with community pharmacists regarding fall prevention. Participants had limited knowledge on drugs that increase the risk of falls. This contributed to their low awareness of the potential role of pharmacists in fall prevention. Other reasons for poor collaboration in fall prevention were lack of agreements with pharmacists, limited coordination and communication. Participants were open to more collaboration with pharmacists and believed this could potentially improve patient outcomes. Conclusions Multidisciplinary agreements among health care providers, including community pharmacists, about referral criteria, roles and responsibilities, communication and coordination, could stimulate further collaboration in fall prevention. Fall prevention needs to receive more attention from primary care providers. Primary care providers have low awareness of the potential role of pharmacists in fall prevention. Primary care providers are positive about collaborating with community pharmacists to prevent falls. Primary care providers need enhanced communication and coordination, clarification of roles, and agreements. Primary care providers expect community pharmacists to focus on deprescribing of fall risk-increasing drugs (FRIDs).
Collapse
|
17
|
Healthcare professional perspectives on barriers and enablers to falls prevention education: A qualitative study. PLoS One 2022; 17:e0266797. [PMID: 35476840 PMCID: PMC9045665 DOI: 10.1371/journal.pone.0266797] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 03/28/2022] [Indexed: 11/19/2022] Open
Abstract
In hospitals, patient falls prevention education is frequently delivered by nurses and allied health professionals. Hospital falls rates remain high globally, despite the many systems and approaches that attempt to mitigate falling. The aim of this study was to investigate health professional views on the enablers and barriers to providing patient falls education in hospitals. Four focus groups with 23 nursing and allied health professionals were conducted at 3 hospitals. Three researchers independently coded the data and findings were analysed thematically with a descriptive qualitative approach to identify and develop themes according to barriers and enablers. Barriers included (i) limited interprofessional communication about patient falls; (ii) sub-optimal systems for falls education for patients and health professionals, and (iii) perceived patient-related barriers to falls education. Enablers to providing patient falls education included: (i) implementing strategies to increase patient empowerment; (ii) ensuring that health professionals had access to effective modes of patient education; and (iii) facilitating interprofessional collaboration. Health professionals identified the need to overcome organisational, patient and clinician-related barriers to falls education. Fostering collective responsibility amongst health professionals for evidence-based falls prevention was also highlighted.
Collapse
|
18
|
Determination of Factors Affecting the Incidence of Falls, Fear of Falling, and Functional Status in Patients After Total Knee Arthroplasty. JOURNAL OF BASIC AND CLINICAL HEALTH SCIENCES 2022. [DOI: 10.30621/jbachs.1024664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
19
|
van Gulick DJJ, Perry SIB, van der Leeden M, van Beek JGM, Lucas C, Stuiver MM. A Prediction Model for Falls in Community-Dwelling Older Adults in Podiatry Practices. Gerontology 2022; 68:1214-1223. [PMID: 34979512 DOI: 10.1159/000520962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 11/12/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Falls are a worldwide health problem among community-dwelling older adults. Emerging evidence suggests that foot problems increase the risk of falling, so the podiatrist may be crucial in detecting foot-related fall risk. However, there is no screening tool available which can be used in podiatry practice. The predictive value of existing tools is limited, and the implementation is poor. The development of risk models for specific clinical populations might increase the prediction accuracy and implementation. Therefore, the aim of this study was to develop and internally validate an easily applicable clinical prediction model (CPM) that can be used in podiatry practice to predict falls in community-dwelling older adults with foot (-related) problems. METHODS This was a prospective study including community-dwelling older adults (≥65 years) visiting podiatry practices. General fall-risk variables, and foot-related and function-related variables were considered as predictors for the occurrence of falls during the 12-month follow-up. Logistic regression analysis was used for model building, and internal validation was done by bootstrap resampling. RESULTS 407 participants were analyzed; the event rate was 33.4%. The final model included fall history in the previous year, unsteady while standing and walking, plantarflexor strength of the lesser toes, and gait speed. The area under the receiver operating characteristic curve was 0.71 (95% CI: 0.66-0.76) in the sample and estimated as 0.65 after shrinkage. CONCLUSION A CPM based on fall history in the previous year, feeling unsteady while standing and walking, decreased plantarflexor strength of the lesser toes, and reduced gait speed has acceptable accuracy to predict falls in our sample of podiatry community-dwelling older adults and is easily applicable in this setting. The accuracy of the model in clinical practice should be demonstrated through external validation of the model in a next study.
Collapse
Affiliation(s)
- Danique J J van Gulick
- Department of Science and Data-analysis, RondOm Podotherapeuten, Podiatric Primary Care Center, Leusden, The Netherlands.,Department of Epidemiology and Data Science, University Medical Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| | - Sander I B Perry
- Department of Epidemiology and Data Science, University Medical Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Public Health Research Institute, University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Marike van der Leeden
- Amsterdam Rehabilitation Research Centre, Reade, Amsterdam, The Netherlands.,Department of Rehabilitation Medicine, University Medical Center Amsterdam, Vrije Universiteit, Amsterdam, The Netherlands
| | - Jolan G M van Beek
- Department of Science and Data-analysis, RondOm Podotherapeuten, Podiatric Primary Care Center, Leusden, The Netherlands
| | - Cees Lucas
- Department of Epidemiology and Data Science, University Medical Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Public Health Research Institute, University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Martijn M Stuiver
- Department of Epidemiology and Data Science, University Medical Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Public Health Research Institute, University Medical Center Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
20
|
Community pharmacists' perceptions on providing fall prevention services: a mixed-methods study. Int J Clin Pharm 2021; 43:1533-1545. [PMID: 34121152 PMCID: PMC8642357 DOI: 10.1007/s11096-021-01277-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 04/29/2021] [Indexed: 11/11/2022]
Abstract
Background Pharmacists may contribute to fall prevention particularly by identifying and deprescribing fall risk-increasing drugs (FRIDs) in patients with high fall risk. Objective To assess community pharmacists’ perceptions on providing fall prevention services, and to identify their barriers and facilitators in offering these fall prevention services including deprescribing of FRIDs. Setting A mixed-methods study was conducted with Dutch pharmacists. Method Quantitative (ranking statements on a Likert scale, survey) and qualitative data (semi-structured interviews) were collected. Out of 466 pharmacists who were invited to participate, 313 Dutch pharmacists ranked statements, about providing fall prevention, that were presented during a lecture, and 205 completed a survey. To explore pharmacists’ perceptions in-depth, 16 were interviewed. Quantitative data were analysed using descriptive statistics. All interviews were audiotaped and transcribed verbatim. The capability opportunity motivation-behaviour model was applied to interpret and analyse the findings of qualitative data. Main outcome measure Community pharmacists’ views on providing fall prevention. Results Pharmacists stated that they were motivated to provide fall prevention. They believed they were capable of providing fall prevention by FRID deprescribing. They perceived limited opportunities to contribute. Major barriers included insufficient multidisciplinary collaboration, patient unwillingness to deprescribe FRIDs, and lack of time. Facilitators included goal-setting behaviour, financial compensation, and skilled communication. Conclusion Despite the complex decision-making process in medication-related fall prevention, community pharmacists are motivated and feel capable of providing fall prevention. Opportunities for pharmacists to provide fall prevention services should be enhanced, for example by implementing multidisciplinary agreements.
Collapse
|
21
|
Romli MH, Mackenzie L, Tan PJ, Chiew RO, Tan SH, Tan MP. Comparison of Retrospective and Prospective Falls Reporting Among Community-Dwelling Older People: Findings From Two Cohort Studies. Front Public Health 2021; 9:612663. [PMID: 33777881 PMCID: PMC7994342 DOI: 10.3389/fpubh.2021.612663] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 01/26/2021] [Indexed: 11/13/2022] Open
Abstract
Background: While prospective recording is considered as the gold standard, retrospective recall is widely utilized for falls outcomes due to its convenience. This brings about the concern on the validity of falls reporting in Southeast Asian countries, as the reliability of falls recall has not previously been studied. This study aimed to evaluate the reliability of retrospective falls recall compared to prospective falls recording. Methods: A secondary analysis of data from two prospective recording methods, falls diary and falls calendar, from two different research projects were obtained and analyzed. Retrospective falls recall was collected either through phone interview or follow-up clinic by asking the participants if they had fallen in the past 12 months. Results: Two-hundred-sixty-eight and 280 elderly participated in the diary and calendar groups, respectively. Moderate (46%) and poor (11%) return rates were found on completed diary and calendar recording. Under-(32%) and overreporting (24%) of falls were found in diary compared to only 4% of overreporting for the calendar. Retrospective recall method achieved 57% response rate for the diary group (followed up at clinic) and 89% for the calendar group (followed up via telephone interview). Agreement between retrospective and prospective reporting was moderate for the diary (kappa =0.44; p < 0.001) and strong for the calendar (kappa = 0.89; p < 0.001). Conclusion: Retrospective recall is reliable and acceptable in an observation study within healthy community older adults, while the combination of retrospective and prospective falls recording is the best for an intervention study with frailer older population. Telephone interview is convenient, low cost, and yielded a high response rate.
Collapse
Affiliation(s)
- Muhammad Hibatullah Romli
- Department of Rehabilitation Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia.,Malaysian Research Institute on Ageing (MyAgeingTM), Universiti Putra Malaysia, Serdang, Malaysia
| | - Lynette Mackenzie
- Discipline of Occupational Therapy, Faculty of Health Sciences, University of Sydney, Camperdown, NSW, Australia
| | - Pey June Tan
- Health Services and Policy Research Division, Geriatric Education and Research Institute, Singapore, Singapore
| | - Re On Chiew
- Faculty of Medicine, University of Malaya, Kuala Lampur, Malaysia
| | - Shun Herng Tan
- Faculty of Medicine, University of Malaya, Kuala Lampur, Malaysia
| | - Maw Pin Tan
- Faculty of Medicine, University of Malaya, Kuala Lampur, Malaysia
| |
Collapse
|
22
|
Ahmad Ainuddin H, Romli MH, Hamid TA, Salim MSF, Mackenzie L. Stroke Rehabilitation for Falls and Risk of Falls in Southeast Asia: A Scoping Review With Stakeholders' Consultation. Front Public Health 2021; 9:611793. [PMID: 33748063 PMCID: PMC7965966 DOI: 10.3389/fpubh.2021.611793] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 01/27/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Research on rehabilitation for falls after stroke is warranted. However, published evidence on fall interventions with stroke survivors is limited and these are mainly international studies that may be less relevant for Southeast Asia. Objective: This review aims to systematically identify literature related to stroke rehabilitation for falls and risk of falls in Southeast Asia. Methods: A scoping review with stakeholders' consultation was implemented. An electronic search was conducted up to December 2020 on 4 databases (Medline, CINAHL, Scopus, ASEAN Citation Index). Only original studies conducted in Southeast Asia were selected. Results: The initial search yielded 3,112 articles, however, only 26 were selected in the final analysis. Most of the articles focused on physical rehabilitation and implemented conventional therapies. While the literature may reflect practice in Southeast Asia, stakeholders perceived that the literature was inadequate to show true practice, was not informative and missed several aspects such as functional, cognitive, and psychological interventions in managing falls. Individual-centric interventions dominated the review while community-based and environmental-focused studies were limited. Majority of the articles were written by physiotherapists while others were from physicians, occupational therapists, and an engineer but few from other healthcare practitioners (i.e., speech therapists, psychologists) or disciplines interested in falls. Conclusions: Falls prevention among stroke survivors has received a lack of attention and is perceived as an indirect goal in stroke rehabilitation in Southeast Asia. More innovative research adopted from falls research with older people is needed to advance falls prevention and intervention practice with stroke survivors.
Collapse
Affiliation(s)
- Husna Ahmad Ainuddin
- Center of Occupational Therapy Studies, Faculty of Health Sciences, Universiti Teknologi MARA Selangor, Selangor, Malaysia
- Department of Rehabilitation Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Muhammad Hibatullah Romli
- Department of Rehabilitation Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
- Malaysian Research Institute on Ageing, Universiti Putra Malaysia, Serdang, Malaysia
| | - Tengku Aizan Hamid
- Malaysian Research Institute on Ageing, Universiti Putra Malaysia, Serdang, Malaysia
| | - Mazatulfazura S. F. Salim
- Department of Rehabilitation Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Lynette Mackenzie
- Discipline of Occupational Therapy, Faculty of Medicine and Health, School of Health Sciences, University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
23
|
de Clercq H, Naude A, Bornman J. The perspectives of healthcare practitioners on fall risk factors in older adults. Health SA 2020; 25:1495. [PMID: 33354363 PMCID: PMC7736677 DOI: 10.4102/hsag.v25i0.1495] [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] [Received: 06/06/2020] [Accepted: 09/21/2020] [Indexed: 11/07/2022] Open
Abstract
Background Accidental falls could have severe and far-reaching consequences for older adults, their families and society at large. Healthcare practitioners’ (HCPs) perspectives on fall risk factors in older adults could assist in reducing and even preventing falls. Currently, no universal tool exists for this purpose. The World Health Organization’s globally accepted International Classification of Functioning, Disability and Health (ICF) was used. Aim This study aimed to (1) describe the perspectives of HCPs on fall risk factors in older adults in South Africa and (2) link these factors to the ICF. Setting Eighteen HCPs participated in two focus groups. Methods Using a qualitative research design, an inductive thematic analysis allowed for the identification of important themes, which were linked to the ICF. Results The factors mentioned by participants were categorised into 38 themes, which were linked to 142 ICF codes, of which 43% (n = 61) were linked to the Body Function category, 23% (n = 32) to the Environmental Factors category, 18% (n = 26) to the Body Structure category and 16% (n = 23) to the Activities and Participation category. HCPs revealed two relevant factors that were not captured in existing fall risk assessment tools (FRATs), namely ‘muscle-power functions’ and ‘mobility-of-joint functions’, which directly relate to the ability to execute mobility activities. Combining HCPs’ perspectives with other stakeholders and with literature provides a holistic picture of fall risk factors in older adults.
Collapse
Affiliation(s)
- Hendrika de Clercq
- Centre for Augmentative and Alternative Communication, Faculty of Humanities, University of Pretoria, Pretoria, South Africa
| | - Alida Naude
- Centre for Augmentative and Alternative Communication, Faculty of Humanities, University of Pretoria, Pretoria, South Africa
| | - Juan Bornman
- Centre for Augmentative and Alternative Communication, Faculty of Humanities, University of Pretoria, Pretoria, South Africa
| |
Collapse
|
24
|
Conde M, Hendry GJ, Woodburn J, Skelton DA. ´Feet are second class citizens`: exploring the perceptions of Scottish and Portuguese older adults about feet, falls and exercise- a qualitative study. J Foot Ankle Res 2020; 13:66. [PMID: 33176825 PMCID: PMC7659063 DOI: 10.1186/s13047-020-00434-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 10/28/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction Foot problems are likely to contribute to falls risk in older adults. Foot and ankle exercises may be beneficial, but uptake may be influenced by cultural factors. Few studies have explored the views of older adults from different cultural backgrounds about foot-specific falls risk factors, and foot and ankle falls prevention exercises. Objectives To explore the views of Scottish and Portuguese community-dwelling older adults who have experienced a fall, about any foot risk factors for falls, and foot and ankle exercises. Methods Cross-cultural qualitative study with (n = 6) focus groups exploring the perceptions of Scottish (n = 10, mean age 76 yrs) and Portuguese older adults (n = 14, mean age 66 years) aged, applying thematic analysis. Results One main theme `evolving awareness about feet and falls prevention´ and three subthemes; (i) Feet are often forgotten, (ii) the important role of footwear, (iii) need to look at my feet and do the exercises were identified. Scottish participants had more experience of falls prevention but there was a lack of knowledge surrounding foot-specific falls risk factors, and the role of ankle and foot exercise in the prevention of falls. Portuguese participants exhibited a fatalistic approach to falls. Conclusions Older adults from both nations had little knowledge of foot-specific falls risk factors, being initially unaware of the functional status of their feet and of the role of exercise in foot care and falls management. There were differences between national groups that should be accounted for when developing culturally adequate interventions.
Collapse
Affiliation(s)
- Monserrat Conde
- School of health and Life Sciences, Glasgow Caledonian University, Govan Mbeki Building, G4 0BA, Glasgow, Scotland, UK.
| | - Gordon J Hendry
- School of health and Life Sciences, Glasgow Caledonian University, Govan Mbeki Building, G4 0BA, Glasgow, Scotland, UK
| | - Jim Woodburn
- School of health and Life Sciences, Glasgow Caledonian University, Govan Mbeki Building, G4 0BA, Glasgow, Scotland, UK
| | - Dawn A Skelton
- School of health and Life Sciences, Glasgow Caledonian University, Govan Mbeki Building, G4 0BA, Glasgow, Scotland, UK
| |
Collapse
|
25
|
Worum H, Lillekroken D, Roaldsen KS, Ahlsen B, Bergland A. Reflections of older people about their experience of fall prevention exercise in the community- a qualitative study exploring evidence-based practice. BMC Public Health 2020; 20:1671. [PMID: 33167887 PMCID: PMC7650178 DOI: 10.1186/s12889-020-09630-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 09/29/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Evidence-based practice (EBP) ensures that clinicians use effective interventions to achieve desired outcomes, thereby contributing to the best quality of care. The perspective of the participants is fundamental in EBP, as they have their own individual and meaningful rationale for participating in fall prevention. This study aims to explore community-dwelling older people reflections about their reflections about EBP in physiotherapy based on their experiences of a fall prevention exercise program. METHODS We conducted semi-structured interviews with 16 community-dwelling older people (men = 7; women = 9). Data were analyzed using thematic analysis. RESULTS The analysis revealed three themes: 1) the tension between knowing and doing, 2) the power of the therapist-participant relationship and the process of putting knowledge into action, and 3) research is interwoven with successful therapy and is an integral component of it. EBP was considered as a collective negotiation and learning process of creating knowledge for clinical practice. The negotiation between different types of knowledge must be performed in a transparent dialogue and through interactive collaboration between the persons involved. The participants appreciated that the research findings indicate that practice gives results. CONCLUSIONS EBP was understood and utilized as a seal of approval and a "guarantee of high quality" treatment, and its effects varied based on older people's preferences, needs, and skills. The therapist's relational competence appeared to be crucial for the negotiation of various sources of knowledge relative to the older people's preferences.
Collapse
Affiliation(s)
- Hilde Worum
- Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway.
| | - Daniela Lillekroken
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Kirsti Skavberg Roaldsen
- Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway.,Department of Neurobiology, Health Sciences and Society, Karolinska Institute, Stockholm, Sweden.,Department of Research, Sunnaas Rehabilitation Hospital, Oslo, Norway
| | - Birgitte Ahlsen
- Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Astrid Bergland
- Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| |
Collapse
|
26
|
Worum H, Lillekroken D, Roaldsen KS, Ahlsen B, Bergland A. Physiotherapists' perceptions of challenges facing evidence-based practice and the importance of environmental empowerment in fall prevention in the municipality - a qualitative study. BMC Geriatr 2020; 20:432. [PMID: 33121434 PMCID: PMC7596977 DOI: 10.1186/s12877-020-01846-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 10/22/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Falls in older adults are an increasingly important public-health concern. Despite abundant research, fall rates have not been reduced, because implementation of evidence-based fall-prevention measures has been slow and limited. This study aims to explore physiotherapists' perceptions on external factors, such as public policy, organisation and leadership, regarding the relation between knowledge translation and the three elements of evidence-based practice (EBP) to effectively address barriers and facilitate the uptake of EBP in fall prevention. METHODS We conducted semi-structured interviews with 18 physiotherapists (men = 7; women = 11) working with fall prevention in the primary healthcare system. The physiotherapists ranged in age from 27 to 60 years (median 36 years) and had worked as a physiotherapist from 1 to 36 years (median 7 years). Data are analysed using thematic analysis. RESULTS The analysis revealed one main theme and four sub-themes. The main theme was 'Environmental empowerment enhances physiotherapists' capabilities for using EBP'. A resourceful work environment facilitates EBP, having access to information about research-based knowledge, supportive leadership, enough human resources and opportunities to learn and grow at work. The four sub-themes were as follows: 1) 'Tension between attributes of research-based knowledge and organisational routines and practices'; 2) 'Evidence must be informed by policymakers-What works?'; 3) 'Empowering culture and work environment-A steppingstone to EBP' and 4) 'Organisation readiness for EBP, managerial and clinical relations'. Success in environmental empowerment depends on the leader's role in creating preconditions at the workplace that may lead to important positive personal and organisational outcomes for EBP. Two-way communication and transfer-of-information are also key factors in the development of positive work engagement when using EBP. CONCLUSION The findings of this study outline tension between policy, leadership, organisational facilitators and EBP. Leadership is influenced by policy with ripple effects for the organisation and clinicians. Organisational facilitators form structural empowerment, which is the foundation for creating an EBP environment. TRIAL REGISTRATION 2018/2227/REC south-east C. Registered 19 December 2018, Norwegian Ethics Committee for Medical and Health Research Ethics.
Collapse
Affiliation(s)
- Hilde Worum
- Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway.
| | - Daniela Lillekroken
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Kirsti Skavberg Roaldsen
- Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
- Department of Neurobiology, Health Sciences and Society, Karolinska Institute, Stockholm, Sweden
- Department of Research, Sunnaas Rehabilitation Hospital, Oslo, Norway
| | - Birgitte Ahlsen
- Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Astrid Bergland
- Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| |
Collapse
|
27
|
Worum H, Lillekroken D, Ahlsen B, Roaldsen KS, Bergland A. Otago exercise programme-from evidence to practice: a qualitative study of physiotherapists' perceptions of the importance of organisational factors of leadership, context and culture for knowledge translation in Norway. BMC Health Serv Res 2020; 20:985. [PMID: 33109177 PMCID: PMC7590709 DOI: 10.1186/s12913-020-05853-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 10/22/2020] [Indexed: 12/22/2022] Open
Abstract
Background Falls and fall-related injuries are a major public health problem and an international priority for health services. Despite research showing that evidence-based fall prevention is effective, its translation into practice has been delayed and limited. Although organisational factors such as leadership, culture and context are key factors for implementing evidence-based practice, there is still limited information on whether these factors represent barriers in the Norwegian and international healthcare context. Thus, this study aimed to explore the views of physiotherapists in clinical practice and their leaders’ views on the importance of organisational factors, such as leadership, culture and contextual and human resources, regarding successful knowledge translation of the Otago evidence-based fall programme in a Norwegian community. Methods Four in-depth interviews with physiotherapists and a focus group interview with nine physiotherapists and leaders representing local hospitals and municipalities were conducted to collect data. The data were analysed using a thematic analysis. Results The analysis yielded an overarching theme: an empowering leader as an anchor is needed for successful knowledge translation of physiotherapists’ and leaders’ views about the role of organisational structure, leadership, culture, financial resources and competence in research-based knowledge, as well as how to enhance the clinical staff’s expertise. Four main themes further elaborated on the overarching theme: (1) multifactor leadership—the importance of reinforcement, knowledge, goals and attention; (2) potential for change in professional roles as shaped by culture, context and type of practice; (3) knowledge translation—the tension between real-life capabilities, optimism and learning; and (4) different types of support—environmental resources and social influences. Conclusions This study highlighted the importance of organisational factors in knowledge translation in fall prevention. The findings emphasise the importance of leaders’ role and style in providing a supportive culture and contextual factors during the knowledge translation process. This study provides an understanding of the knowledge translation and sustainability of evidence-based practice and the Otago exercise programme for fall prevention programmes for community-dwelling older adults in Norway. Supplementary Information Supplementary information accompanies this paper at 10.1186/s12913-020-05853-8.
Collapse
Affiliation(s)
- Hilde Worum
- Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, Postbox 4, St. Olavs Plass, 0130, Oslo, Norway.
| | - Daniela Lillekroken
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Birgitte Ahlsen
- Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, Postbox 4, St. Olavs Plass, 0130, Oslo, Norway
| | - Kirsti Skavberg Roaldsen
- Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, Postbox 4, St. Olavs Plass, 0130, Oslo, Norway.,Department of Neurobiology, Health Sciences and Society, Karolinska Institute, Stockholm, Sweden.,Department of Research, Sunnaas Rehabilitation Hospital, Oslo, Norway
| | - Astrid Bergland
- Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, Postbox 4, St. Olavs Plass, 0130, Oslo, Norway
| |
Collapse
|
28
|
de la Cuesta-Benjumea C, Abad-Corpa E, Lidón-Cerezuela B, Orts-Cortés I, Meseguer-Liza C, Arredondo-González CP. Situating Preventive Action in a Moral and Clinical Context: A Qualitative Synthesis on Fall Prevention. QUALITATIVE HEALTH RESEARCH 2020; 30:1913-1923. [PMID: 32564706 DOI: 10.1177/1049732320921144] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The prevention of falls is an integral part of the safety culture of health institutions with mandatory fall prevention programs set within health care facilities. Care providers are key in identifying the risks of falls and in implementing strategic actions to prevent them. With the aim to better understand practices of fall prevention, we conducted a synthesis of qualitative evidence on care providers' practices to prevent older people from falling in health care facilities. This synthesis is part of an integrative review of the role of care providers in fall prevention of adults aged 65 years and above. Primary studies were synthesized with the emerging core category of "a complex decision" and described by four emerging conditions that make that decision complex: (a) permanent threat of a fall, (b) continuous flow of information, (c) lack of control, and (d) ethical dilemmas and moral issues over the course of action. The present synthesis shows that before implementing preventive actions, care providers consider the conditions in which they are immersed, in this way situating their preventive actions in a clinical and a moral context.
Collapse
|
29
|
Fonseca RFMDR, Matumoto S, Xavier JJDS, Faller JW. Risk Behavior for Falls in the Elderly: Experiences of Community Health Workers. AQUICHAN 2020. [DOI: 10.5294/aqui.2020.20.2.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective: To identify the risk behaviors of the elderly at home, described by community health workers, and related factors.
Materials and methods: Qualitative research, in the dialectical perspective, carried out through a focus group with community health workers from a family health strategy unit in a municipality of the State of São Paulo, Brazil. Thematic content analysis was used for the study.
Results: The revealed risk behaviors are related to extrinsic factors (architecture, furniture, and equipment), socioeconomic factors (low income, level of education, deficit of social and a family support), and psychological factors (feeling of vulnerability, dependence and not self-acknowledging in a dangerous condition).
Conclusions: Falls are the result of a complex interaction between the factors and, the behaviors studied so that adequate identification of these can subsidize individual and collective intervention actions, as well as care management and planning processes aimed at the health of the elderly person.
Collapse
|
30
|
Martin RA, Dickie B, Skinner H, Hurring S, Marshall R, Hanger HC. Implementing a 'Safe Recovery' fall prevention program: Refining intervention theory using realist methods. Australas J Ageing 2020; 39:e259-e270. [PMID: 32329242 DOI: 10.1111/ajag.12795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 03/02/2020] [Accepted: 03/05/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This research aimed to explain how the Safe Recovery Programme (SRP) may best work to reduce falls in older adults undergoing rehabilitation in four wards in an older person's health and rehabilitation service. METHODS Qualitative realist methods were used, including surveys completed by patients and staff, and qualitative interviews or focus groups exploring views of patients, ward staff and SRP educators. RESULTS Emphasising different types of information for patients with different pre-existing understandings may facilitate their responses to SRP messaging. Consistency and coherence of SRP messaging within ward routines varied in response to staff SRP training and ongoing feedback mechanisms from SRP educators. CONCLUSIONS Tailored individualised approaches for patients with specific characteristics may lead to patients being less likely to engage in risky behaviours. Staff training and processes for facilitating ongoing feedback between patients, SRP and ward staff are required to ensure consistency and coherence of SRP messaging.
Collapse
Affiliation(s)
- Rachelle A Martin
- Burwood Academy of Independent Living, Christchurch, New Zealand.,Rehabilitation Research and Teaching Unit, University of Otago, Wellington, New Zealand
| | - Benn Dickie
- Older Persons Health Specialist Service, Burwood Hospital, Christchurch, New Zealand
| | - Helen Skinner
- Older Persons Health Specialist Service, Burwood Hospital, Christchurch, New Zealand
| | - Sarah Hurring
- Older Persons Health Specialist Service, Burwood Hospital, Christchurch, New Zealand
| | - Rachel Marshall
- Older Persons Health Specialist Service, Burwood Hospital, Christchurch, New Zealand
| | - Hugh Carl Hanger
- Older Persons Health Specialist Service, Burwood Hospital, Christchurch, New Zealand.,University of Otago, Christchurch, New Zealand
| |
Collapse
|
31
|
Cederbom S, Bjerk M, Bergland A. A qualitative study exploring physical therapists' views on the Otago Exercise Programme for fall prevention: a stepping stone to "age in place" and to give faith in the future. Physiother Theory Pract 2020; 38:132-140. [PMID: 32090667 DOI: 10.1080/09593985.2020.1731895] [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] [Indexed: 01/10/2023]
Abstract
Background: One of the most effective interventions to prevent falls is exercise. A commonly used program that prevents falls is the Otago Exercise Programme (OEP). Despite this, user-based knowledge of its applicability in real-world settings for older adults who are dependent on formal care in their homes is lacking. Purposes: To explore how physical therapists (PTs) experience the applicability of the OEP in clinical practice for home-dwelling older adults who are dependent on formal home care and to determine their beliefs regarding the benefits of the OEP for living longer at home. Methods: Semi-structured interviews were conducted with 17 physical therapists. Data were analyzed using qualitative thematic analysis. Results: The OEP was described by PTs to be applicable in clinical practice. Their experience was that the OEP seemed to be meaningful and to have a strong relationship with everyday activities. The OEP improved physical function, mood, self-efficacy, and participation in social activities in older adults, as well as provided faith in the future. Conclusion: The OEP is suitable for use in a primary care setting, and according to the perceptions of physical therapists, the OEP contributes to older adults' capability to live longer at home.
Collapse
Affiliation(s)
- Sara Cederbom
- Department of Physiotherapy, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Maria Bjerk
- Department of Physiotherapy, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Astrid Bergland
- Department of Physiotherapy, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
| |
Collapse
|
32
|
Cerderbom S, Bjerk M, Bergland A. The tensions between micro-, meso- and macro-levels: physiotherapists' views of their role towards fall prevention in the community - a qualitative study. BMC Health Serv Res 2020; 20:97. [PMID: 32028938 PMCID: PMC7006061 DOI: 10.1186/s12913-020-4940-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Accepted: 01/28/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Falls are a global public health concern. Physiotherapists are a key resource in this context, but there is sparse knowledge about how they perceive their role in the primary care setting. Therefore, the purpose of the present study is to explore physical therapists' (PTs) view of how they experience and perceive their role working with fall prevention in a community care setting. METHODS Semi-structured interviews were conducted with 17 physiotherapists. Data were analysed using a qualitative thematic analysis. RESULTS The analysis resulted in a core theme and three subthemes. The core theme was 'capability to cope with the tensions between the micro-, meso- and macro-levels in fall, prevention', which indicated the importance of an evolving multifaceted, evidence based and innovative physiotherapy role. A key factor for this role is to take an integrative biopsychosocial approach based on how biological and psychosocial factors are uniquely related in fall prevention. The three themes were as follows: 1) always moving and changing: the competent explorative knowledge-hungry clinician's multifaceted role; 2) multiprofessional - but in the end alone; 3) reaching out - from the bottom to the top. Success in the role of physiotherapists in fall prevention depends on the empowering leadership and working culture, as well as on the time and multifaceted professional competence of the clinicians. CONCLUSION Our findings indicate that the PTs' role reflects their abilities to change and improve their professional work in accordance with evidence based knowledge. To ensure good quality the PTs focused on the special needs of the patients, evidence-based fall prevention, interdisciplinary team work, good clinical competences, good skills in communication, and interpersonal relations. Attention should be placed on the importance of biopsychosocial perspective framing in the actual clinical and political context. The PTs saw the need for working at the micro-, meso- and macro-levels to succeed in the work of fall prevention.
Collapse
Affiliation(s)
- Sara Cerderbom
- Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, 0130, Oslo, Norway
| | - Maria Bjerk
- Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, 0130, Oslo, Norway
| | - Astrid Bergland
- Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, 0130, Oslo, Norway.
| |
Collapse
|
33
|
Worum H, Lillekroken D, Ahlsen B, Roaldsen KS, Bergland A. Bridging the gap between research-based knowledge and clinical practice: a qualitative examination of patients and physiotherapists' views on the Otago exercise Programme. BMC Geriatr 2019; 19:278. [PMID: 31638912 PMCID: PMC6805671 DOI: 10.1186/s12877-019-1309-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 10/10/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Falls and fall-related injuries exacerbate the health problems of older adults, and they are a public health concern. Despite an abundance of research, the implementation of evidence-based fall prevention programs has been slow and limited, additionally and these programs have not reduced the incidence of falling. Therefore, the primary objective of the present study was to examine patients and physiotherapists' views on the factors that influence the implementation of the community- and evidence-based Otago Exercise Programme for fall prevention. METHODS We conducted eight in-depth interviews with physiotherapists and patients, and a focus group interview with 12 physiotherapists and authority figures who represented local hospitals and municipalities. The resultant qualitative data were subjected to thematic analysis. RESULTS The analysis yielded two main themes: the researcher's role and position in the implementation process and the tension between research-based knowledge and clinical practice. The participants believed that research-based knowledge can address the challenges of clinical practice. Further, the patients reported that the fall prevention program made them feel safe and enhanced their ability to cope with daily life. The physiotherapists also observed that research findings do not readily translate into clinical practice. Further, they contended that research-based knowledge is not universal and that it cannot be generalized across different contexts; instead, it must be adapted and translated into a user-friendly language. The findings suggest that the application of research-based knowledge does equate to filling up empty jars and that research-based knowledge does not flow from the expert to the non-expert as water through a tube. Indeed, physiotherapists and patients are not tabula rasa. Additionally, the participants believed that researchers and stakeholders must think critically about who has the power and voice to create a common understanding. CONCLUSIONS Our findings delineate the means by which the gap between research and practice regarding the Otago fall prevention program can bridged. The program can guide clinical work and provide important information that can be used to improve the quality of other fall prevention programs. However, the research-based knowledge that it confers must be adapted for use in clinical contexts.
Collapse
Affiliation(s)
- Hilde Worum
- Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Daniela Lillekroken
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Birgitte Ahlsen
- Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Kirsti Skavberg Roaldsen
- Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
- Department of Neurobiology, Health Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Department of Research, Sunnaas Rehabilitation Hospital, Oslo, Norway
| | - Astrid Bergland
- Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| |
Collapse
|