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Hoffman GJ, Ha J, Li J. Association of Medicare Home Health Ratings With Older Adult Fall Injuries: An Instrumental Variables Analysis. J Am Med Dir Assoc 2024; 25:105013. [PMID: 38729215 DOI: 10.1016/j.jamda.2024.03.123] [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: 02/09/2024] [Revised: 03/29/2024] [Accepted: 03/29/2024] [Indexed: 05/12/2024]
Abstract
OBJECTIVES To understand the role of high-quality home health care for fall prevention. DESIGN A 100% sample of national Medicare claims and home health survey data (2015-2017) were used to assess fall injuries and receipt of a fall risk assessment among recently hospitalized Medicare fee-for-service home health users aged ≥66 years. Subanalyses examined patients by prior fall history status and hospital admission diagnosis type (eg, neurologic, respiratory, cardiovascular, infection, and orthopedic diagnoses). An instrumental variables design addressed potential endogeneity in home health care use by patient fall risk. SETTING AND PARTICIPANTS Home health agencies and Medicare fee-for-service beneficiaries. METHODS Multivariate regression and instrumental variables. RESULTS Among 962,610 patients with hospital discharges to home health, being treated by home health agencies with the highest star ratings in a person's zip code was associated with a 1.8-percentage point (ppt) (95% CI: 0.1, 3.5; P = .03) higher likelihood of receipt of fall risk assessment. There was no overall change in 30-day (-0.6 ppt, 95% CI: -1.3, 0.1; P = .09), 15-day (-0.3 ppt, 95% CI: -0.0.8, 0.2; P = .35), or 7-day fall injury risk (-0.2 ppt, 95% CI: -0.5, 0.1; P = .22), but a 1.9-ppt (95% CI: -3.9, -0.02; P = .048) lower 30-day fall injury risk for individuals with a history of falls. Effects were directionally similar by diagnosis type. CONCLUSIONS AND IMPLICATIONS Fall injury risk is reduced at higher-rated home health agencies. Star ratings may be adequate indicators of quality for key outcomes not explicitly measured in the ratings.
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Affiliation(s)
- Geoffrey J Hoffman
- Department of Systems, Population and Leadership, University of Michigan School of Nursing, Ann Arbor, MI, USA; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.
| | - Jinkyung Ha
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Jun Li
- Public Administration and International Affairs Department, Maxwell School of Citizenship & Public Affairs, Syracuse University, Syracuse, NY, USA; Aging Studies Institute, Syracuse University, Syracuse, NY, USA
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Morris ME, Thwaites C, Lui R, McPhail SM, Haines T, Kiegaldie D, Heng H, Shaw L, Hammond S, McKercher JP, Knight M, Carey LM, Gray R, Shorr R, Hill AM. Preventing hospital falls: feasibility of care workforce redesign to optimise patient falls education. Age Ageing 2024; 53:afad250. [PMID: 38275097 PMCID: PMC10811524 DOI: 10.1093/ageing/afad250] [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: 08/02/2023] [Indexed: 01/27/2024] Open
Abstract
OBJECTIVE To examine the feasibility of using allied health assistants to deliver patient falls prevention education within 48 h after hospital admission. DESIGN AND SETTING Feasibility study with hospital patients randomly allocated to usual care or usual care plus additional patient falls prevention education delivered by supervised allied health assistants using an evidence-based scripted conversation and educational pamphlet. PARTICIPANTS (i) allied health assistants and (ii) patients admitted to participating hospital wards over a 20-week period. OUTCOMES (i) feasibility of allied health assistant delivery of patient education; (ii) hospital falls per 1,000 bed days; (iii) injurious falls; (iv) number of falls requiring transfer to an acute medical facility. RESULTS 541 patients participated (median age 81 years); 270 control group and 271 experimental group. Allied health assistants (n = 12) delivered scripted education sessions to 254 patients in the experimental group, 97% within 24 h after admission. There were 32 falls in the control group and 22 in the experimental group. The falls rate was 8.07 falls per 1,000 bed days in the control group and 5.69 falls per 1,000 bed days for the experimental group (incidence rate ratio = 0.66 (95% CI 0.32, 1.36; P = 0.26)). There were 2.02 injurious falls per 1,000 bed days for the control group and 1.03 for the experimental group. Nine falls (7 control, 2 experimental) required transfer to an acute facility. No adverse events were attributable to the experimental group intervention. CONCLUSIONS It is feasible and of benefit to supplement usual care with patient education delivered by allied health assistants.
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Affiliation(s)
- Meg E Morris
- Academic and Research Collaborative in Health (ARCH), and Care Economy Research Institute (CERI), La Trobe University, Melbourne, VIC, Australia
- Victorian Rehabilitation Centre, Healthscope, Glen Waverley, Melbourne, VIC, Australia
| | - Claire Thwaites
- Academic and Research Collaborative in Health (ARCH), and Care Economy Research Institute (CERI), La Trobe University, Melbourne, VIC, Australia
- Victorian Rehabilitation Centre, Healthscope, Glen Waverley, Melbourne, VIC, Australia
| | - Rosalie Lui
- Victorian Rehabilitation Centre, Healthscope, Glen Waverley, Melbourne, VIC, Australia
| | - Steven M McPhail
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
- Digital Health and Informatics Directorate, Metro South Health, Brisbane, QLD, Australia
| | - Terry Haines
- School of Primary and Allied Health Care, Monash University, Melbourne, VIC, Australia
| | - Debra Kiegaldie
- Faculty of Health Sciences & Community Studies, Holmesglen Institute, Melbourne, VIC, Australia
- Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
| | - Hazel Heng
- Northern Health Academic and Research Collaborative in Health (ARCH), La Trobe University, Melbourne, VIC, Australia
- Northern Health, Epping, VIC, Australia
| | - Louise Shaw
- Academic and Research Collaborative in Health (ARCH), and Care Economy Research Institute (CERI), La Trobe University, Melbourne, VIC, Australia
- Centre for Digital Transformation of Health, University of Melbourne, Melbourne, VIC, Australia
| | - Susan Hammond
- Victorian Rehabilitation Centre, Healthscope, Glen Waverley, Melbourne, VIC, Australia
| | - Jonathan P McKercher
- Academic and Research Collaborative in Health (ARCH), and Care Economy Research Institute (CERI), La Trobe University, Melbourne, VIC, Australia
| | - Matthew Knight
- Victorian Rehabilitation Centre, Healthscope, Glen Waverley, Melbourne, VIC, Australia
| | - Leeanne M Carey
- Occupational Therapy, Department of Community and Clinical Health, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC, Australia
- Neurorehabilitation and Recovery, Florey Institute of Neuroscience and Mental Health, Melbourne, VIC, Australia
| | - Richard Gray
- School of Nursing and Midwifery, La Trobe University, Melbourne, VIC, Australia
| | - Ron Shorr
- Department of Epidemiology, University of Florida, Gainesville, FL, USA
| | - Anne-Marie Hill
- School of Allied Health, Western Australian Centre for Health & Ageing, The University of Western Australia, Perth, WA, Australia
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Sturnieks DL, Hicks C, Smith N, Ratanapongleka M, Menant J, Turner J, Lo J, Chaplin C, Garcia J, Valenzuela MJ, Delbaere K, Herbert RD, Sherrington C, Toson B, Lord SR. Exergame and cognitive training for preventing falls in community-dwelling older people: a randomized controlled trial. Nat Med 2024; 30:98-105. [PMID: 38228913 DOI: 10.1038/s41591-023-02739-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 11/27/2023] [Indexed: 01/18/2024]
Abstract
Exergame training, in which video games are used to promote exercise, can be tailored to address cognitive and physical risk factors for falls and is a promising method for fall prevention in older people. Here, we performed a randomized clinical trial using the smart±step gaming system to examine the effectiveness of two home-based computer game interventions, seated cognitive training and step exergame training, for fall prevention in community-dwelling older people, as compared with a minimal-intervention control group. Participants aged 65 years or older (n = 769, 71% female) living independently in the community were randomized to one of three arms: (1) cognitive training using a computerized touchpad while seated, (2) exergame step training on a computerized mat or (3) control (provided with an education booklet on healthy ageing and fall prevention). The rate of falls reported monthly over 12 months-the primary outcome of the trial-was significantly reduced in the exergame training group compared with the control group (incidence rate ratio = 0.74, 95% confidence interval = 0.56-0.98), but was not statistically different between the cognitive training and control groups (incidence rate ratio = 0.86, 95% confidence interval = 0.65-1.12). No beneficial effects of the interventions were found for secondary outcomes of physical and cognitive function, and no serious intervention-related adverse events were reported. The results of this trial support the use of exergame step training for preventing falls in community-dwelling older people. As this intervention can be conducted at home and requires only minimal equipment, it has the potential for scalability as a public health intervention to address the increasing problem of falls and fall-related injuries. Australian and New Zealand Clinical Trial Registry identifier: ACTRN12616001325493 .
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Affiliation(s)
- Daina L Sturnieks
- Neuroscience Research Australia, Randwick, New South Wales, Australia.
- School of Biomedical Sciences, University of New South Wales, Sydney, New South Wales, Australia.
- UNSW Ageing Futures Institute, Sydney, New South Wales, Australia.
| | - Cameron Hicks
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Natassia Smith
- Neuroscience Research Australia, Randwick, New South Wales, Australia
| | | | - Jasmine Menant
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- UNSW Ageing Futures Institute, Sydney, New South Wales, Australia
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Jessica Turner
- Neuroscience Research Australia, Randwick, New South Wales, Australia
| | - Joanne Lo
- Neuroscience Research Australia, Randwick, New South Wales, Australia
| | - Carly Chaplin
- Neuroscience Research Australia, Randwick, New South Wales, Australia
| | - Jaime Garcia
- UTS Games Studio, Faculty of Engineering and IT, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Michael J Valenzuela
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, New South Wales, Australia
- Skin2Neuron Pty Ltd, Sydney, New South Wales, Australia
| | - Kim Delbaere
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- UNSW Ageing Futures Institute, Sydney, New South Wales, Australia
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Robert D Herbert
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- School of Biomedical Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Catherine Sherrington
- Sydney Musculoskeletal Health, Sydney School of Public Health, Sydney Local Health District, University of Sydney, Sydney, New South Wales, Australia
| | - Barbara Toson
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Stephen R Lord
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- UNSW Ageing Futures Institute, Sydney, New South Wales, Australia
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
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Najafpour Z, Arab M, Rashidian A, Shayanfard K, Yaseri M, Biparva-Haghighi S. A Stepped-Wedge Cluster-Randomized Controlled Trial of Multi-interventional Approach for Fall Prevention. Qual Manag Health Care 2023:00019514-990000000-00066. [PMID: 38031258 DOI: 10.1097/qmh.0000000000000435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
BACKGROUND AND OBJECTIVES Falls are one of the most common adverse events at hospitals that may result in injury and even death. They are also associated with raised length of stay (LOS) and hospitalization costs. This experiment aimed to examine the effectiveness of multiple interventions in reducing inpatient fall rates and the consequent injuries. METHODS The present study was a stepped-wedge cluster-randomized controlled trial. It was done in 18 units in a public university hospital over 36 weeks. Patients included in this research were at risk of falls. Overall, 33 856 patients were admitted, of whom 4766 were considered high-risk patients. During the intervention phases, a series of preventive and control measures were considered, namely staff training; patient education; placement of nursing call bells; adequate lighting; supervision of high-risk patients during transmission and handovers; mobility device allocation; placement of call bell and safe guard in bathrooms; placing "fall alert" signs above patients' beds; nurses informing physicians timely about complications such as delirium and hypoxia; encouraging appropriate use of eyeglasses, hearing aids and footwear; keeping side rails up; and reassessing patients after each fall. The primary outcome was participant falls per 1000 patient-days. Secondary outcomes were fall-related injuries and LOS. RESULTS The results revealed a decrease in fall rate (n = 4 per 1000 patient-days vs 1.34 per 1000 patient-days, incidence rate ratio (IRR) = 0.19 [95% confidence interval (CI), 0.14-0.26]; P = .001) and injuries (n = 2.4 per 1000 patient-days vs 0.79 per 1000 patient-days, IRR = 0.22 [95% CI, 0.15-0.32]; P = .001) in exposed compared with unexposed phases. There was not a significant difference in LOS (exposed mean 10.63 days [95% CI, 10.26-10.97], unexposed mean 10.84 days [95% CI, 10.59-11.09], mean difference = -0.13 [95% CI, -0.53 to 0.27], P = .52). CONCLUSIONS This multi-interventional trial showed a reduction in falls and fall rates with injury but without an overall effect on LOS. Further research is needed to understand the sustainability of multiple fall prevention strategies in hospitals and their long-term impacts.
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Affiliation(s)
- Zhila Najafpour
- Department of Health Care Management, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran (Dr Najafpour); School of Public Health, Tehran University of Medical Sciences, Tehran, Iran (Drs Arab and Rashidian); University of Luxembourg, Luxembourg (Dr Shayanfard); Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran (Dr Yaseri); and Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran (Dr Biparva-Haghighi)
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Roberts AKG, Kane C, Allen NE. The acceptability and accessibility of magnetic walking aids when used in hospital: a randomised trial. Disabil Rehabil Assist Technol 2023:1-8. [PMID: 38019042 DOI: 10.1080/17483107.2023.2287159] [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: 02/25/2023] [Accepted: 11/20/2023] [Indexed: 11/30/2023]
Abstract
PURPOSE Poor walking aid compliance and accessibility can put the user at an increased risk of falls. We explored the acceptability and accessibility of magnetic walking aids (MWAs) compared to standard walking aids (SWAs) in inpatients following joint replacement. METHODS AND MATERIALS A non-blinded pilot randomised controlled trial was conducted. Inpatients following hip or knee replacement were randomly allocated to the MWA group (n = 20) or the SWA group (n = 20). Primary outcomes were the acceptability and accessibility of the MWA compared to the SWA during their inpatient stay, assessed through made-to-measure patient and staff questionnaires. The secondary outcome was the number of times the walking aid came to rest on the floor, measured using logbooks kept by participants. RESULTS The participants in the MWA group reported their aid was more easily accessible, and that they were more likely to use their aid in their room than participants in the SWA group. Participants in the MWA group dropped their aid less often, with a median of 0.3 walking aid drops per day in the MWA group and 1.1 drops per day in the SWA group (p = 0.002). CONCLUSION The results of this pilot randomised trial suggest MWAs may be an acceptable and inexpensive intervention for improving walking aid accessibility and adherence and reducing walking aid drops when compared to SWAs.
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Affiliation(s)
- Alexander K G Roberts
- Wolper Jewish Hospital, Sydney, New South Wales, Australia
- Westmead Hospital, Sydney, New South Wales, Australia
| | - Cody Kane
- Wolper Jewish Hospital, Sydney, New South Wales, Australia
| | - Natalie E Allen
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Kobayashi K, Kido N, Wakabayashi S, Yamamoto K, Hihara J, Tamura M, Sakahara T. Association between fall-related serious injury and activity during fall in an acute care hospital. PLoS One 2023; 18:e0288320. [PMID: 37418434 DOI: 10.1371/journal.pone.0288320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 06/23/2023] [Indexed: 07/09/2023] Open
Abstract
OBJECTIVES Few studies have evaluated the mechanism of serious injury in acute hospitalization. Thus, the association between fall-related serious injury and activity during falls in acute care hospital remains unclear. Herein, we investigated the relationship between serious injury caused by fall and activity at the time of the fall in an acute care hospital. METHODS This retrospective cohort study was conducted at Asa Citizens Hospital. All inpatients aged 65 years and older were eligible for the study, which was conducted from April 1, 2021, through March 31, 2022. The magnitude of the association between injury severity and activity during the fall was quantified using odds ratio. RESULTS Among the 318 patients with reported falls, 268 (84.3%) had no related injury, 40 (12.6%) experienced minor injury, 3 (0.9%) experienced moderate injury, 7 (2.2%) experienced major injury. Moderate or major injuries caused by a fall was associated with the activity during the fall (odds ratio: 5.20; confidence intervals: 1.43-18.9, p = 0.013). CONCLUSION This study recognizes that falling during ambulation caused moderate or major injuries in an acute care hospital. Our study suggests that falls while ambulating in an acute care hospital were associated not only with fractures, but also with lacerations requiring sutures and brain injuries. Among the patients with moderate or major injuries, more falls occurred outside the patient's bedroom as compared with patients with minor or no injuries. Therefore, it is important to prevent moderate or major injuries related to falls that occur while the patient is walking outside their bedroom in an acute care hospital.
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Affiliation(s)
- Kosuke Kobayashi
- Department of Rehabilitation, Hiroshima City North Medical Center Asa Citizens Hospital, Asa-kita Ward, Hiroshima City, Hiroshima, Japan
| | - Naohiro Kido
- Department of Rehabilitation, Hiroshima City North Medical Center Asa Citizens Hospital, Asa-kita Ward, Hiroshima City, Hiroshima, Japan
| | - Shoji Wakabayashi
- Department of Rehabilitation, Hiroshima City North Medical Center Asa Citizens Hospital, Asa-kita Ward, Hiroshima City, Hiroshima, Japan
| | - Kyoko Yamamoto
- Department of Rehabilitation, Hiroshima City North Medical Center Asa Citizens Hospital, Asa-kita Ward, Hiroshima City, Hiroshima, Japan
| | - Jun Hihara
- Total Quality Management Center, Hiroshima City North Medical Center Asa Citizens Hospital, Asa-kita Ward, Hiroshima City, Hiroshima, Japan
| | - Masami Tamura
- Total Quality Management Center, Hiroshima City North Medical Center Asa Citizens Hospital, Asa-kita Ward, Hiroshima City, Hiroshima, Japan
| | - Tomoko Sakahara
- Total Quality Management Center, Hiroshima City North Medical Center Asa Citizens Hospital, Asa-kita Ward, Hiroshima City, Hiroshima, Japan
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Rezaei-Darzi E, Grantham KL, Forbes AB, Kasza J. The impact of iterative removal of low-information cluster-period cells from a stepped wedge design. BMC Med Res Methodol 2023; 23:160. [PMID: 37415140 PMCID: PMC10324156 DOI: 10.1186/s12874-023-01969-7] [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: 02/06/2023] [Accepted: 06/08/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND Standard stepped wedge trials, where clusters switch from the control to the intervention condition in a staggered manner, can be costly and burdensome. Recent work has shown that the amount of information contributed by each cluster in each period differs, with some cluster-periods contributing a relatively small amount of information. We investigate the patterns of the information content of cluster-period cells upon iterative removal of low-information cells, assuming a model for continuous outcomes with constant cluster-period size, categorical time period effects, and exchangeable and discrete-time decay intracluster correlation structures. METHODS We sequentially remove pairs of "centrosymmetric" cluster-period cells from an initially complete stepped wedge design which contribute the least amount of information to the estimation of the treatment effect. At each iteration, we update the information content of the remaining cells, determine the pair of cells with the lowest information content, and repeat this process until the treatment effect cannot be estimated. RESULTS We demonstrate that as more cells are removed, more information is concentrated in the cells near the time of the treatment switch, and in "hot-spots" in the corners of the design. For the exchangeable correlation structure, removing the cells from these hot-spots leads to a marked reduction in study precision and power, however the impact of this is lessened for the discrete-time decay structure. CONCLUSIONS Removing cluster-period cells distant from the time of the treatment switch may not lead to large reductions in precision or power, implying that certain incomplete designs may be almost as powerful as complete designs.
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Affiliation(s)
- Ehsan Rezaei-Darzi
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Kelsey L. Grantham
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Andrew B. Forbes
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Jessica Kasza
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Roberts M. Patient falls while under supervision: trends from incident reporting. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2023; 32:508-513. [PMID: 37289705 DOI: 10.12968/bjon.2023.32.11.508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
In one large UK hospital trust, data from the electronic incident reporting system were studied to determine the number of falls within one division taking place while patients were under enhanced supervision. This supervision was commonly carried out by registered nurses or healthcare assistants. It was noted that, despite increased supervision, patients were still falling and when they did the degree of harm they suffered was often greater than for those patients not under supervision. It was also noted that more male patients fell under supervision than female patients, although the reasons for this were not clear, suggesting an area for further research. A large number of patients fell while in the bathroom, where they were often left alone for periods of time. This shows an increasing need to find a balance between maintaining patient dignity and ensuring patient safety.
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Affiliation(s)
- Matthew Roberts
- Anticoagulation Nurse Specialist, Queen's Medical Centre, Nottingham
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Inoue S, Otaka Y, Horimoto Y, Shirooka H, Sugasawa M, Kondo K. Discrepancies in perception of fall risk between patients with subacute stroke and physical therapists in a rehabilitation hospital: a retrospective cohort study. FRONTIERS IN AGING 2023; 4:1204488. [PMID: 37342863 PMCID: PMC10277567 DOI: 10.3389/fragi.2023.1204488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 05/29/2023] [Indexed: 06/23/2023]
Abstract
Objective: Falls are one of the most common complications of a stroke. This study aimed to clarify the discrepancy between the perceived fall risk of hospitalized patients with stroke and the clinical judgment of physical therapists and to examine the changes in discrepancy during hospitalization. Design: Retrospective cohort study. Patients: This study included 426 patients with stroke admitted to a Japanese convalescent rehabilitation hospital between January 2019 and December 2020. Methods: The Falls Efficacy Scale-International was used to assess both patients' and physical therapists' perception of fall risk. The difference in Falls Efficacy Scale-International scores assessed by patients and physical therapists was defined as the discrepancy in fall risk, and its association with the incidence of falls during hospitalization was investigated. Results: Patients had a lower perception of fall risk than physical therapists at admission (p < 0.001), and this trend continued at discharge (p < 0.001). The discrepancy in fall risk perception was reduced at discharge for non-fallers and single fallers (p < 0.001), whereas the difference remained in multiple fallers. Conclusion: Unlike physical therapists, patients underestimated their fall risk, especially patients who experienced multiple falls. These results may be useful for planning measures to prevent falls during hospitalization.
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Affiliation(s)
- Seigo Inoue
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan
| | - Yohei Otaka
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
| | - Yukari Horimoto
- Education and Management in Health and Welfare Section, Health Sciences Program, Graduate School of International University of Health and Welfare, Tokyo, Japan
| | - Hidehiko Shirooka
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan
| | - Masafumi Sugasawa
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan
| | - Kunitsugu Kondo
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan
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Tymkew H, Taylor B, Vyers K, Costantinou E, Arroyo C, Schallom M. Original Research: Patient Perception of Fall Risk in the Acute Care Setting. Am J Nurs 2023; 123:20-25. [PMID: 37166161 DOI: 10.1097/01.naj.0000937184.96893.a7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
PURPOSE Hospitals are implementing a variety of fall prevention programs to reduce the fall rates of hospitalized patients. But if patients don't perceive themselves to be at risk for falling and don't adhere to fall prevention strategies, such programs are likely to be less effective. The purpose of this study was to describe the perceptions of fall risk among hospitalized patients across four acute care specialty services. METHODS One hundred patients who had been admitted to the study hospital and who had a Morse Fall Scale score over 45 were asked to complete the Patient Perception Questionnaire, a tool designed to explore a patient's confidence regarding their fall risk, fear of falling, and intention to engage in fall prevention activities. Morse Fall Scale scores were collected via retrospective chart review. Data were analyzed using descriptive statistics, Pearson correlation coefficients, and independent sample t tests. RESULTS Participants' mean age was 65 years; 52% were male, 48% female. Although all 100 participants were deemed at risk for falls per their Morse Fall Scale scores, only 55% considered themselves to be at such risk. As patients' confidence in their ability to perform mobility tasks increased, their intention to ask for help and fear of falling significantly decreased. Patients who had been admitted as the result of a fall demonstrated significantly lower confidence scores and higher fear scores. CONCLUSIONS Patients who score high on fall risk assessments often don't perceive themselves to be at high risk for falling, and thus might not engage in fall prevention activities. Developing a fall risk assessment method that incorporates both a patient's physiological condition and their perception of their fall risk could help reduce fall rates in the acute care setting.
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Affiliation(s)
- Heidi Tymkew
- Heidi Tymkew , Beth Taylor , and Marilyn Schallom are research scientists at Barnes-Jewish Hospital, St. Louis, where Cassandra Arroyo is a statistician and at the time of this study Kara Vyers was the research coordinator and Eileen Costantinou was a practice specialist. Contact author: Heidi Tymkew, . The authors and planners have disclosed no potential conflicts of interest, financial or otherwise
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Pham CT, Visvanathan R, Strong M, Wilson ECF, Lange K, Dollard J, Ranasinghe D, Hill K, Wilson A, Karnon J. Cost-Effectiveness and Value of Information Analysis of an Ambient Intelligent Geriatric Management (AmbIGeM) System Compared to Usual Care to Prevent Falls in Older People in Hospitals. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2023; 21:315-325. [PMID: 36494574 DOI: 10.1007/s40258-022-00773-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/13/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND The Ambient Intelligent Geriatric Management (AmbIGeM) system combines wearable sensors with artificial intelligence to trigger alerts to hospital staff before a fall. A clinical trial found no effect across a heterogenous population, but reported a reduction in the injurious falls rate in a post hoc analysis of patients on Geriatric Evaluation Management Unit (GEMU) wards. Cost-effectiveness and Value of Information (VoI) analyses of the AmbIGeM system in GEMU wards was undertaken. METHODS An Australian health-care system perspective and 5-year time horizon were used for the cost-effectiveness analysis. Implementation costs, inpatient costs and falls data were collected. Injurious falls were defined as causing bruising, laceration, fracture, loss of consciousness, or if the patient reported persistent pain. To compare costs and outcomes, generalised linear regression models were used to adjust for baseline differences between the intervention and usual care groups. Bootstrapping was used to represent uncertainty. For the VoI analysis, 10,000 different sample sizes with randomly sampled values ranging from 1 to 50,000 were tested to estimate the optimal sample size of a new trial that maximised the Expected Net Benefits of Sampling. RESULTS An adjusted 0.036 fewer injurious falls (adjusted rate ratio of 0.56) and AUD$4554 lower costs were seen in the intervention group. However, uncertainty that the intervention is cost effective for the prevention of an injurious fall was present at all monetary values of this effectiveness outcome. A new trial with a sample of 4376 patients was estimated to maximise the Expected Net Benefit of Sampling, generating a net benefit of AUD$186,632 at a benefit-to-cost ratio of 1.1. CONCLUSIONS The benefits to cost ratio suggests that a new trial of the AmbIGeM system in GEMU wards may not be high-value compared to other potential trials, and that the system should be implemented. However, a broader analysis of options for preventing falls in GEMU is required to fully inform decision making. TRIAL REGISTRATION Australian and New Zealand Clinical Trial Registry (ACTRN 12617000981325).
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Affiliation(s)
- Clarabelle T Pham
- Flinders Health and Medical Research Institute, Flinders University, Bedford Park, SA, Australia.
| | - Renuka Visvanathan
- Aged and Extended Care Services, The Queen Elizabeth Hospital, Central Adelaide Local Health Network and Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Mark Strong
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Edward C F Wilson
- Peninsula Technology Assessment Group, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Kylie Lange
- Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
| | - Joanne Dollard
- Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Basil Hetzel Institute for Translational Health Research, Central Adelaide Local Health Network, Adelaide, SA, Australia
| | - Damith Ranasinghe
- The Auto-ID Lab, The School of Computer Science, University of Adelaide, Adelaide, SA, Australia
| | - Keith Hill
- Rehabilitation Ageing and Independent Living (RAIL) Research Centre, Monash University, Melbourne, VIC, Australia
| | - Anne Wilson
- College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Jonathan Karnon
- Flinders Health and Medical Research Institute, Flinders University, Bedford Park, SA, Australia
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12
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Sullivan R, Harding K, Skinner I, Hemsley B. Falls in Patients With Communication Disability Secondary to Stroke. Clin Nurs Res 2023; 32:478-489. [PMID: 36541748 DOI: 10.1177/10547738221144214] [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: 12/24/2022]
Abstract
Patients with stroke are at high risk of falls during inpatient rehabilitation admission. Communication disability is common following stroke; however, this population is often excluded from falls research. This study aimed to examine the falls of patients with communication disability following stroke, including the circumstances, contributing factors, and outcomes of the fall. This medical record review used the Generic Reference Model of patient safety as the analytical lens and data were analyzed descriptively. The study included 109 patients who experienced 308 falls. The most common type of fall was an "unwitnessed roll from bed." Patient factors contributed to half of all falls, injuries occurred in 15% of falls, and impacts to the hospital system included additional costs and staffing. Understanding the reasons why patients are attempting to get out of bed may identify ways to reduce the risk and incidence of falls in this population.
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Affiliation(s)
- Rebecca Sullivan
- University of Technology Sydney, Ultimo, NSW, Australia.,Eastern Health, Box Hill, VIC, Australia
| | - Katherine Harding
- Eastern Health, Box Hill, VIC, Australia.,La Trobe University, Bundoora, VIC, Australia
| | - Ian Skinner
- Charles Sturt University, Port Macquarie, NSW, Australia
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Delaforce A, Li J, Grujovski M, Parkinson J, Richards P, Fahy M, Good N, Jayasena R. Creating an Implementation Enhancement Plan for a Digital Patient Fall Prevention Platform Using the CFIR-ERIC Approach: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3794. [PMID: 36900804 PMCID: PMC10001076 DOI: 10.3390/ijerph20053794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/09/2023] [Accepted: 02/18/2023] [Indexed: 06/18/2023]
Abstract
(1) Background: Inpatient falls are a major cause of hospital-acquired complications (HAC) and inpatient harm. Interventions to prevent falls exist, but it is unclear which are most effective and what implementation strategies best support their use. This study uses existing implementation theory to develop an implementation enhancement plan to improve the uptake of a digital fall prevention workflow. (2) Methods: A qualitative approach using focus groups/interview included 12 participants across four inpatient wards, from a newly built, 300-bed rural referral hospital. Interviews were coded to the Consolidated Framework for Implementation Research (CFIR) and then converted to barrier and enabler statements using consensus agreement. Barriers and enablers were mapped to the Expert Recommendations for Implementing Change (ERIC) tool to develop an implementation enhancement plan. (3) Results: The most prevalent CFIR enablers included: relative advantage (n = 12), access to knowledge and information (n = 11), leadership engagement (n = 9), patient needs and resources (n = 8), cosmopolitanism (n = 5), knowledge and beliefs about the intervention (n = 5), self-efficacy (n = 5) and formally appointed internal implementation leaders (n = 5). Commonly mentioned CFIR barriers included: access to knowledge and information (n = 11), available resources (n = 8), compatibility (n = 8), patient needs and resources (n = 8), design quality and packaging (n = 10), adaptability (n = 7) and executing (n = 7). After mapping the CFIR enablers and barriers to the ERIC tool, six clusters of interventions were revealed: train and educate stakeholders, utilize financial strategies, adapt and tailor to context, engage consumers, use evaluative and iterative strategies and develop stakeholder interrelations. (4) Conclusions: The enablers and barriers identified are similar to those described in the literature. Given there is close agreement between the ERIC consensus framework recommendations and the evidence, this approach will likely assist in enhancing the implementation of Rauland's Concentric Care fall prevention platform and other similar workflow technologies that have the potential to disrupt team and organisational routines. The results of this study will provide a blueprint to enhance implementation that will be tested for effectiveness at a later stage.
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Affiliation(s)
- Alana Delaforce
- Australian e-Health Research Centre, Health and Biosecurity, Commonwealth Scientific and Industrial Research Organisation, Herston, QLD 4029, Australia
| | - Jane Li
- Australian e-Health Research Centre, Health and Biosecurity, Commonwealth Scientific and Industrial Research Organisation, Westmead, NSW 2145, Australia
| | - Melisa Grujovski
- Nursing and Midwifery Services, Maitland Hospital, Hunter New England Local Health District, Maitland, NSW 2323, Australia
| | - Joy Parkinson
- Australian e-Health Research Centre, Health and Biosecurity, Commonwealth Scientific and Industrial Research Organisation, Herston, QLD 4029, Australia
| | - Paula Richards
- Nursing and Midwifery Services, Maitland Hospital, Hunter New England Local Health District, Maitland, NSW 2323, Australia
| | - Michael Fahy
- Nursing and Midwifery Services, Maitland Hospital, Hunter New England Local Health District, Maitland, NSW 2323, Australia
| | - Norman Good
- Australian e-Health Research Centre, Health and Biosecurity, Commonwealth Scientific and Industrial Research Organisation, Herston, QLD 4029, Australia
| | - Rajiv Jayasena
- Australian e-Health Research Centre, Health and Biosecurity, Commonwealth Scientific and Industrial Research Organisation, Parkville, VIC 3052, Australia
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14
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Thwaites C, Nayyar R, Blennerhassett J, Egerton T, Tan J, Bower K. Is telehealth an effective and feasible option for improving falls-related outcomes in community-dwelling adults with neurological conditions? A systematic review and meta-analysis. Clin Rehabil 2022; 37:17-46. [PMID: 36263524 DOI: 10.1177/02692155221133468] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine the effectiveness of telehealth interventions in reducing community falls risk or rates compared to equivalent in-person interventions in adults with neurological conditions. DATA SOURCES Eight electronic databases, trial registries and search engines were searched for the concepts 'falls', 'neurological conditions', and 'telehealth', limited to English language, from inception until August 2022. REVIEW METHODS Search for original research where the intervention was delivered via synchronous videoconferencing with the aim of reducing falls and falls-related outcomes. Screening and risk of bias assessment were completed by two independent researchers. Outcome data included falls rates, falls-related outcomes, safety, feasibility, and acceptability. Risk of bias was assessed using the ROB-2 and ROBINS-I tools. Quality of evidence was rated with the grading of recommendations, assessment, development and evaluation (GRADE) approach. RESULTS Seventeen studies with 581 participants were included; six were randomised controlled trials. Risk of bias ranged from low to high. Only one study (n = 76) reported falls and did not find differences between telehealth and in-person physiotherapy. There was low-quality evidence that telehealth interventions improve balance outcomes more than face-to-face interventions (pooled between-group mean difference 2.48 Berg Balance Scale units, 95%CI 0.77 to 4.20). Fear of falling was not different between intervention delivery modes. CONCLUSION Findings suggest that telehealth delivered falls prevention interventions are safe, feasible and acceptable in community-dwelling adults with neurological conditions, however, data related to effectiveness in reducing falls is limited. Low-quality evidence suggests that telehealth may deliver similar or better outcomes for standing balance in this population.PROSPERO Registration: (CRD42021240167).
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Affiliation(s)
- Claire Thwaites
- Academic and Research Collaborative in Health (ARCH), La Trobe University, Melbourne, Australia.,The Victorian Rehabilitation Centre, Healthscope, Melbourne, Australia
| | - Rohini Nayyar
- Faculty of Medicine, Dentistry and Health Sciences, Department of Physiotherapy, 2281The University of Melbourne, Melbourne, Australia
| | - Jannette Blennerhassett
- Physiotherapy Department and Health Independence Program, 3805Austin Health, Heidelberg, Australia
| | - Thorlene Egerton
- Faculty of Medicine, Dentistry and Health Sciences, Department of Physiotherapy, 2281The University of Melbourne, Melbourne, Australia
| | - Jasmine Tan
- Faculty of Medicine, Dentistry and Health Sciences, Department of Physiotherapy, 2281The University of Melbourne, Melbourne, Australia
| | - Kelly Bower
- Faculty of Medicine, Dentistry and Health Sciences, Department of Physiotherapy, 2281The University of Melbourne, Melbourne, Australia
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15
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Wang Q, Zou H, Wang Q. The effectiveness of multimedia combined with teach-back method on the level of knowledge, confidence and behavior of professional caregivers in preventing falls in elderly patients: A randomized non-blind controlled clinical study. Medicine (Baltimore) 2022; 101:e30869. [PMID: 36181096 PMCID: PMC9524941 DOI: 10.1097/md.0000000000030869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Teach-back is a teaching method that can quickly improve the acknowledge of target audience and change their behaviors effectively. However, this approach has not been reported in previous studies that were dedicated to reducing the incidence of falls in elderly inpatients. Therefore, we aimed to evaluate the effectiveness of the teach-back method for improving the knowledge, confidence, and behaviors (KCB) of professional caregivers on the fall prevention in elderly inpatients and to provide practical evidence for reducing the incidence of falls. METHODS This is a prospective study. At the recruitment, the demographic data of the professional caregivers were completely collected. Questionnaire about KCB of professional caregivers on fall prevention in elderly inpatients was used as an assessment scale, and the differences between the scores were analyzed. At the end of the study, the fall rate of the patients cared by different groups was counted and analyzed. RESULTS A total of 100 professional caregivers were recruited, all of which participated in the whole study process. There was no statistical differences in demographic data. Three or six months after the courses, the knowledge scores, confidence scores, and behavior scores of the two groups were significantly improved, and the observation group scores were significantly higher than it was in the control group (P < .05). During the study period, the incidence of falls in the observation group was 1.32%, while it was 0.30% in the control group (P < .05). CONCLUSION Teach-back method can rapidly improve KCB of professional caregivers about fall prevention in elderly inpatients, which is worthy of clinical practice.
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Affiliation(s)
- Qinqin Wang
- Outpatient department of People’s Hospital of Deyang City, Deyang, China
- *Correspondence: Qinqin Wang, Outpatient Department, People’s Hospital of Deyang City, No. 173 of Sec. 1, Taishan North Road, Jingyang District, Deyang, 618000, China (e-mail: )
| | - Huixiang Zou
- Outpatient department of People’s Hospital of Deyang City, Deyang, China
| | - Qin Wang
- Outpatient department of People’s Hospital of Deyang City, Deyang, China
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16
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Heng H, Kiegaldie D, Shaw L, Jazayeri D, Hill AM, Morris ME. Implementing Patient Falls Education in Hospitals: A Mixed-Methods Trial. Healthcare (Basel) 2022; 10:healthcare10071298. [PMID: 35885823 PMCID: PMC9316918 DOI: 10.3390/healthcare10071298] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/23/2022] [Accepted: 07/08/2022] [Indexed: 11/28/2022] Open
Abstract
Patient education is key to preventing hospital falls yet is inconsistently implemented by health professionals. A mixed methods study was conducted involving a ward-based evaluation of patients receiving education from health professionals using a scripted conversation guide with a falls prevention brochure, followed by semi-structured qualitative interviews with a purposive sample of health professionals involved in delivering the intervention. Over five weeks, 37 patients consented to surveys (intervention n = 27; control n = 10). The quantitative evaluation showed that falls prevention education was not systematically implemented in the trial ward. Seven individual interviews were conducted with health professionals to understand the reasons why implementation failed. Perceived barriers included time constraints, limited interprofessional collaboration, and a lack of staff input into designing the research project and patient interventions. Perceived enablers included support from senior staff, consistent reinforcement of falls education by health professionals, and fostering patient empowerment and engagement. Recommended strategies to enhance implementation included ensuring processes were in place supporting health professional accountability, the inclusion of stakeholder input in designing the falls intervention and implementation processes, as well as leadership engagement in falls prevention education. Although health professionals play a key role in delivering evidence-based falls prevention education in hospitals, implementation can be compromised by staff capacity, capability, and opportunities for co-design with patients and researchers. Organisational buy-in to practice change facilitates the implementation of evidence-based falls prevention activities.
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Affiliation(s)
- Hazel Heng
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC 3086, Australia; (H.H.); (L.S.); (D.J.)
- Northern Health, Melbourne, VIC 3076, Australia
| | - Debra Kiegaldie
- Holmesglen Institute and Healthscope, Monash University, Melbourne, VIC 3800, Australia;
- The Victorian Rehabilitation Centre, Healthscope, ARCH La Trobe University, Melbourne, VIC 3086, Australia
| | - Louise Shaw
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC 3086, Australia; (H.H.); (L.S.); (D.J.)
| | - Dana Jazayeri
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC 3086, Australia; (H.H.); (L.S.); (D.J.)
| | - Anne-Marie Hill
- Western Australian Centre for Health & Ageing, School of Allied Health, The University of Western Australia, Perth, WA 6009, Australia;
| | - Meg E. Morris
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC 3086, Australia; (H.H.); (L.S.); (D.J.)
- The Victorian Rehabilitation Centre, Healthscope, ARCH La Trobe University, Melbourne, VIC 3086, Australia
- Correspondence:
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17
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Allen NE, Canning CG, Almeida LRS, Bloem BR, Keus SH, Löfgren N, Nieuwboer A, Verheyden GS, Yamato TP, Sherrington C. Interventions for preventing falls in Parkinson's disease. Cochrane Database Syst Rev 2022; 6:CD011574. [PMID: 35665915 PMCID: PMC9169540 DOI: 10.1002/14651858.cd011574.pub2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Most people with Parkinson's disease (PD) experience at least one fall during the course of their disease. Several interventions designed to reduce falls have been studied. An up-to-date synthesis of evidence for interventions to reduce falls in people with PD will assist with informed decisions regarding fall-prevention interventions for people with PD. OBJECTIVES To assess the effects of interventions designed to reduce falls in people with PD. SEARCH METHODS CENTRAL, MEDLINE, Embase, four other databases and two trials registers were searched on 16 July 2020, together with reference checking, citation searching and contact with study authors to identify additional studies. We also conducted a top-up search on 13 October 2021. SELECTION CRITERIA We included randomised controlled trials (RCTs) of interventions that aimed to reduce falls in people with PD and reported the effect on falls. We excluded interventions that aimed to reduce falls due to syncope. DATA COLLECTION AND ANALYSIS We used standard Cochrane Review procedures. Primary outcomes were rate of falls and number of people who fell at least once. Secondary outcomes were the number of people sustaining one or more fall-related fractures, quality of life, adverse events and economic outcomes. The certainty of the evidence was assessed using GRADE. MAIN RESULTS This review includes 32 studies with 3370 participants randomised. We included 25 studies of exercise interventions (2700 participants), three studies of medication interventions (242 participants), one study of fall-prevention education (53 participants) and three studies of exercise plus education (375 participants). Overall, participants in the exercise trials and the exercise plus education trials had mild to moderate PD, while participants in the medication trials included those with more advanced disease. All studies had a high or unclear risk of bias in one or more items. Illustrative risks demonstrating the absolute impact of each intervention are presented in the summary of findings tables. Twelve studies compared exercise (all types) with a control intervention (an intervention not thought to reduce falls, such as usual care or sham exercise) in people with mild to moderate PD. Exercise probably reduces the rate of falls by 26% (rate ratio (RaR) 0.74, 95% confidence interval (CI) 0.63 to 0.87; 1456 participants, 12 studies; moderate-certainty evidence). Exercise probably slightly reduces the number of people experiencing one or more falls by 10% (risk ratio (RR) 0.90, 95% CI 0.80 to 1.00; 932 participants, 9 studies; moderate-certainty evidence). We are uncertain whether exercise makes little or no difference to the number of people experiencing one or more fall-related fractures (RR 0.57, 95% CI 0.28 to 1.17; 989 participants, 5 studies; very low-certainty evidence). Exercise may slightly improve health-related quality of life immediately following the intervention (standardised mean difference (SMD) -0.17, 95% CI -0.36 to 0.01; 951 participants, 5 studies; low-certainty evidence). We are uncertain whether exercise has an effect on adverse events or whether exercise is a cost-effective intervention for fall prevention. Three studies trialled a cholinesterase inhibitor (rivastigmine or donepezil). Cholinesterase inhibitors may reduce the rate of falls by 50% (RaR 0.50, 95% CI 0.44 to 0.58; 229 participants, 3 studies; low-certainty evidence). However, we are uncertain if this medication makes little or no difference to the number of people experiencing one or more falls (RR 1.01, 95% CI 0.90 to 1.14230 participants, 3 studies) and to health-related quality of life (EQ5D Thermometer mean difference (MD) 3.00, 95% CI -3.06 to 9.06; very low-certainty evidence). Cholinesterase inhibitors may increase the rate of non fall-related adverse events by 60% (RaR 1.60, 95% CI 1.28 to 2.01; 175 participants, 2 studies; low-certainty evidence). Most adverse events were mild and transient in nature. No data was available regarding the cost-effectiveness of medication for fall prevention. We are uncertain of the effect of education compared to a control intervention on the number of people who fell at least once (RR 10.89, 95% CI 1.26 to 94.03; 53 participants, 1 study; very low-certainty evidence), and no data were available for the other outcomes of interest for this comparisonWe are also uncertain (very low-certainty evidence) whether exercise combined with education makes little or no difference to the number of falls (RaR 0.46, 95% CI 0.12 to 1.85; 320 participants, 2 studies), the number of people sustaining fall-related fractures (RR 1.45, 95% CI 0.40 to 5.32,320 participants, 2 studies), or health-related quality of life (PDQ39 MD 0.05, 95% CI -3.12 to 3.23, 305 participants, 2 studies). Exercise plus education may make little or no difference to the number of people experiencing one or more falls (RR 0.89, 95% CI 0.75 to 1.07; 352 participants, 3 studies; low-certainty evidence). We are uncertain whether exercise combined with education has an effect on adverse events or is a cost-effective intervention for fall prevention. AUTHORS' CONCLUSIONS: Exercise interventions probably reduce the rate of falls, and probably slightly reduce the number of people falling in people with mild to moderate PD. Cholinesterase inhibitors may reduce the rate of falls, but we are uncertain if they have an effect on the number of people falling. The decision to use these medications needs to be balanced against the risk of non fall-related adverse events, though these adverse events were predominantly mild or transient in nature. Further research in the form of large, high-quality RCTs are required to determine the relative impact of different types of exercise and different levels of supervision on falls, and how this could be influenced by disease severity. Further work is also needed to increase the certainty of the effects of medication and further explore falls prevention education interventions both delivered alone and in combination with exercise.
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Affiliation(s)
- Natalie E Allen
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Colleen G Canning
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Lorena Rosa S Almeida
- Movement Disorders and Parkinson's Disease Clinic, Roberto Santos General Hospital, Salvador, Brazil
- Motor Behavior and Neurorehabilitation Research Group, Bahiana School of Medicine and Public Health, Salvador, Brazil
| | - Bastiaan R Bloem
- Raboud University Medical Centre; Donders Institute for Brain, Cognition and Behaviour; Department of Neurology, Centre of Expertise for Parkinson & Movement Disorders, Nijmegen, Netherlands
| | - Samyra Hj Keus
- Department of Neurology, Radboud University Nijmegen Medical Center, Nijmegen, Netherlands
- Quality and Improvement, OLVG, Amsterdam, Netherlands
| | - Niklas Löfgren
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Department of Women's and Children's Health, Physiotherapy, Uppsala University, Uppsala, Sweden
| | - Alice Nieuwboer
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | | | - Tiê P Yamato
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
| | - Catherine Sherrington
- Institute for Musculoskeletal Health, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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18
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Leland NE, Lekovitch C, Martínez J, Rouch S, Harding P, Wong C. Optimizing Post-Acute Care Patient Safety: A Scoping Review of Multifactorial Fall Prevention Interventions for Older Adults. J Appl Gerontol 2022; 41:2187-2196. [PMID: 35618304 DOI: 10.1177/07334648221104375] [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: 11/17/2022] Open
Abstract
Accidental falls are preventable adverse events for older post-acute care (PAC) patients. Yet, due to the functional and medical care needs of this population, there is little guidance to inform multidisciplinary prevention efforts. This scoping review aims to characterize the evidence for multifactorial PAC fall prevention interventions. Of the 33 included studies, common PAC intervention domains included implementing facility-based strategies (e.g., staff education), evaluating patient-specific fall risk factors (e.g., function), and developing an individualized risk profile and treatment plan that targets the patient's constellation of fall risk factors. However, there was variability across studies in how and to what extent the domains were addressed. While further research is warranted, health system efforts to prevent accidental falls in PAC should consider a patient-centered multifactorial approach that fosters a culture of safety, addresses individuals' fall risk, and champions a multidisciplinary team.
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Affiliation(s)
- Natalie E Leland
- Department of Occupational Therapy, 6614University of Pittsburgh, Pittsburgh, PA, USA
| | - Cara Lekovitch
- Department of Occupational Therapy, 6614University of Pittsburgh, Pittsburgh, PA, USA
| | - Jenny Martínez
- Department of Occupational Therapy, 6559Jefferson College of Rehabilitation Sciences, Philadelphia, PA, USA
| | - Stephanie Rouch
- Department of Occupational Therapy, 6614University of Pittsburgh, Pittsburgh, PA, USA
| | - Patrick Harding
- Chan Division of Occupational Science and Occupational Therapy, 5116University of Southern California, Los Angeles, CA, USA
| | - Carin Wong
- Department of Sociology, 14669California State University Los Angeles, Los Angeles, CA, USA
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19
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Morris ME, Webster K, Jones C, Hill AM, Haines T, McPhail S, Kiegaldie D, Slade S, Jazayeri D, Heng H, Shorr R, Carey L, Barker A, Cameron I. Interventions to reduce falls in hospitals: a systematic review and meta-analysis. Age Ageing 2022; 51:6581612. [PMID: 35524748 PMCID: PMC9078046 DOI: 10.1093/ageing/afac077] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Falls remain a common and debilitating problem in hospitals worldwide. The aim of this study was to investigate the effects of falls prevention interventions on falls rates and the risk of falling in hospital. DESIGN Systematic review and meta-analysis. PARTICIPANTS Hospitalised adults. INTERVENTION Prevention methods included staff and patient education, environmental modifications, assistive devices, policies and systems, rehabilitation, medication management and management of cognitive impairment. We evaluated single and multi-factorial approaches. OUTCOME MEASURES Falls rate ratios (rate ratio: RaR) and falls risk, as defined by the odds of being a faller in the intervention compared to control group (odds ratio: OR). RESULTS There were 43 studies that satisfied the systematic review criteria and 23 were included in meta-analyses. There was marked heterogeneity in intervention methods and study designs. The only intervention that yielded a significant result in the meta-analysis was education, with a reduction in falls rates (RaR = 0.70 [0.51-0.96], P = 0.03) and the odds of falling (OR = 0.62 [0.47-0.83], P = 0.001). The patient and staff education studies in the meta-analysis were of high quality on the GRADE tool. Individual trials in the systematic review showed evidence for clinician education, some multi-factorial interventions, select rehabilitation therapies, and systems, with low to moderate risk of bias. CONCLUSION Patient and staff education can reduce hospital falls. Multi-factorial interventions had a tendency towards producing a positive impact. Chair alarms, bed alarms, wearable sensors and use of scored risk assessment tools were not associated with significant fall reductions.
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Affiliation(s)
- Meg E Morris
- La Trobe University Academic and Research Collaborative in Health, Melbourne, Victoria, Australia,The Victorian Rehabilitation Centre, Healthscope, Glen Waverley, Victoria, Australia,Address correspondence to: Meg E. Morris, La Trobe University, Bundoora, Victoria 3186, Australia.
| | - Kate Webster
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - Cathy Jones
- La Trobe University Academic and Research Collaborative in Health, Melbourne, Victoria, Australia
| | - Anne-Marie Hill
- Western Australian Centre for Health & Ageing, School of Allied Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Terry Haines
- School of Primary and Allied Health Care, Monash University, Melbourne, Victoria, Australia
| | - Steven McPhail
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health & Social Work, Queensland University of Technology, Brisbane, Queensland, Australia Australia,Digital Health and Informatics Directorate, Metro South Health, Brisbane, Queensland, Australia
| | - Debra Kiegaldie
- Holmesglen Institute and Monash University, Melbourne, Victoria, Australia
| | - Susan Slade
- La Trobe University Academic and Research Collaborative in Health, Melbourne, Victoria, Australia
| | - Dana Jazayeri
- La Trobe University Academic and Research Collaborative in Health, Melbourne, Victoria, Australia
| | - Hazel Heng
- La Trobe University Academic and Research Collaborative in Health, Melbourne, Victoria, Australia
| | - Ronald Shorr
- Geriatric Research Education and Clinical Center, Malcom Randall VAMC, Department of Epidemiology, University of Florida, Gainesville, FL, USA,Department of Epidemiology, University of Florida, Gainesville, FL, USA
| | - Leeanne Carey
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia,Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia
| | - Anna Barker
- School of Primary and Allied Health Care, Monash University, Melbourne, Victoria, Australia,Silver Chain, Melbourne, Victoria, Australia
| | - Ian Cameron
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District and The University of Sydney, Sydney, NSW, Australia
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20
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Falling for It: Of Falls, Families, and Delirium. Crit Care Med 2022; 50:889-891. [PMID: 35485590 DOI: 10.1097/ccm.0000000000005431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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21
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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.
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22
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Abstract
OBJECTIVES Falls have a significant negative impact on the health and well-being of people with dementia and increase service costs related to staff time, paramedic visits, and accident and emergency (A&E) admissions. We examined whether a remote digital vision-based monitoring and management system had an impact on the prevention of falls. METHODS Our study was conducted within the Manor dementia inpatient wards at the Coventry and Warwickshire Partnership Trust. Data were retrieved from incident reports before and 22 months after installation of the system. We examined number of night time falls, severity of fall, number of paramedic visits and A&E admissions, and the number of enhanced observations during both time periods. RESULTS There was a significant 48% reduction in the number of nighttime falls (P < 0.01), a 49% reduction in visits from paramedics (P < 0.2), and a 68% reduction in A&E admissions (P < 0.02). In addition, the data indicated an 82% reduction in the number of moderate severity falls and that enhanced one-to-one observation hours were reduced by 71%. CONCLUSIONS The study demonstrated that a contact-free, remote digital vision-based monitoring and management system reduced falls, fall-related injuries, emergency services time, clinician time, and disruptive night time observations. This benefits the clinicians by allowing them to undertake other clinical duties and promotes the health and safety of patients who might normally experience injury-related stress and disruption to sleep.
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Affiliation(s)
- Kay Wright
- From the Research & Innovation Department, Coventry and Warwickshire Partnership NHS Trust, United Kingdom
| | - Swaran Singh
- From the Research & Innovation Department, Coventry and Warwickshire Partnership NHS Trust, United Kingdom
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23
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Designing and evaluating falls prevention education with residents and staff in aged care homes: a feasibility study. HEALTH EDUCATION 2022. [DOI: 10.1108/he-08-2021-0113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThe purpose of this study was to co-design a falls prevention education programme with aged care home residents and staff and evaluate its feasibility. The intention of providing the education programme was to assist residents to stay safe and mobile whilst reducing their risk of falling.Design/methodology/approachA two-phase mixed methods participatory design using a resident (n = 6) and care staff (n = 5) consumer engagement panel, pre- and post-programme resident (n = 35) survey and semi-structured care staff interviews (n = 8) was undertaken in two countries.FindingsA poster, brochure, video and staff education guide featuring 12 safety messages depicting fall prevention behaviours were co-designed. Residents, supported by staff, perceived the falls prevention education programme as enjoyable and informative, but there were no significant differences in capability, opportunity or motivation. However, several residents were observed enacting fall prevention behaviours such as “If I feel unwell, I'll ring the bell” and waiting for staff assistance. Challenges to programme demand, acceptability and implementation which may have impacted residents' exposure and engagement with the programme were identified, along with recommendations to improve feasibility.Practical implicationsWhen developing falls prevention education programmes partnering with residents and staff, providing choices to meet personal and aesthetic preferences along with frequent, shorter duration learning opportunities are important for translating education messages into actions.Originality/valueThe use of bespoke resources, novel rhymes, positive messages emphasising safety and co-designing with residents themselves was a welcomed point of programme difference.
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24
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Le Couteur DG, Flicker L, Hilmer SN. Geriatric medicine and health care for older people in Australia. Age Ageing 2022; 51:6543102. [PMID: 35253051 DOI: 10.1093/ageing/afac001] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Indexed: 11/14/2022] Open
Abstract
Aged care coverage in Australia is universal but fragmented and has been challenged by government policy to deregulate aged care and open it up to market forces. A recent inquiry into aged care (Royal Commission into Aged Care Quality and Safety) documented the outcome of this policy-substandard care at most levels. The provision of services to older Aboriginal and Torres Strait Islander peoples, who have high prevalence of frailty and cognitive impairment, was also identified as inadequate. The effects of yet to be implemented changes in policy and funding in response to this report remain to be seen. Despite this policy backdrop, geriatricians have contributed to a steady growth in medical services and interventions focussed on specific geriatric issues such as dementia, falls, polypharmacy and orthogeriatrics. These are often driven by, or in collaboration with researchers, and aim to generate research data as well as provide patient care. The numbers of academic geriatricians and other aged care health professionals is increasing, and the training of specialist geriatricians now includes a significant research component.
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Affiliation(s)
- David G Le Couteur
- ANZAC Research Institute and Charles Perkins Centre, University of Sydney, Sydney, Australia.,Department of Geriatric Medicine, Concord Hospital, Sydney, Australia
| | - Leon Flicker
- Western Australian Centre for Health and Ageing, Medical School, University of Western Australia, Perth, Australia.,Department of Geriatric Medicine, Royal Perth Hospital, Perth, Australia
| | - Sarah N Hilmer
- Kolling Institute, University of Sydney, Sydney, Australia.,Departments of Clinical Pharmacology and Aged Care, Royal North Shore Hospital, Sydney, Australia
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25
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Multifactorial falls interventions for people over 65 years in the acute hospital setting: An integrative review. Collegian 2022. [DOI: 10.1016/j.colegn.2021.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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26
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Drahota A, Felix LM, Raftery J, Keenan BE, Lachance CC, Mackey DC, Markham C, Laing AC, Farrell-Savage K, Okunribido O. Shock-absorbing flooring for fall-related injury prevention in older adults and staff in hospitals and care homes: the SAFEST systematic review. Health Technol Assess 2022; 26:1-196. [PMID: 35089119 DOI: 10.3310/zowl2323] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Injurious falls in hospitals and care homes are a life-limiting and costly international issue. Shock-absorbing flooring may offer part of the solution; however, evidence is required to inform decision-making. OBJECTIVES The objectives were to assess the clinical effectiveness and cost-effectiveness of shock-absorbing flooring for fall-related injury prevention among older adults in care settings. REVIEW METHODS A systematic review was conducted of experimental, observational, qualitative and economic studies evaluating flooring in care settings targeting older adults and/or staff. Studies identified by a scoping review (inception to May 2016) were screened, and the search of MEDLINE, AgeLine and Scopus (to September 2019) was updated, alongside other sources. Two independent reviewers assessed risk of bias in duplicate (using Cochrane's Risk of Bias 2.0 tool, the Risk Of Bias In Non-randomized Studies - of Interventions tool, or the Joanna Briggs Institute's qualitative tool). RESULTS Of the 22 included studies, 20 assessed the outcomes (three randomised controlled trials; and seven observational, five qualitative and five economic studies) on novel floors (n = 12), sports floors (n = 5), carpet (n = 5) and wooden subfloors (n = 1). Quantitative data related to 11,857 patient/resident falls (nine studies) and 163 staff injuries (one study). Qualitative studies included patients/residents (n = 20), visitors (n = 8) and staff (n = 119). Hospital-based randomised controlled trial data were too imprecise; however, very low-quality evidence indicated that novel/sports flooring reduced injurious falls from three per 1000 patients per day on vinyl with concrete subfloors to two per 1000 patients per day (rate ratio 0.55, 95% confidence interval 0.36 to 0.84; two studies), without increasing falls rates (two studies). One care home-based randomised controlled trial found that a novel underlay produces similar injurious falls rates (high-quality evidence) and falls rates (moderate-quality evidence) to those of a plywood underlay with vinyl overlays and concrete subfloors. Very low-quality data demonstrated that, compared with rigid floors, novel/sports flooring reduced the number of falls resulting in injury in care homes (26.4% vs. 33.0%; risk ratio 0.80, 95% confidence interval 0.70 to 0.91; three studies) and hospitals (27.1% vs. 42.4%; risk ratio 0.64, 95% confidence interval 0.44 to 0.93; two studies). Fracture and head injury outcomes were imprecise; however, hip fractures reduced from 30 per 1000 falls on concrete to 18 per 1000 falls on wooden subfloors in care homes (odds ratio 0.59, 95% confidence interval 0.45 to 0.78; one study; very low-quality evidence). Four low-quality economic studies concluded that shock-absorbing flooring reduced costs and improved outcomes (three studies), or increased costs and improved outcomes (one study). One, more robust, study estimated that shock-absorbing flooring resulted in fewer quality-adjusted life-years and lower costs, if the number of falls increased on shock-absorbing floors, but that shock-absorbing flooring would be a dominant economic strategy if the number of falls remained the same. Staff found moving wheeled equipment more difficult on shock-absorbing floors, leading to workplace adaptations. Staff injuries were observed; however, very low-quality evidence suggests that these are no less frequent on rigid floors. LIMITATIONS Evidence favouring shock-absorbing flooring is of very low quality; thus, much uncertainty remains. CONCLUSIONS Robust evidence is lacking in hospitals and indicates that one novel floor may not be effective in care homes. Very low-quality evidence indicates that shock-absorbing floors may be beneficial; however, wider workplace implications need to be addressed. Work is required to establish a core outcome set, and future research needs to more comprehensively deal with confounding and the paucity of hospital-based studies, and better plan for workplace adaptations in the study design. STUDY REGISTRATION This study is registered as PROSPERO CRD42019118834. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 5. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Amy Drahota
- School of Health and Care Professions, University of Portsmouth, Portsmouth, UK
| | - Lambert M Felix
- School of Health and Care Professions, University of Portsmouth, Portsmouth, UK
| | - James Raftery
- Wessex Institute, University of Southampton, Southampton, UK
| | | | | | - Dawn C Mackey
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
| | - Chris Markham
- School of Health and Care Professions, University of Portsmouth, Portsmouth, UK
| | - Andrew C Laing
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
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27
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Drahota A, Felix LM, Raftery J, Keenan BE, Lachance CC, Mackey DC, Markham C, Laing AC. The SAFEST review: a mixed methods systematic review of shock-absorbing flooring for fall-related injury prevention. BMC Geriatr 2022; 22:32. [PMID: 34991466 PMCID: PMC8739972 DOI: 10.1186/s12877-021-02670-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 11/19/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Shock-absorbing flooring may minimise impact forces incurred from falls to reduce fall-related injuries; however, synthesized evidence is required to inform decision-making in hospitals and care homes. METHODS This is a Health Technology Assessment mixed methods systematic review of flooring interventions targeting older adults and staff in care settings. Our search incorporated the findings from a previous scoping review, MEDLINE, AgeLine, and Scopus (to September 2019) and other sources. Two independent reviewers selected, assessed, and extracted data from studies. We assessed risk of bias using Cochrane and Joanna Briggs Institute tools, undertook meta-analyses, and meta-aggregation. RESULTS 20 of 22 included studies assessed our outcomes (3 Randomised Controlled Trials (RCTs); 7 observational; 5 qualitative; 5 economic), on novel floors (N = 12), sports floors (N = 5), carpet (N = 5), and wooden sub-floors (N = 1). Quantitative data related to 11,857 patient falls (9 studies), and 163 staff injuries (1 study). One care home-based RCT found a novel underlay produced similar injurious falls rates (high-quality evidence) and falls rates (moderate-quality evidence) to a plywood underlay with vinyl overlay and concrete sub-floors. Very low-quality evidence suggested that shock-absorbing flooring may reduce injuries in hospitals (Rate Ratio 0.55, 95% CI 0.36 to 0.84, 2 studies; 27.1% vs. 42.4%; Risk Ratio (RR) = 0.64, 95% CI 0.44 to 0.93, 2 studies) and care homes (26.4% vs. 33.0%; RR 0.80, 95% CI 0.70 to 0.91, 3 studies), without increasing falls. Economic evidence indicated that if injuries are fewer and falls not increased, then shock-absorbing flooring would be a dominant strategy. Fracture outcomes were imprecise; however, hip fractures reduced from 30 in 1000 falls on concrete to 18 in 1000 falls on wooden sub-floors (OR 0.59, 95% CI 0.45 to 0.78; one study; very low-quality evidence). Staff found moving wheeled equipment harder on shock-absorbing floors leading to workplace adaptations. Very low-quality evidence suggests staff injuries were no less frequent on rigid floors. CONCLUSION Evidence favouring shock-absorbing flooring is uncertain and of very low quality. Robust research following a core outcome set is required, with attention to wider staff workplace implications. TRIAL REGISTRATION PROSPERO CRD42019118834 .
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Affiliation(s)
- Amy Drahota
- School of Health and Care Professions, University of Portsmouth, St. Andrew's Court, St. Michael's Road, Portsmouth, PO1 2PR, UK.
| | - Lambert M Felix
- International Centre for Evidence in Disability, Department of Clinical Research, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - James Raftery
- Wessex Institute, University of Southampton, Alpha House, Enterprise Road, Southampton, SO16 7NS, UK
| | - Bethany E Keenan
- School of Engineering, Cardiff University, Queen's Buildings, The Parade, Cardiff, CF24 3AA, UK
| | - Chantelle C Lachance
- School of Health and Care Professions, University of Portsmouth, St. Andrew's Court, St. Michael's Road, Portsmouth, PO1 2PR, UK
| | - Dawn C Mackey
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, 8888 University Drive East, Burnaby, British Columbia, V5A 1S6, Canada
| | - Chris Markham
- School of Health and Care Professions, University of Portsmouth, St. Andrew's Court, St. Michael's Road, Portsmouth, PO1 2PR, UK
| | - Andrew C Laing
- Department of Kinesiology, University of Waterloo, B.C. Matthews Hall, Waterloo, Ontario, N2L 3G1, Canada
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28
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Turner K, Staggs VS, Potter C, Cramer E, Shorr RI, Mion LC. Fall Prevention Practices and Implementation Strategies: Examining Consistency Across Hospital Units. J Patient Saf 2022; 18:e236-e242. [PMID: 32732628 PMCID: PMC7854936 DOI: 10.1097/pts.0000000000000758] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Our study examines how consistently fall prevention practices and implementation strategies are used by U.S. hospitals. METHODS We conducted a cross-sectional, descriptive study of 60 general adult hospital units.We administered a survey measuring 5 domains of fall prevention practices: visibility and identification, bed modification, patient monitoring, patient safety, and education. We measured 4 domains of implementation strategies including quality management (e.g., providing data and support for quality improvement), planning (e.g., designating leadership), education (e.g., providing consultation and training), and restructuring (e.g., revising staff roles and modifying equipment). RESULTS Of 60 units, 43% were medical units and 57% were medical-surgical units. The hospital units varied in fall prevention practices, with practices such as keeping a patient's bed in a locked position (73% strongly agree) being used more consistently than other practices, such as scheduled toileting (15% strongly agree). Our study observed variation in fall prevention implementation strategies. For example, publicly posting fall rates (60% strongly agree) was more consistently used than having a multidisciplinary huddle after a fall event (12% strongly agree). CONCLUSIONS There is substantial variation in the implementation of fall prevention practices and implementation strategies across inpatient units. Our study found that resource-intensive practices (e.g., scheduled toileting) are less consistently used than less resource-intensive practices and that interdisciplinary approaches to fall prevention are limited. Future studies should examine how units tailor fall prevention practices based on patient risk factors and how units decide, based on their available resources, which implementation strategies should be used.
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Affiliation(s)
- Kea Turner
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - Vincent S. Staggs
- Health Services and Outcomes Research, Children’s Mercy Kansas City
- School of Medicine, University of Missouri-Kansas City
| | | | - Emily Cramer
- University of Kansas Medical Center, College of Nursing, Kansas City, Missouri
| | - Ronald I. Shorr
- Department of Epidemiology, University of Florida
- Geriatric Research, Education and Clinical Center (GRECC), Malcolm Randall Veterans Administration Medical Center, Gainesville, FL
| | - Lorraine C. Mion
- Ohio State University, College of Nursing
- Center for Healthy Aging, Self-Management and Complex Care, Columbus, Ohio
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29
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Aihara S, Kitamura S, Dogan M, Sakata S, Kondo K, Otaka Y. Patients' thoughts on their falls in a rehabilitation hospital: a qualitative study of patients with stroke. BMC Geriatr 2021; 21:713. [PMID: 34922484 PMCID: PMC8684226 DOI: 10.1186/s12877-021-02649-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 11/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients with stroke in rehabilitation wards are at an increased risk of falling. Although patients' participation in establishing medical safety is considered crucial, there is limited evidence on their perspectives of falls. This study aims to comprehensively elucidate the subjective falling experience of patients with stroke who have been admitted to rehabilitation wards. METHODS Twenty-three consecutive patients with stroke (44 to 90 years) who experienced a fall during hospitalisation were interviewed within 1 week after the fall, and thematic analysis was used to analyse the data. RESULTS Five themes surrounding fall events were extracted from the narratives: 'Psychological background before the action', 'Support for the action', 'Direct causes of the fall', 'Patients' awareness after the fall', and 'Changes in attitudes and behaviours after the fall'. 'Psychological background before the action' comprised hastiness or hesitation to call for help. Participants often took an action based on 'Support for the action' derived from their past experiences of moving safely, their confidence, and/or motivation to challenge themselves to move. 'Direct causes of the fall' consisted of unfamiliar actions, training fatigue, the surrounding environment, reduced physical function due to paralysis, lack of attention, overconfidence in their ability, and insufficient prediction of falls. 'Patients' awareness after the fall' consisted of re-affirming difficult movements, the need for rehabilitation, a reduced ability to move, an increased risk of falling, the need for attention while moving, a fear of falling, and a lack of lessons learned from falling. Finally, patients demonstrated 'Changes in attitudes and behaviours after the fall' such as embodying a positive attitude to cope with the risk of falling or behavioural changes to reduce the risk of falling. CONCLUSIONS Comprehensive information on patients' perspectives before and after the fall was elucidated, uncovering many aspects including the psychological background for why patients engaged in risky behaviours resulting in falls, presence of positive thinking, and behaviour after the fall. By incorporating the patients' views on fall incidences and their assessment, we can develop appropriate prevention strategies against falls.
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Affiliation(s)
- Saika Aihara
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Narashino, Chiba, Japan.,Department of Rehabilitation, Faculty of Health Science, Tohoku Fukushi University, Sendai, Miyagi, Japan
| | - Shin Kitamura
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Narashino, Chiba, Japan.,Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Aichi, Japan
| | - Masayuki Dogan
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Narashino, Chiba, Japan
| | - Sachiko Sakata
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Narashino, Chiba, Japan
| | - Kunitsugu Kondo
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Narashino, Chiba, Japan
| | - Yohei Otaka
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Narashino, Chiba, Japan. .,Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan.
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30
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de Jong LD, Francis-Coad J, Waldron N, Ingram K, McPhail SM, Etherton-Beer C, Haines TP, Flicker L, Weselman T, Hill AM. Does Free-Text Information in Falls Incident Reports Assist to Explain How and Why the Falls Occurred in a Hospital Setting? J Patient Saf 2021; 17:e1472-e1479. [PMID: 30192260 DOI: 10.1097/pts.0000000000000533] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to explore whether information captured in falls reports in incident management systems could be used to explain how and why the falls occurred, with a view to identifying whether such reports can be a source of subsequent learnings that inform practice change. METHODS An analysis of prospectively collected falls incident reports found in the incident management systems from eight Western Australian hospitals during a stepped-wedge cluster-randomized controlled trial. The falls reported occurred in a cohort of older hospital patients (mean age = 82 y) on rehabilitation wards. Data coded from free-text comments in the incident reports were analyzed using deductive content analysis. RESULTS In the 493 analyzed falls incident reports, qualitative information describing aspects of the fall that clarified the patient, staff, and environment-related contributory factors was consistently low. Reports infrequently contained information about patients' and staff's call bell use behaviors (13%-19% of reports), fidelity of implementation of the care plan (8%) or environment-related factors such as bed settings (20%), and presence of clutter at the fall location (1%). The patients' account of the fall was present in less than 50% of reports, with an absence of concurrent text, which explained whether patient cognitive impairment was the reason for not obtaining this first-person account of the incident. CONCLUSIONS Falls reports in hospital incident management systems may not capture adequate information to explain how and why falls occur. This could limit creation of effective feedback loops to drive quality improvement efforts and targeted practice change.
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Affiliation(s)
- Lex D de Jong
- From the School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Bentley, Perth
| | | | | | - Katharine Ingram
- Department of Rehabilitation and Aged Care, Sir Charles Gairdner Hospital, Perth, Western Australia
| | - Steven M McPhail
- Centre for Functioning and Health Research, Metro South Health, Brisbane, Queensland, Australia & Institute of Health and Biomedical Innovation and School of Public Health & Social Work, Queensland University of Technology, Brisbane, Queensland
| | - Christopher Etherton-Beer
- WA Centre for Health and Ageing, Royal Perth Hospital Unit, School of Medicine & Pharmacology and Centre for Medical Research, University of Western Australia, Perth, Western Australia
| | - Terry P Haines
- School of Primary and Allied Health Care, Monash University, Frankston, Victoria, Australia
| | - Leon Flicker
- WA Centre for Health and Ageing, Royal Perth Hospital Unit, School of Medicine & Pharmacology and Centre for Medical Research, University of Western Australia, Perth, Western Australia
| | - Tammy Weselman
- From the School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Bentley, Perth
| | - Anne-Marie Hill
- From the School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Bentley, Perth
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31
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Dolan H, Slebodnik M, Taylor-Piliae R. Older adults' perceptions of their fall risk in the hospital: An integrative review. J Clin Nurs 2021; 31:2418-2436. [PMID: 34786777 DOI: 10.1111/jocn.16125] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 09/18/2021] [Accepted: 10/29/2021] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES The objectives of this review are to determine what is currently known about older adults' perceptions of their own fall risk in the hospital and associated factors and explore how perceived fall risk in the hospital is assessed. BACKGROUND Every year, up to one million patients suffer an accidental fall in the hospital. Despite research efforts during the last decade, inpatient fall rates have not significantly decreased, and about one third of inpatient falls result in injuries. Limited evidence suggests that assessing hospitalised patients' perceptions of their fall risk and engaging them in their own fall prevention can reduce inpatient falls. DESIGN An integrative review. METHODS An electronic literature search was conducted in the Cumulative Index of Nursing and Allied Health Literature, Cochrane Database of Systematic Reviews, Embase, Google Scholar, OpenGrey, ProQuest Dissertations & Theses Global, PsycINFO and PubMed. Data extraction and quality assessments were independently performed by two reviewers. PRISMA guidelines were followed for reporting this review. RESULTS Twenty-two studies met the inclusion criteria. The findings suggest that hospitalised older adults inadequately estimate their own fall risk. Most participants did not perceive themselves as at risk for falling in the hospital. Educational and motivational interventions can change the patients' perceptions of their own fall risk in the hospital and engage them in fall prevention. The desire to remain independent and feeling vulnerable were associated with fall risk, and the relationship with nursing staff may affect how hospitalised patients perceive their own fall risk. CONCLUSIONS Hospitalised adults, and specifically older adults, do not adequately estimate their own fall risk. Factors associated with these perceptions must be further explored to develop assessment tools and interventions to decrease inpatient fall rates. RELEVANCE TO CLINICAL PRACTICE Nurses' understanding and assessment of hospitalised adults' perception of their own fall risk is important to consider for reducing inpatient falls.
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Affiliation(s)
- Hanne Dolan
- College of Nursing, The University of Arizona, Tucson, Arizona, USA
| | - Maribeth Slebodnik
- Arizona Health Sciences Library and College of Nursing, The University of Arizona, Tucson, Arizona, USA
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Kato Y, Kitamura S, Katoh M, Hirano A, Senjyu Y, Ogawa M, Maeda H, Mukaino M, Hirano S, Sakurai H, Shibata S, Otaka Y. Stroke Patients with Nearly Independent Transfer Ability are at High Risk of Falling. J Stroke Cerebrovasc Dis 2021; 31:106169. [PMID: 34735899 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106169] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 09/25/2021] [Accepted: 10/10/2021] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES To examine the relationship between patients' transfer ability and fall risk in stroke patients during hospitalization. MATERIALS AND METHODS We retrospectively enrolled 237 stroke patients who were transferred to a convalescent rehabilitation ward from acute wards in the same hospital. Using incident reports, we investigated their fall rates and activity status at the falls according to their transfer abilities, which were assessed with Functional Independence Measure (FIM) transfer scores. The bi-weekly time trend of fall rates in all patients and in three subgroups based on FIM transfer scores of 1-3, 4-5, and 6-7, and activity status at the falls, were investigated. In addition, changes of patients' transfer ability on admission, at the first fall, and at discharge were investigated among falling patients. RESULTS The fall rate was the greatest in patients with a FIM transfer score of 4 (14.3 times/1000 person-days). The majority of falls for patients with a FIM transfer score of 1 occurred at the activity status of "on the bed" and "sitting", while three quarters of patients with a FIM score of 7 had falls during "standing" and "walking". No longitudinal trend in fall rates was found overall; however, the fall rate trends differed depending on the FIM transfer score. The majority of the patients who fell required full assistance for transfers upon admission but required no assistance at discharge. CONCLUSIONS Fall risk differed among patients with various transfer abilities; the greatest risk was in those who needed minimal assistance for transfers.
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Affiliation(s)
- Yoshitaka Kato
- Department of Rehabilitation, Fujita Health University Hospital, 1-98 Dengakugakubo, Kutsukake, Aichi, Toyoake 470-1192, Japan.
| | - Shin Kitamura
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Aichi, Japan; Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Aichi, Japan.
| | - Masaki Katoh
- Department of Rehabilitation, Fujita Health University Hospital, 1-98 Dengakugakubo, Kutsukake, Aichi, Toyoake 470-1192, Japan; Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Aichi, Japan.
| | - Asuka Hirano
- Department of Rehabilitation, Fujita Health University Hospital, 1-98 Dengakugakubo, Kutsukake, Aichi, Toyoake 470-1192, Japan.
| | - Yuki Senjyu
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Aichi, Japan.
| | - Mao Ogawa
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Aichi, Japan.
| | - Hirofumi Maeda
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Aichi, Japan.
| | - Masahiko Mukaino
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Aichi, Japan.
| | - Satoshi Hirano
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Aichi, Japan.
| | - Hiroaki Sakurai
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Aichi, Japan.
| | - Seiko Shibata
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Aichi, Japan.
| | - Yohei Otaka
- Department of Rehabilitation, Fujita Health University Hospital, 1-98 Dengakugakubo, Kutsukake, Aichi, Toyoake 470-1192, Japan; Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Aichi, Japan.
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Shaik AR, Ahmad F, Miraj M, Alqahtani M, Alzhrani M, Alanazi A, Kashoo F. Efficacy of the structured balance awareness program on perceived balance confidence and fear-related maladaptive behaviour in post-stroke survivors. NeuroRehabilitation 2021; 49:547-552. [PMID: 34542039 DOI: 10.3233/nre-210144] [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: 11/15/2022]
Abstract
BACKGROUND The risk of falling for individuals with stroke is about twice that of healthy older adults. Lack of appropriate initiative to address the fear-related maladaptive behaviour can manifest itself in the form of loss of physical functions resulting in disability and handicap. OBJECTIVE To examine the effectiveness of the structured balance awareness program (SBAP) in improving the perceived balance confidence, and thereby modifying the fear-related maladaptive behaviour in post-stroke survivors. METHODS A randomized experimental control design was used on a sample of 97 post-stroke survivors aged between 55 to 75 years. The patients received either the SBAP or health awareness program (HAP) for eight weeks and were compared on Activities-specific Balance Confidence (ABC) Scale, Berg Balance Scale (BBS) and Falls Efficacy Scale International (FESI). RESULTS A paired t-test demonstrated statistically significant improvement among all the variables in the SBAP group. An independent t-test exhibited a statistically significant improvement on ABC (t = 2.57, p = 0.012 *), BBS (t = 3.32, p = 0.001 *) and FESI (t = 3.38, p = 0.001 *) in the SBAP group. CONCLUSION The study showed that the SBAP was effective in minimizing the fear-related maladaptive behaviour in post-stroke survivors.
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Affiliation(s)
- Abdul Rahim Shaik
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Al-Majmaah, Saudi Arabia
| | - Fuzail Ahmad
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Al-Majmaah, Saudi Arabia
| | - Mohammad Miraj
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Al-Majmaah, Saudi Arabia
| | - Mazen Alqahtani
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Al-Majmaah, Saudi Arabia
| | - Msaad Alzhrani
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Al-Majmaah, Saudi Arabia
| | - Ahmad Alanazi
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Al-Majmaah, Saudi Arabia
| | - Faizan Kashoo
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Al-Majmaah, Saudi Arabia
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Naseri C, McPhail SM, Morris ME, Haines TP, Etherton-Beer C, Shorr R, Flicker L, Bulsara M, Lee DCA, Francis-Coad J, Waldron N, Hill AM. Tailored Education Increased Capability and Motivation for Fall Prevention in Older People After Hospitalization. Front Public Health 2021; 9:683723. [PMID: 34414157 PMCID: PMC8369365 DOI: 10.3389/fpubh.2021.683723] [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: 03/22/2021] [Accepted: 06/28/2021] [Indexed: 12/25/2022] Open
Abstract
Recently hospitalized older people are at risk of falls and face barriers to undertaking fall prevention strategies after they return home from hospital. The authors examined the effects of tailored education delivered by physiotherapists on the knowledge (capability) and the motivation of older people to engage in fall prevention after hospital discharge. Utilizing data gathered from a recent trial, data was analyzed from 390 people who were 60 years and over without impaired cognition (>7/10 abbreviated mental test score) and discharged from three Australian hospitals. Motivation and capability were measured at baseline in the hospital and at 6-months after hospital discharge by blinded assistants using structured surveys. Bivariate analysis using generalized linear modeling explored the impact of education on the capability and motivation. Engagement in fall prevention strategies was entered as an independent variable during analysis to determine associations with capability and motivation. The education significantly improved capability [-0.4, 95% CI (-0.7, -0.2), p < 0.01] and motivation [-0.8, 95% CI (-1.1, -0.5), p < 0.01] compared with social-control at the time of hospital discharge. In contrast, social-control participants gained capability and motivation over the 6-months, and no significant differences were found between groups in capability [0.001, 95% CI (-0.2, 0.2), p = 0.9] and motivation [-0.01, 95% CI (-0.3, 0.3), p = 0.9] at follow-up. Tailored fall prevention education is recommended around hospital discharge. Participants still needed to overcome barriers to falls prevention engagement post hospitalization. Thus, tailored education along with direct clinical services such as physiotherapy and social supports is warranted for older people to avoid falls and regain function following hospitalization.
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Affiliation(s)
- Chiara Naseri
- Faculty of Health Sciences, Curtin School of Allied Health, Curtin University, Perth, WA, Australia
| | - Steven M McPhail
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, Faculty of Health, School of Public Health & Social Work, Queensland University of Technology, Brisbane, QLD, Australia.,Clinical Informatics Directorate, Metro South Health, Brisbane, QLD, Australia
| | - Meg E Morris
- Healthscope Academic and Research Collaborative in Health, La Trobe University, Bundoora, VIC, Australia.,College of Healthcare Sciences, James Cook University, Douglas, QLD, Australia
| | - Terry P Haines
- School of Primary and Allied Health Care, Monash University, Frankston, VIC, Australia
| | - Christopher Etherton-Beer
- Royal Perth Hospital, Perth, WA, Australia.,Western Australian Centre for Health and Ageing, Medical School, University of Western Australia, Perth, WA, Australia
| | - Ronald Shorr
- Malcom Randall Veterans Affairs Medical Center, Geriatric Research Education and Clinical Center, Gainesville, FL, United States.,College of Medicine, University of Florida, Gainesville, FL, United States
| | - Leon Flicker
- Royal Perth Hospital, Perth, WA, Australia.,Western Australian Centre for Health and Ageing, Medical School, University of Western Australia, Perth, WA, Australia
| | - Max Bulsara
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, WA, Australia
| | - Den-Ching A Lee
- School of Primary and Allied Health Care, Monash University, Frankston, VIC, Australia
| | - Jacqueline Francis-Coad
- Faculty of Health Sciences, Curtin School of Allied Health, Curtin University, Perth, WA, Australia
| | - Nicholas Waldron
- Department of Geriatric Rehabilitation, Armadale Health Service, Department of Health, Perth, WA, Australia
| | - Anne-Marie Hill
- Faculty of Health Sciences, Curtin School of Allied Health, Curtin University, Perth, WA, Australia
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The Significance of Posterior Occlusal Support of Teeth and Removable Prostheses in Oral Functions and Standing Motion. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18136776. [PMID: 34202488 PMCID: PMC8297000 DOI: 10.3390/ijerph18136776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 06/16/2021] [Accepted: 06/21/2021] [Indexed: 01/19/2023]
Abstract
The purpose of this study was to evaluate the effect of posterior occlusal support of natural teeth and artificial teeth on oral functions and standing motion. Patients who had been treated with removable prostheses were enrolled as the subjects. Their systemic conditions (body mass index (BMI) and skeletal muscle mass index (SMI)) were recorded. The subjects were classified into two groups according to a modified Eichner index: B1-3 (with posterior occlusal support) and B4C (without posterior occlusal support). Maximum occlusal force (MOF), masticatory performance (MP), and standing motion (sway and strength) were evaluated for cases with and without removable prostheses. There were no significant differences in BMI and SMI between the B1-3 group and the B4C group. The subjects with removable prostheses demonstrated significantly higher values in MOF, MP, and sway and strength than the subjects without removable prostheses. The comparison of oral functions between the B1-3 group and the B4C group revealed that the positive effect of posterior occlusal support of natural teeth and removable prostheses and the significant positive effects of posterior occlusal support on standing motion were partly observed in these comparisons. Posterior occlusal support of natural teeth and even of removable prostheses may contribute to the enhancement of oral functions and standing motion.
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Marshall K, Gustafsson L, McKittrick A, Fleming J. Falls Occurring After a Spinal Cord Injury: A Scoping Review. Am J Occup Ther 2021; 75:12500. [PMID: 34781344 DOI: 10.5014/ajot.2021.043695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Falls have a considerable physical and psychological impact on people with spinal cord injury (SCI). Occupational therapy practitioners require evidence to support the timely development of occupation-based programs that can be applied to fall prevention in daily life. OBJECTIVE To determine what is known about falls after SCI, including wheelchair users and people who are ambulatory, and to understand elements of fall prevention to be addressed by occupational therapy practitioners. We applied the Canadian Measure of Occupational Performance and Engagement to understand elements to be addressed in fall education and prevention with this population. DATA SOURCES We searched eight databases using the key words falls and spinal cord injury with no limit set on dates. Study Selection and Data Collection: Studies were included that reported on falls among adults with SCI and measured one or more of the following: incidence of falls, consequences of falls, contributing factors for falls, the person's experience of falls, and strategies to prevent falls. FINDINGS Thirty-five articles were included. The majority of the articles included information on the incidence (n = 20), consequences (n = 26), and contributing factors (n = 30) of falls. Two articles analyzed the person's experience of falls, and 1 study reviewed a fall prevention program for people with SCI specifically. CONCLUSIONS AND RELEVANCE Research on participants' experience of falls and fall prevention programs used in spinal cord rehabilitation is extremely limited. Future research on the lived experience of falls for people with SCI is warranted. What This Article Adds: This review of evidence on falls after SCI highlights gaps in the current available evidence.
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Affiliation(s)
- Kathryn Marshall
- Kathryn Marshall, BOccThy, is PhD Student, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia, and Occupational Therapist, Department of Occupational Therapy, Princess Alexandra Hospital, Brisbane, Queensland, Australia;
| | - Louise Gustafsson
- Louise Gustafsson, PhD, BOccThy(Hons), is Professor, School of Allied Health Sciences, Griffith University, Brisbane, Queensland, Australia, and Honorary Professor, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Andrea McKittrick
- Andrea McKittrick, BSc(Hons) CurrOcc, is PhD Student, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia, and Occupational Therapist, Department of Occupational Therapy, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Jennifer Fleming
- Jennifer Fleming, PhD, BOccThy(Hons), FOTARA, is Professor and Head of Occupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
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Cognitive Dissonance of Students Between Falls Prevention Evidence and Strategies. Clin Simul Nurs 2021. [DOI: 10.1016/j.ecns.2021.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Krakau K, Andersson H, Dahlin ÅF, Egberg L, Sterner E, Unbeck M. Validation of nursing documentation regarding in-hospital falls: a cohort study. BMC Nurs 2021; 20:58. [PMID: 33836734 PMCID: PMC8034134 DOI: 10.1186/s12912-021-00577-4] [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: 09/16/2020] [Accepted: 03/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In-hospital fall incidents are common and sensitive to nursing care. It is therefore important to have easy access to valid patient data to evaluate and follow-up nursing care. The aim of the study was to validate the nursing documentation, using a specific term in the registered nurses´ (RNs´) discharge note, regarding inpatient falls according to the outcome of a digitalized data extraction tool and the discharge note itself. METHODS At a teaching hospital, 31,571 episodes of care were eligible for inclusion in this retrospective cohort study. A stratified sampling including five groups was used, two with random sampling and three with total sampling. In total, 1232 episodes of care were reviewed in the electronic patient record using a study-specific protocol. Descriptive statistics were used. RESULTS In total, 590 episodes of care in the study cohort included 714 falls. When adjusted for the stratified sampling the cumulative incidence for the study population was 1.9%. The positive predictive value in total for the data extraction tool regarding the presence of any fall, in comparison with the record review, was 87.4%. Discrepancies found were, for example, that the RNs, at discharge, stated that the patient had fallen but no documented evidence of that could be detected during admission. It could also be the opposite, that the RNs correctly had documented that no fall had occurred, but the data extraction tool made an incorrect selection. When the latter had been withdrawn, the positive predictive value was 91.5%. Information about minor injuries due to the fall was less accurate. In the group where RNs had stated that the patient had fallen without injury, minor injuries had actually occurred in 28.3% of the episodes of care. CONCLUSIONS The use of a specific term regarding fall in the RNs´ discharge note seems to be a valid and reliable data measurement and can be used continuously to evaluate and follow-up nursing care.
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Affiliation(s)
- Karolina Krakau
- Department of Rehabilitation Medicine, Danderyd Hospital, Danderyd, Sweden
| | - Helene Andersson
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Solna, Sweden.,Department of Infection, Danderyd Hospital, Danderyd, Sweden
| | - Åsa Franzén Dahlin
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Solna, Sweden. .,Department of Neurology, Danderyd Hospital, Danderyd, Sweden.
| | - Louise Egberg
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Solna, Sweden.,Department of Surgery and Urology, Danderyd Hospital, Danderyd, Sweden
| | - Eila Sterner
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden.,Department of Trauma, Acute Care Surgery and Orthopedics, Karolinska University Hospital, Solna, Sweden
| | - Maria Unbeck
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden.,School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
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Morris ME, Haines T, Hill AM, Cameron ID, Jones C, Jazayeri D, Mitra B, Kiegaldie D, Shorr RI, McPhail SM. Divesting from a Scored Hospital Fall Risk Assessment Tool (FRAT): A Cluster Randomized Non-Inferiority Trial. J Am Geriatr Soc 2021; 69:2598-2604. [PMID: 33834490 PMCID: PMC8518986 DOI: 10.1111/jgs.17125] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 02/21/2021] [Accepted: 02/26/2021] [Indexed: 12/26/2022]
Abstract
Background/Objectives We investigated the impact of ceasing routine falls risk assessment tool (FRAT) completion and instead used clinical reasoning to select fall mitigation strategies. Design Two‐group, multi‐site cluster‐randomized active‐control non‐inferiority trial. Setting Hospital wards. Participants Adult inpatients admitted to participating hospitals (n = 10 hospitals, 123,176 bed days). Intervention Hospitals were randomly assigned (1:1) to a usual care control group that continued to use a historical FRAT to assign falls risk scores and accompanying mitigation strategies, or an experimental group whereby clinicians did not assign risk scores and instead used clinical reasoning to select fall mitigation strategies using a decision support list. Measurements The primary measure was between‐group difference in mean fall rates (falls/1000 bed days). Falls were identified from incident reports supplemented by hand searches of medical records over three consecutive months at each hospital. The incidence rate ratio (IRR) of monthly falls rates in control versus experimental hospitals was also estimated. Results The experimental clinical reasoning approach was non‐inferior to the usual care FRAT that assigned fall risk ratings when compared to a‐priori stakeholder derived and sensitivity non‐inferiority margins. The mean fall rates were 3.84 falls/1000 bed days for the FRAT continuing sites and 3.11 falls/1000 bed days for experimental sites. After adjusting for historical fall rates at each hospital, the IRR (95%CI) was 0.78 (0.64, 0.95), where IRR < 1.00 indicated fewer falls among the experimental group. There were 4 and 3 serious events in the control and experimental groups, respectively. Conclusion Replacing a FRAT scoring system with clinical reasoning did not lead to inferior fall outcomes in the short term and may even reduce fall incidence.
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Affiliation(s)
- Meg E Morris
- Healthscope ARCH, Victorian Rehabilitation Centre, Glen Waverley, Victoria, Australia.,La Trobe Centre for Sport and Exercise Medicine Research, La Trobe University, Bundoora, Melbourne, Australia
| | - Terry Haines
- School of Primary and Allied Health Care, Monash University, Melbourne, Victoria, Australia
| | - Anne Marie Hill
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - Ian D Cameron
- John Walsh Centre for Rehabilitation Research, Faculty of Medicine and Health, Kolling Institute, University of Sydney, St. Leonards, New South Wales, Australia
| | | | - Dana Jazayeri
- Healthscope ARCH, Victorian Rehabilitation Centre, Glen Waverley, Victoria, Australia.,La Trobe Centre for Sport and Exercise Medicine Research, La Trobe University, Bundoora, Melbourne, Australia
| | - Biswadev Mitra
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Debra Kiegaldie
- Holmesglen Institute, Melbourne, Victoria, Australia.,Eastern Clinical School, Monash University, Melbourne, Australia
| | - Ronald I Shorr
- Geriatric Research Education and Clinical Center (GRECC), Malcom Randall VAMC, Gainesville, Florida, USA and Department of Epidemiology, University of Florida, Gainesville, Florida, USA
| | - Steven M McPhail
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health & Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia.,Clinical Informatics Directorate, Metro South Health, Brisbane, Queensland, Australia
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Heng H, Slade SC, Jazayeri D, Jones C, Hill AM, Kiegaldie D, Shorr RI, Morris ME. Patient Perspectives on Hospital Falls Prevention Education. Front Public Health 2021; 9:592440. [PMID: 33796493 PMCID: PMC8007862 DOI: 10.3389/fpubh.2021.592440] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 02/19/2021] [Indexed: 12/02/2022] Open
Abstract
Hospital falls remain an intractable problem worldwide and patient education is one approach to falls mitigation. Although educating patients can help their understanding of risks and empower them with prevention strategies, patient experiences of hospital falls education are poorly understood. This study aimed to understand the perspectives and preferences of hospitalized patients about falls prevention education. Three focus groups were conducted in Australian hospitals. A phenomenological approach was used to explore patient perspectives and data were analyzed thematically. The focus groups revealed that most people did not realize their own risk of falling whilst an inpatient. Experiences of falls prevention education were inconsistent and sometimes linked to beliefs that falls were not relevant to them because they were being cared for in hospital. Other barriers to falls mitigation included poor patient knowledge about hospital falls risk and inconsistencies in the delivery of falls prevention education. A strong theme was that individualized, consistent education, and small interactive groups were helpful.
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Affiliation(s)
- Hazel Heng
- La Trobe Centre for Sport and Exercise Medicine Research, La Trobe University, Bundoora, VIC, Australia
| | - Susan C. Slade
- La Trobe Centre for Sport and Exercise Medicine Research, La Trobe University, Bundoora, VIC, Australia
| | - Dana Jazayeri
- La Trobe Centre for Sport and Exercise Medicine Research, La Trobe University, Bundoora, VIC, Australia
| | | | - Anne-Marie Hill
- Faculty of Health Sciences, School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia
| | - Debra Kiegaldie
- Healthscope Ltd, Melbourne, VIC, Australia
- Faculty of Health Science, Youth and Community Studies, Holmesglen Institute, Melbourne, VIC, Australia
| | - Ronald I. Shorr
- Geriatric Research Education and Clinical Center (GRECC), Malcom Randall Veterans Affairs Medical Center, Gainesville, FL, United States
- Department of Epidemiology, University of Florida, Gainesville, FL, United States
| | - Meg E. Morris
- La Trobe Centre for Sport and Exercise Medicine Research, La Trobe University, Bundoora, VIC, Australia
- Healthscope Ltd, Melbourne, VIC, Australia
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Giap TTT, Park M. Implementing Patient and Family Involvement Interventions for Promoting Patient Safety: A Systematic Review and Meta-Analysis. J Patient Saf 2021; 17:131-140. [PMID: 33208637 DOI: 10.1097/pts.0000000000000714] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The aims of the study were to evaluate and to quantify the effects of patient and family involvement (PFI) interventions on patient safety by synthesizing the available global data. METHODS Four databases were searched to identify relevant studies that have assessed the impact of PFI on patient safety up to March 2019. Reference lists of potential selected articles were also used to identify additional relevant studies. Effect sizes (ESs) were calculated using random and fixed effects models. Statistical heterogeneity was measured using the I2 test. RESULTS Twenty-two studies met the review criteria. The meta-analysis showed that PFI were beneficial in significantly reducing adverse events (ES = -0.240, P < 0.001), decreasing the length of hospital stay (ES = -0.122, P < 0.001), increasing patient safety experiences (ES = 0.630, P = 0.007), and improving patient satisfaction (ES = 0.268, P = 0.004). However, the PFI interventions did not significantly enhance the perception of patient safety (ES = 0.205, P = 0.09) or the quality of life (ES = 0.057, P = 0.61). Moreover, moderate-to-high heterogeneity was found for all impacts except adverse events (I2 = 0%) and length of hospital stay (I2 = 35%). A funnel plot indicated a low degree of publication bias for the adverse event outcome. CONCLUSIONS The synthesized evidence in this review demonstrates the benefits of PFI for promoting patient safety. However, further studies should extend the research scope to fill the existing gaps for both the type of PFI interventions and the patient safety outcomes.
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Affiliation(s)
- Thi-Thanh-Tinh Giap
- From the College of Nursing, Chungnam National University, Daejeon, Republic of Korea
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Performance of the Hendrich Fall Risk Model II in Patients Discharged from Rehabilitation Wards. A Preliminary Study of Predictive Ability. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041444. [PMID: 33557091 PMCID: PMC7913882 DOI: 10.3390/ijerph18041444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 01/30/2021] [Accepted: 02/02/2021] [Indexed: 11/17/2022]
Abstract
(1) Background: Falls are a dangerous adverse event in patients discharged from rehabilitation units, with the risk of falling being higher in the first weeks after discharge. In this study, we assessed the predictive performance of the Hendrich Fall Risk Model II tool (HIIFRM) when administered before discharging patients to their home from rehabilitative units in orthopedic (OR), neurologic (NR) and pulmonary (PR) rehabilitation wards. (2) Methods: Over a 6-month period, all adult patients who returned home after discharge were assessed by HIIFRM. At six months from discharge the occurrence of falls was obtained by performing a structured survey. The HIIFRM predictive performance was determined by the area under the ROC curve (AUC), sensitivity (Se) and specificity (Sp) for the whole sample and split by ward. (3) Results: 85 of 141 discharged patients were living at home and agreed to take part in the survey. Of these, 19 subjects fell, 6 suffered fractures or head traumas and 5 were hospitalized. The AUC was 0.809 (95% CI: 0.656–0.963), Se was 0.67 (0.30–0.93) and Sp was 0.79 (0.63–0.90) for OR patients. (4) Conclusions: Our preliminary results support the use of HIIFRM as a tool to be administered to OR patients at discharge and provides data for the design of a large study of predictive ability.
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An opportunistic evaluation of a routine service improvement project to reduce falls in hospital. BMC Health Serv Res 2021; 21:79. [PMID: 33482793 PMCID: PMC7821491 DOI: 10.1186/s12913-021-06073-4] [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: 09/01/2020] [Accepted: 01/11/2021] [Indexed: 12/02/2022] Open
Abstract
Background Preventing falls in hospital is a perennial patient safety issue. The University Hospital Coventry and Warwickshire initiated a programme to train ward staff in accordance with guidelines. The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West Midlands was asked to expedite an independent evaluation of the initiative. We set out to describe the intervention to implement the guidelines and to evaluate it by means of a step-wedge cluster study using routinely collected data. Methods The evaluation was set up as a partially randomised, step-wedge cluster study, but roll-out across wards was more rapid than planned. The study was therefore analysed as a time-series. Primary outcome was rate of falls per 1000 Occupied Bed Days (OBDs) collected monthly using routine data. Data was analysed using a mixed-effects Poisson regression model, with a fixed effect for intervention, time and post-intervention time. We allowed for random variations across clusters in initial fall rate, pre-intervention slope and post-intervention slope. Results There was an average of 6.62 falls per 1000 OBDs in the control phase, decreasing to an average of 5.89 falls per 1000 OBDs in the period after implementation to the study end. Regression models showed no significant step change in fall rates (IRR: 1.02, 95% CI: 0.92–1.14). However, there was a gradual decrease, of approximately 3%, after the intervention was introduced (IRR: 0.97 per month, 95% CI: 0.95–0.99). Conclusion The intervention was associated with a small but statistically significantly improvement in falls rates. Expedited roll-out of an intervention may vitiate a step-wedge cluster design, but the intervention can still be studied using a time-series analysis. Assuming that there is some value in time series analyses, this is better than no evaluation at all. However, care is needed in making causal inferences given the non-experimental nature of the design. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06073-4.
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Iyamu T, Nunu K. Healthcare data management conceptual framework for service delivery. EDUCATION AND INFORMATION TECHNOLOGIES 2021; 26:3513-3527. [PMID: 33456311 PMCID: PMC7803662 DOI: 10.1007/s10639-020-10413-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 12/09/2020] [Indexed: 06/12/2023]
Abstract
In the context of South Africa, what we do know is that huge amount of healthcare data does exist and that they are consciously and unconsciously scattered in bits and pieces across facilities within the country. This has directly or indirectly resulted to underutilisation of data, which affects service delivery to the community. For example, many patients have been wrongly diagnosed, and some others have been given wrong medications due to duplication of prescriptions, which were influenced by lack of real-time information. Consequently, there have been loss and damages to lives, contributing to the mortality rate in the country. This study was undertaken on the premise of these challenges, to develop a conceptual framework that can guide how data could be managed towards improved services within the South African healthcare facilities. The interpretive approach was employed. Qualitative data were gathered from existing works. Structuration theory was applied as a lens to guide the analysis of the data. From the findings, a framework was developed, primarily to guide and advance the waysin which data are stored, retrieved, managed, and used for healthcare improved services.
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Affiliation(s)
- Tiko Iyamu
- Department of Information Technology, Cape Peninsula University of Technology, Cape Town, South Africa
| | - Khaya Nunu
- Department of Information Technology, Cape Peninsula University of Technology, Cape Town, South Africa
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Kasza J, Bowden R, Forbes AB. Information content of stepped wedge designs with unequal cluster-period sizes in linear mixed models: Informing incomplete designs. Stat Med 2021; 40:1736-1751. [PMID: 33438255 DOI: 10.1002/sim.8867] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 12/13/2020] [Accepted: 12/16/2020] [Indexed: 12/30/2022]
Abstract
In practice, stepped wedge trials frequently include clusters of differing sizes. However, investigations into the theoretical aspects of stepped wedge designs have, until recently, typically assumed equal numbers of subjects in each cluster and in each period. The information content of the cluster-period cells, clusters, and periods of stepped wedge designs has previously been investigated assuming equal cluster-period sizes, and has shown that incomplete stepped wedge designs may be efficient alternatives to the full stepped wedge. How this changes when cluster-period sizes are not equal is unknown, and we investigate this here. Working within the linear mixed model framework, we show that the information contributed by design components (clusters, sequences, and periods) does depend on the sizes of each cluster-period. Using a particular trial that assessed the impact of an individual education intervention on log-length of stay in rehabilitation units, we demonstrate how strongly the efficiency of incomplete designs depends on which cells are excluded: smaller incomplete designs may be more powerful than alternative incomplete designs that include a greater total number of participants. This also serves to demonstrate how the pattern of information content can be used to inform a set of incomplete designs to be considered as alternatives to the complete stepped wedge design. Our theoretical results for the information content can be extended to a broad class of longitudinal (ie, multiple period) cluster randomized trial designs.
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Affiliation(s)
- Jessica Kasza
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Rhys Bowden
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Andrew B Forbes
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Basic D, Huynh ET, Gonzales R, Shanley CG. Twice-Weekly Structured Interdisciplinary Bedside Rounds and Falls among Older Adult Inpatients. J Am Geriatr Soc 2021; 69:779-784. [PMID: 33395498 DOI: 10.1111/jgs.17007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 11/26/2020] [Accepted: 12/04/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND/OBJECTIVE Ineffective interdisciplinary communication has negative impacts on patient outcomes. The use of regular structured interdisciplinary bedside rounds (SIBR), where each patient interaction lasts 3-5 minutes, is a model of care that improves interdisciplinary communication. We evaluated the impact of SIBR on in-hospital falls. DESIGN Prospective before-after study of older people hospitalized with acute illness. SETTING Two side-by-side aged care wards in a university hospital in Sydney, Australia. PARTICIPANTS A total of 3,673 consecutive inpatients of mean age 83.8 ± 7.7 years, with 1,703 before SIBR compared with 1,970 after SIBR. No patients were excluded from potential participation. INTERVENTION Twice-weekly SIBR. MEASUREMENTS Falls data were manually extracted from a mandatory institutional incident reporting database. Medical diagnoses were based on the Australian Refined Diagnosis Related Groups classification system. Injuries due to falls were corroborated using the institutional electronic medical record (Cerner PowerChart). Generalized estimating equations were used to evaluate the incidence rate ratio (IRR) of falls and fall-related injuries. A negative binomial distribution and a logarithmic link function were used to linearize regression equations. RESULTS After SIBR, there were 7.4 falls per 1,000 occupied bed days (OBD), compared with 10.6 falls per 1,000 OBD before SIBR (P < .001). The implementation of SIBR reduced falls (IRR = 0.67, 95% CI = 0.52-0.85), after adjusting for age, gender, cognitive impairment, behavioral and psychological symptoms of dementia, deconditioning and frailty, but not fall-related injuries (IRR = 0.79, 95% CI = 0.52-1.20). CONCLUSION This study is the first to investigate the effect of SIBR on in-hospital falls. It provides evidence that a sustainable, twice-weekly intervention is associated with a reduction in falls. It has the potential to be used in other settings where falls are frequent.
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Affiliation(s)
- David Basic
- Aged Care Research Unit, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Elizabeth T Huynh
- Aged Care Research Unit, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Rinaldo Gonzales
- Aged Care Research Unit, Liverpool Hospital, Sydney, New South Wales, Australia
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Ximenes MAM, Brandão MGSA, Araújo TMD, Galindo Neto NM, Barros LM, Caetano JÁ. EFFECTIVENESS OF EDUCATIONAL INTERVENTIONS FOR FALL PREVENTION: A SYSTEMATIC REVIEW. TEXTO & CONTEXTO ENFERMAGEM 2021. [DOI: 10.1590/1980-265x-tce-2020-0558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Objective: to assess the effectiveness of educational interventions for fall prevention implemented in hospitals, at homes and nursing homes. Method: this is a systematic review, carried out based on the guiding question: what is the effectiveness of isolated educational interventions for preventing falls in adults and the elderly developed in experimental studies? The search took place in the electronic databases: Scopus, PubMed/PMC, Web of Science, CINAHL, SciELO, Cochrane and EMBASE. The exposure factor was the educational intervention on preventing falls, and as outcomes: reducing fall rates, improving knowledge, awareness and adherence to preventive care for adult and elderly patients. Only randomized controlled trials, in all languages and published between 2011 and 2020 were included. Results: 1,474 articles were identified, of which 16 were included. Four studies did not show effectiveness related to fall prevention. As common characteristics, these studies were carried out with elderly patients and without one-to-one follow-up. The others were effective in reducing falls and/or improving knowledge and were mostly studies with personalized interventions, carried out by nurses and mediated by educational technologies. Conclusion: educational interventions are effective for preventing falls in the home, hospital and nursing homes. Studies have shown a reduction in fall rates, improved knowledge and engagement in prevention strategies.
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French C, Pinnock H, Forbes G, Skene I, Taylor SJC. Process evaluation within pragmatic randomised controlled trials: what is it, why is it done, and can we find it?-a systematic review. Trials 2020; 21:916. [PMID: 33168067 PMCID: PMC7650157 DOI: 10.1186/s13063-020-04762-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 09/22/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Process evaluations are increasingly conducted within pragmatic randomised controlled trials (RCTs) of health services interventions and provide vital information to enhance understanding of RCT findings. However, issues pertaining to process evaluation in this specific context have been little discussed. We aimed to describe the frequency, characteristics, labelling, value, practical conduct issues, and accessibility of published process evaluations within pragmatic RCTs in health services research. METHODS We used a 2-phase systematic search process to (1) identify an index sample of journal articles reporting primary outcome results of pragmatic RCTs published in 2015 and then (2) identify all associated publications. We used an operational definition of process evaluation based on the Medical Research Council's process evaluation framework to identify both process evaluations reported separately and process data reported in the trial results papers. We extracted and analysed quantitative and qualitative data to answer review objectives. RESULTS From an index sample of 31 pragmatic RCTs, we identified 17 separate process evaluation studies. These had varied characteristics and only three were labelled 'process evaluation'. Each of the 31 trial results papers also reported process data, with a median of five different process evaluation components per trial. Reported barriers and facilitators related to real-world collection of process data, recruitment of participants to process evaluations, and health services research regulations. We synthesised a wide range of reported benefits of process evaluations to interventions, trials, and wider knowledge. Visibility was often poor, with 13/17 process evaluations not mentioned in the trial results paper and 12/16 process evaluation journal articles not appearing in the trial registry. CONCLUSIONS In our sample of reviewed pragmatic RCTs, the meaning of the label 'process evaluation' appears uncertain, and the scope and significance of the term warrant further research and clarification. Although there were many ways in which the process evaluations added value, they often had poor visibility. Our findings suggest approaches that could enhance the planning and utility of process evaluations in the context of pragmatic RCTs. TRIAL REGISTRATION Not applicable for PROSPERO registration.
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Affiliation(s)
- Caroline French
- Institute of Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, 58 Turner Street, London, E1 2AB, UK.
| | - Hilary Pinnock
- Usher Institute, The University of Edinburgh, Doorway 3, Medical School, Teviot Place, Edinburgh, EH8 9AG, UK
| | - Gordon Forbes
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), Kings College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Imogen Skene
- Emergency Department, Royal London Hospital, Barts Health NHS Trust, Whitechapel, London, E1 1FR, UK
| | - Stephanie J C Taylor
- Institute of Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, 58 Turner Street, London, E1 2AB, UK
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Shaw L, Kiegaldie D, Farlie MK. Education interventions for health professionals on falls prevention in health care settings: a 10-year scoping review. BMC Geriatr 2020; 20:460. [PMID: 33167884 PMCID: PMC7653707 DOI: 10.1186/s12877-020-01819-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 10/05/2020] [Indexed: 02/06/2023] Open
Abstract
Background Falls in hospitals are a major risk to patient safety. Health professional education has the potential to be an important aspect of falls prevention interventions. This scoping review was designed to investigate the extent of falls prevention education interventions available for health professionals, and to determine the quality of reporting. Method A five stage scoping review process was followed based on Arksey and O’Malley’s framework and refined by the Joanna Briggs Institute Methodology for JBI Scoping Reviews. Five online databases identified papers published from January 2008 until May 2019. Papers were independently screened by two reviewers, and data extracted and analysed using a quality reporting framework. Results Thirty-nine publications were included. Interventions included formal methods of educational delivery (for example, didactic lectures, video presentations), interactive learning activities, experiential learning, supported learning such as coaching, and written learning material. Few studies employed comprehensive education design principles. None used a reporting framework to plan, evaluate, and document the outcomes of educational interventions. Conclusions Although health professional education is recognised as important for falls prevention, no uniform education design principles have been utilised in research published to date, despite commonly reported program objectives. Standardised reporting of education programs has the potential to improve the quality of clinical practice and allow studies to be compared and evaluated for effectiveness across healthcare settings.
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Affiliation(s)
- L Shaw
- Faculty of Health Science, Youth and Community Studies, Holmesglen Institute, 488 South Road, Moorabbin, VIC, 3189, Australia. .,School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, 3086, Australia.
| | - D Kiegaldie
- Faculty of Health Science, Youth and Community Studies and Healthscope Hospitals, Holmesglen Institute, 488 South Road, Moorabbin, VIC, 3189, Australia.,Eastern Clinical School, Faculty of Medicine, Nursing & Health Sciences, Monash University, Melbourne, Australia
| | - M K Farlie
- Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Moorooduc Highway, Frankston, VIC, 3199, Australia
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Sullivan R, Harding K, Skinner I, Hemsley B. Falls in hospital patients with acquired communication disability secondary to stroke: A systematic review and meta-analysis. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2020; 55:837-851. [PMID: 32970385 DOI: 10.1111/1460-6984.12570] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 08/03/2020] [Accepted: 08/07/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Falls are a common safety incident in people with stroke. Studies report that between 14% and 65% of people with stroke fall at least once during their hospital admission. Risk factors for falls in people with stroke have been reported to include neglect, balance and dependence for activities of daily living. Communication disability has been identified as a risk factor for patient safety incidents in hospital that has not been closely examined as a potential risk factor for falls in people with stroke. AIM To determine the association between communication disability secondary to stroke and falls in people with stroke in hospital. METHODS & PROCEDURES Systematic searches of five electronic databases were conducted in June 2019 using the key concepts of 'falls' and 'stroke' (PROSPERO CRD 42019137199). Included studies provided comparative data of falls in patients with stroke with and without communication disability. The methodological quality of the studies was examined using the Quality Assessment Tool for Studies with Diverse Designs (QATSDD). Both a narrative synthesis and a meta-analysis were completed. MAIN CONTRIBUTION A total of 15 studies met the criteria for inclusion and 11 were included in a meta-analysis. Three studies found people with communication disability had an increased rate of falls in hospital. However, a meta-analysis showed no significant association between a non-specific classification of communication disability and an increased risk of falls. There was some indication from individual studies that higher risk of falls may be associated with severe communication disability, but there were insufficient data reported on the severity of the communication disability to draw robust conclusions. CONCLUSION & IMPLICATIONS The results of this systematic review suggest that a generic classification of communication disability following stroke is not a risk factor for falls. However, further research that is inclusive of this population and considers severity of communication disability more specifically is required. What this paper adds What is already known on the subject The association between communication disability following stroke and falls in hospital is unclear. The literature reports mixed results regarding the impact of a communication disability following stroke on falls risk or rates of falls during hospital admission. What this paper adds to existing knowledge This review is the first to bring together this diverse literature to examine the association between communication disability following stroke and falls in hospital. The results suggest that a generic classification of communication disability following stroke is not a risk factor for falls. What are the potential or actual clinical implications of this work? There is a possibility that moderate to severe communication disability may be related to falls in patients in hospital. Further research is indicated to be more inclusive of people with communication disability, including those with severe communication disability.
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Affiliation(s)
- Rebecca Sullivan
- Speech Pathology Department, Eastern Health, Box Hill, Melbourne, Australia
| | - Katherine Harding
- Allied Health Clinical Research Office, Eastern Health & La Trobe University
| | - Ian Skinner
- School of Community Health, Charles Sturt University
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