A community-based single fall prevention exercise intervention for older adults (STEADY FEET): Study protocol for a randomised controlled trial

Ong, Rebecca Hui Shan; Nurjono, Milawaty; Jumala, Junisha; Teo, Raymond Choon Chye; Png, Gek Kheng; Tan, Pei‐Hua; Kee, Mong Nee; Oh, Hong Choon; Wee, Moi Kim; Kan, Karen Lai Ming; Rosle, Lina Farhana Binte; Lien, Christopher Tsung Chien; Low, Shou Lin

doi:10.1371/journal.pone.0276385

Cited by 3 publications

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“…The group included four geriatricians, an occupational therapist and four falls researchers. Between the stakeholders, the group conducted three independent community-based falls intervention programs in Singapore [ 19 , 31 , 32 ].…”

Section: Resultsmentioning

confidence: 99%

Group Model Building on causes and interventions for falls in Singapore: insights from a systems thinking approach

Lai,

Chan,

Matchar

et al. 2023

BMC Geriatr

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Background Falls in older adults are the result of a complex web of interacting causes, that further results in other physical, emotional, and psychological sequelae. A conceptual framework that represents the reciprocal dynamics of these causal factors can enable clinicians, researchers, and policymakers to clarify goals in falls intervention in older adults. Methods A Group Model Building (GMB) exercise was conducted with researchers and clinicians from academic units and public healthcare institutes in Singapore. The aim of the exercise was to produce a shared visual representation of the causal structure for falls and engage in discussions on how current and future falls intervention programmes can address falls in the older adults, especially in the Asian context. It was conducted in four steps: 1) Outlining and prioritising desirable patient outcomes, 2) Conceptual model building, 3) Identifying key intervention elements of effective falls intervention programmes, 4) Mapping of interventions to outcomes. This causal loop diagram (CLD) was then used to generate insights into the current understanding of falls causal relationships, current efforts in falls intervention in Singapore, and used to identify gaps in falls research that could be further advanced in future intervention studies. Results Four patient outcomes were identified by the group as key in falls intervention: 1) Falls, 2) Injurious falls, 3) Fear of falling, and 4) Restricted mobility and life space. A CLD of the reciprocal relationships between risk factors and these outcomes are represented in four sub-models: 1) Fear of falling, 2) Injuries associated with falls, 3) Caregiver overprotectiveness, 4) Post-traumatic stress disorder and psychological resilience. Through this GMB exercise, the group gained the following insights: (1) Psychological sequelae of falls is an important falls intervention outcome. (2) The effects of family overprotectiveness, psychological resilience, and PTSD in exacerbating the consequences of falls are not well understood. (3) There is a need to develop multi-component falls interventions to address the multitude of falls and falls related sequelae. Conclusion This work illustrates the potential of GMB to promote shared understanding of complex healthcare problems and to provide a roadmap for the development of more effective preventive actions.

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Section: Resultsmentioning

confidence: 99%

Group Model Building on causes and interventions for falls in Singapore: insights from a systems thinking approach

Lai,

Chan,

Matchar

et al. 2023

BMC Geriatr

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“… 12 In view of these considerations, a multidisciplinary team from Changi General Hospital (CGH), including geriatricians, physiotherapists, exercise physiologists, and community care colleagues, partnered with community-based stakeholders like Sport Singapore, ActiveSG, and NTUC Health, to develop the “Steady Feet” (SF) fall prevention exercise program for community-dwelling older adults. A comprehensive description of SF has been previously described by Ong et al 13 …”

Section: Introductionmentioning

confidence: 99%

Factors Influencing the Implementation of a Fall Prevention Exercise Program for Community-Dwelling Older Adults: A Qualitative Study Guided by the PRECEDE-PROCEED Model

Ong,

Nurjono,

et al. 2024

CIA

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Purpose Multiple falls preventions exercise programs have been rolled out globally, however, few studies have explored the factors necessary for their implementation. This study aimed to investigate the factors influencing the implementation of “Steady Feet” (SF), a 12-week community fall prevention exercise intervention, for older adults living in Singapore. Material and Methods This study utilized purposive sampling to recruit two participant groups: (i) older adults who declined or withdrew from the program and (ii) providers of the program (eg, instructors). We conducted 22 semi-structured interviews, recordings were transcribed and translated, followed by thematic analysis. Data collection and analysis were informed by the PRECEDE-PROCEED framework, focusing on predisposing, enabling, and reinforcing factors. Results Findings revealed two predisposing, four enabling, and two reinforcing themes. Predisposing themes encompassed (i) knowledge, attitudes, and practices of older adults towards exercises and falls prevention, and (ii) perceptions and attitudes of providers towards SF. Both older adults and providers identified several enabling elements in implementing SF, emphasizing the significance of (i) accessibility, availability, and affordability. Providers highlighted (ii) tools and structural support for continual engagement, (iii) minimizing variations in capabilities through a competency development program, and (iv) fostering synergistic partnerships. Positive reinforcement included (i) the role of providers in engaging and promoting participation, (ii) family support, social networks, and (iii) incentives for older adults. Conversely, both groups highlighted negative reinforcements, including (iv) communication issues and (v) repetitive exercises, while providers specifically identified (vi) labor constraints as a deterrent for implementation. Conclusion Findings indicate that effective implementation necessitates a multifaceted approach. Promoting participation involves engaging instructors, emphasizing social bonds and family involvement, offering incentives, and providing subsidized or free classes. A competency development program proved effective in reducing variations in providers’ capabilities. Strengthening community partnerships, with management support, was crucial for ensuring the availability and accessibility of falls prevention programs.

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“…Currently, most multicomponent fall prevention programs in the community are research-based programs. These include group-based programs such as SAFE ( Matchar et al, 2017 ) and STEADY-FEET ( Ong et al, 2022 ), where patients are recruited from hospitals or the community. Additionally, single-component fall prevention initiatives are available and conducted through organizations such as the Health Promotion Board or Agency for Integrated Care, which includes community outreach, exercise programs, or home safety assessments ( Agent for Integrated Care, n.d. ; HealthHubSG, n.d. ).…”

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Reducing Falls Among Community-Dwelling Older Adults From Clinicians’ Perspectives: A Systems Modeling Approach

Wen

Matchar

Chan

et al. 2023

Innovation in Aging

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Background and Objectives Falls among older adults are a significant health problem globally. Studies of multicomponent fall prevention programmes in randomised controlled trials demonstrate effectiveness in reducing falls, however, the translation of research into the community remains challenging. While there is an increasing interest to understand the factors contributing to implementation barriers, the dynamic relationships between factors are less well examined. Furthermore, evidence on implementation barriers from Asia is lacking as most of these studies originate from the West. As such, this study aims to engage stakeholders in uncovering the factors that facilitate or inhibit implementing community-based fall prevention programmes in Singapore, with a focus on the inter-relationship between those factors. Research Design and Methods Healthcare professionals familiar with fall prevention programmes were invited to discuss the enablers and challenges to the implementation. This effort was facilitated using a systems modelling methodology of Group Model Building (GMB), to share ideas and to create a common conceptual model of the challenges. The GMB employs various engagement techniques to draw on the experiences and perceptions of all stakeholders involved. Results This process led to the development of a Causal Loop Diagram (CLD), a qualitative conceptual model of the dynamic relationships between the barriers and facilitators of implementing fall prevention programmes. Results from the CLD show that implementation is influenced by two main drivers: healthcare provider factors that influenced referrals, and patient factors that influenced referral acceptance and long-term adherence. Key leverage points for potential interventions were identified as well. Discussion and Implications The overall recommendation emphasised closer coordination and collaboration across providers to ensure sustainable and effective community-based fall prevention programmes. This has to be supported by a national effort, involving a multidisciplinary stakeholder advisory group. These findings generated would be promising to guide future approaches to fall prevention.

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A community-based single fall prevention exercise intervention for older adults (STEADY FEET): Study protocol for a randomised controlled trial

Cited by 3 publications

References 50 publications

Group Model Building on causes and interventions for falls in Singapore: insights from a systems thinking approach

Group Model Building on causes and interventions for falls in Singapore: insights from a systems thinking approach

Factors Influencing the Implementation of a Fall Prevention Exercise Program for Community-Dwelling Older Adults: A Qualitative Study Guided by the PRECEDE-PROCEED Model

Reducing Falls Among Community-Dwelling Older Adults From Clinicians’ Perspectives: A Systems Modeling Approach

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