Fall rates in hospital rehabilitation units after individualised patient and staff education programmes: a pragmatic, stepped-wedge, cluster-randomised controlled trial

Hill, Anne‐Marie; McPhail, Steven; Waldron, Nicholas; Etherton‐Beer, Christopher; Ingram, Katharine; Flicker, Leon; Bulsara, Max; Haines, Terrence Peter

doi:10.1016/s0140-6736(14)61945-0

Cited by 202 publications

(258 citation statements)

References 34 publications

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“…Eleven trials were cluster-randomised trials (Beck 2016; Becker 2003; Dyer 2004; Jensen 2002; Kerse 2004; McMurdo 2000; Neyens 2009; Ray 1997; Salvà 2016; Walker 2015; Whitney 2017; 3470 participants), and two were individually randomised (Rubenstein 1990; Shaw 2003; 756 participants). Whitney 2017 was also a cross-over trial.…”

Section: Resultsmentioning

confidence: 99%

Interventions for preventing falls in older people in care facilities and hospitals

Cameron

Dyer²,

Panagoda

et al. 2018

Cochrane Database of Systematic Reviews

355

370

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Background Falls in care facilities and hospitals are common events that cause considerable morbidity and mortality for older people. This is an update of a review first published in 2010 and updated in 2012. Objectives To assess the effects of interventions designed to reduce the incidence of falls in older people in care facilities and hospitals. Search methods We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (August 2017); Cochrane Central Register of Controlled Trials (2017, Issue 8); and MEDLINE, Embase, CINAHL and trial registers to August 2017. Selection criteria Randomised controlled trials of interventions for preventing falls in older people in residential or nursing care facilities, or hospitals. Data collection and analysis One review author screened abstracts; two review authors screened full‐text articles for inclusion. Two review authors independently performed study selection, 'Risk of bias' assessment and data extraction. We calculated rate ratios (RaR) with 95% confidence intervals (CIs) for rate of falls and risk ratios (RRs) and 95% CIs for outcomes such as risk of falling (number of people falling). We pooled results where appropriate. We used GRADE to assess the quality of evidence. Main results Thirty‐five new trials (77,869 participants) were included in this update. Overall, we included 95 trials (138,164 participants), 71 (40,374 participants; mean age 84 years; 75% women) in care facilities and 24 (97,790 participants; mean age 78 years; 52% women) in hospitals. The majority of trials were at high risk of bias in one or more domains, mostly relating to lack of blinding. With few exceptions, the quality of evidence for individual interventions in either setting was generally rated as low or very low. Risk of fracture and adverse events were generally poorly reported and, where reported, the evidence was very low‐quality, which means that we are uncertain of the estimates. Only the falls outcomes for the main comparisons are reported here. Care facilities Seventeen trials compared exercise with control (typically usual care alone). We are uncertain of the effect of exercise on rate of falls (RaR 0.93, 95% CI 0.72 to 1.20; 2002 participants, 10 studies; I² = 76%; very low‐quality evidence). Exercise may make little or no difference to the risk of falling (RR 1.02, 95% CI 0.88 to 1.18; 2090 participants, 10 studies; I² = 23%; low‐quality evidence). There is low‐quality evidence that general medication review (tested in 12 trials) may make little or no difference to the rate of falls (RaR 0.93, 95% CI 0.64 to 1.35; 2409 participants, 6 studies; I² = 93%) or the risk of falling (RR 0.93, 95% CI 0.80 to 1.09; 5139 participants, 6 studies; I² = 48%). There is moderate‐quality evidence that vitamin D supplementation (4512 particip...

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Section: Resultsmentioning

confidence: 99%

Interventions for preventing falls in older people in care facilities and hospitals

Cameron

Dyer²,

Panagoda

et al. 2018

Cochrane Database of Systematic Reviews

355

370

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“…However, although falls rates were significantly reduced among patients who directly received the education, falls rates were also reduced in the subgroup of patients with poorer levels of cognition, who did not receive the education 14. These results suggested that delivering the education as a ward level intervention also caused a ward level change which was effective in reducing falls.…”

Section: Introductionmentioning

confidence: 92%

“…This patient education programme, called the Safe Recovery programme, significantly reduced falls and injurious falls (adjusted rate ratio 0.65, 95% CI 0.42 to 0.88) in hospital rehabilitation wards 1415 The Safe Recovery programme has been described extensively and piloted previously 14–17. It consists of providing eligible, older patients with multimedia information (DVD and workbook) about falls and falls prevention and tailored follow-up by a trained health professional, who aims to personalise the information for each patient.…”

Section: Introductionmentioning

confidence: 99%

‘It promoted a positive culture around falls prevention’: staff response to a patient education programme—a qualitative evaluation

et al. 2016

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ObjectivesThe purpose of this study was to understand how staff responded to individualised patient falls prevention education delivered as part of a cluster randomised trial, including how they perceived the education contributed to falls prevention on their wards.DesignA qualitative explanatory study.Methods5 focus groups were conducted at participatory hospital sites. The purposive sample of clinical staff (including nurses, physiotherapists and quality improvement staff) worked on aged care rehabilitation wards when a cluster randomised trial evaluating a patient education programme was conducted. During the intervention period, an educator, who was a trained health professional and not a member of staff, provided individualised falls prevention education to patients with good levels of cognition (Mini-Mental State Examination >23/30). Clinical staff were provided with training to support the programme and their feedback was sought after the trial concluded, to understand how they perceived the programme impacted on falls prevention. Data were thematically analysed using NVivo qualitative data analysis software.Results5 focus groups were conducted at different hospitals (n=30 participants). Staff perceived that the education created a positive culture around falls prevention and further, facilitated teamwork, whereby patients and staff worked together to address falls prevention. The educator was perceived to be a valuable member of the team. Staff reported that they developed increased knowledge and awareness about creating a safe ward environment. Patients being proactive and empowered to engage in falls prevention strategies, such as ringing the bell for assistance, was viewed as supporting staff falls prevention efforts and motivating staff to change practice.ConclusionsStaff responded positively to patient falls prevention education being delivered on their wards. Providing individualised patient education to older patients with good levels of cognition can empower staff and patients to work as a team to address falls prevention on hospital rehabilitation wards.

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“…35 One study 36 found a one-on-one patient education program, targeted at those without cognitive impairment, to be effective in preventing falls in a rehabilitation settings and some carryover of this impact to fall prevention in people with cognitive impairment, presumably due to changes in staff behaviour and awareness. 37 …”

Section: Hospital and Residential Carementioning

confidence: 99%

Physiotherapy in the prevention of falls in older people

Sherrington

Tiedemann

2015

Journal of Physiotherapy

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Fall rates in hospital rehabilitation units after individualised patient and staff education programmes: a pragmatic, stepped-wedge, cluster-randomised controlled trial

Abstract: State Health Research Advisory Council, Department of Health, Government of Western Australia.

Cited by 202 publications

References 34 publications

Interventions for preventing falls in older people in care facilities and hospitals

Interventions for preventing falls in older people in care facilities and hospitals

‘It promoted a positive culture around falls prevention’: staff response to a patient education programme—a qualitative evaluation

Physiotherapy in the prevention of falls in older people

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