Sandy Brauer

The 6-PACK programme to decrease fall-related injuries in acute hospitals: protocol for a cluster randomised controlled trial

Background and aims In-hospital fall-related injuries are a source of personal harm, preventable hospitalisation costs, and access block through increased length of stay. Despite increased fall prevention awareness and activity over the last decade, rates of reported fall-related fractures in hospitals appear not to have decreased. This cluster randomised controlled trial (RCT) aims to determine the efficacy of the 6-PACK programme for preventing fall-related injuries, and its generalisability to other acute hospitals. Methods 24 acute medical and surgical wards from six to eight hospitals throughout Australia will be recruited for the study. Wards will be matched by type and fall-related injury rates, then randomly allocated to the 6-PACK intervention (12 wards) or usual care control group (12 wards). The 6-PACK programme includes a nine-item fall risk assessment and six nursing interventions: ‘falls alert’ sign; supervision of patients in the bathroom; ensuring patients walking aids are within reach; establishment of a toileting regime; use of a low-low bed; and use of bed/chair alarm. Intervention wards will be supported by a structured implementation strategy. The primary outcomes are fall and fall-related injury rates 12 months following 6-PACK implementation. Discussion This study will involve approximately 16 000 patients, and as such is planned to be the largest hospital fall prevention RCT to be undertaken and the first to be powered for the important outcome of fall-related injuries. If effective, there is potential to implement the programme widely as part of daily patient care in acute hospital wards where fall-related injuries are a problem. Trial registration The protocol for this study is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12611000332921).

Randomized Trial of Domiciliary Versus Center-based Rehabilitation: Which is More Effective in Reducing Falls and Improving Quality of Life in Older Fallers?

BACKGROUND To compare the effect of two modes of delivering a falls prevention service in reducing the rate of falls and improving quality of life, activity levels, and physical status among older adults with a history of recent falls. METHODS A randomized controlled trial was conducted with a total of 107 participants with blinded baseline and follow-up assessments. The participants were older community-dwelling adults referred for a falls prevention service located in Brisbane, Australia. The intervention was a multiple component falls prevention service delivered in either in a domiciliary or center-based mode of delivery. Both programs were similar apart from setting and consisted of three components, a balance and strength component, falls prevention education, and functional tasks. Physical and psychosocial assessments were administered at baseline, 8-week follow-up and 6-month follow-up. Falls data were collected by monthly telephone contact and by interview at 8 weeks and 6 months. RESULTS The center-based service demonstrated significantly better results in preventing falls over the home-based service. Clients in the center-based arm of the trial experienced fewer total falls and this group also had a greater reduction in the total number of fallers after the intervention. CONCLUSION This research demonstrates that delivering a similar service in different settings-home based or center based-impacts upon the effectiveness of the service. Community-dwelling older adults with a history of falls should be provided with center-based programs in preference to home-based programs where they are available.

Domiciliary vs Centre-Based Rehabilitation of Older Community Dwellers: Randomised Trial with Economic Evaluation

Background: Community rehabilitation services for older adults aim to address factors that lead to physical de- cline and falls and return people to their normal activities in the community. While community rehabilitation has been proven effective in reducing falls in the elderly, previous studies have not specified whether delivering services at home or in a centre-based format is the more appropriate method of service delivery. Aim: This study aims to compare a centre-based group program with a home-based program. The purpose of this study is to identify the most clinically effective way of delivering community rehabilitation services to older fallers and determine which service delivery setting is more economically efficient. Methods/Design: This paper describes the study design and methods of a randomised clinical trial. One group of partici- pants will receive a centre-based community rehabilitation service, the other group a domiciliary (home-based) commu- nity rehabilitation service of near identical content. Participants in this study are those clients over 60 years of age referred to a community rehabilitation service. Patients referred to this service typically have had recent falls, poor or declining mobility, functional dependency, cognitive decline, and / or physical deconditioning. Clinical effectiveness will be primarily determined by comparison of health-related quality of life and rates of accidental falls. Secondary outcomes include the levels of participation in functional activities, and physical capacity between the two groups. Economic efficiency will be determined through conduct of a cost-benefit analysis. Discussion: Results from this study will guide clinicians and policy makers to identify the more effective and efficient falls prevention community rehabilitation program service delivery model for older adults living in the community. Trial Registration: Australian New Zealand Clinical Trials Register: ACTRN12605000056695.

Promoting physical activity after stroke via self-management: a feasibility study

Abstract Background: Many people with mild disability after stroke are physically inactive despite the risk of recurrent stroke. A self-management program may be one strategy to increase physical activity in stroke survivors. Objectives: To investigate the feasibility of a self-management program, and determine whether self-management can increase daily physical activity levels and self-efficacy for exercise, decrease cardiovascular risk, and improve walking ability, participation, and quality of life in people with mild disability after stroke. Method: A Phase I, single-group, pre-post intervention study was carried out with twenty stroke survivors who had mild disability and were discharged directly home from acute stroke units. A self-management program was delivered via five home-based sessions over 3 months, incorporating: education, goal setting, barrier identification, self-monitoring, and feedback. Feasibility of the intervention was determined by examining adherence, duration, usefulness, and safety. Clinical outcomes were amount of physical activity (duration of moderate physical activity in min/day and counts of physical activity in steps/day), self-efficacy, cardiovascular risk, walking ability, participation, and quality of life. Results: The intervention was feasible with 96% of sessions being delivered, each taking less than an hour (41 min, SD 12). Participants perceived the self-management program to be useful and there were few adverse events. At 3 months, participants completed 27 min/day (95% CI 4–49) more moderate physical activity than at baseline and 16 min/day (95% CI −10 to 42) at 6 months. Conclusion: Self-management appears to be feasible and has the potential to increase physical activity in people with mild disability after stroke. A Phase II randomized trial is warranted.

A break-even analysis of a community rehabilitation falls prevention service.

Objective: To identify and compare the minimum number of clients that a multidisciplinary falls prevention service delivered through domiciliary or centre‐based care needs to treat to allow the service to reach a ‘break‐even’ point.