The objective of this study is to evaluate if the implementation of a systematic and targeted screening of fall risk among independently living frail older people in primary care will result in more referrals to existing evidence-based fall…
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Brief title
Condition
- Other condition
Synonym
Health condition
gevolgen van vallen (zeer divers; bv. gebroken heup, hersenletsel, kan ook gevolgen hebben op sociaal leven)
Research involving
Sponsors and support
Intervention
Outcome measures
Primary outcome
The objective of this study is to evaluate if the implementation of a
systematic and targeted screening of fall risk among independently living frail
older people in primary care will result in more referrals to existing
evidence-based fall preventive care. This will be evaluated with help of the
RE-AIM model of Glasgow et al (1999): Reach, Effectiveness, Adoption,
Implementation and Maintenance. Evaluation will take place at the level of the
primary care provider (implementation index) in Part 1 and the level of the
patient (patient-related outcome measures) in Part 2 of this study;
In Part 1 of this research, the reach of the implementation strategy at the
level of the primary care provider will be evaluated with the following outcome
measures:
1. The percentage of vulnerable elderly screened for fall prevention care;
2. The percentage of screened vulnerable elderly eligible for a fall prevention
program;
3. The percentage of eligible elderly for a fall prevention program that agreed
with a referral to a fall prevention program
4. The percentage of vulnerable elderly that actually start the program
5. The percentage of vulnerable elderly that complete the program
In Part 2 of this research, the effectiveness of the fall prevention
implementation strategy on patient level will be assessed. In this part, based
on the patient*s risk profile, patients are offered fall preventive treatment
by their GP, practice nurse or home care provider like referral to an exercise
program, treatment of urine incontinence, or perhaps an adjustment of
medication. The group of patients who receive an exercise program are called
group 1. The group of patients who are treated by their GP in example for urine
incontinence or adjustment of medication, are called group 2. Patients from
both groups can receive several fall preventive treatments, yet group 1
patients always receive an exercise program and group 2 patients do not. (see
Figure 1. Overview procedures fall prevention implementation study, in the
Protocol.) Patients from group 1 will be followed more intensively than
patients from group 2.
The outcome measures of patients from group 1 are assessed at baseline (T0), at
the end of the intervention (T1) and after 12 months (T2) (See Figure 2.
Timeline assessments group 1, in the Protocol). The following four physical
tests, six short questionnaires and a falls-calendar will be conducted/provided
by the GP, practice nurse, home care provider and the physio- or exercise
therapist:
1. The Functional Reach Test (FRT): The patient is instructed to stand next to
a wall, but not to touch it. The arm is positioned at 90 degrees of shoulder
flexion with a closed fist. The started position is recorded at the third
metacarpal head on the yardstick. The patient is asked to reach forward as far
as possible, without taking a step. The difference between the start and the
end position of the third metacarpal is used as score. Three trials are done
and the average of the last two is noted (Weiner, 1992)
2. The Timed-Get-Up-and-Go-Test (TUG): This test will be used to assess
patients* mobility. The patient is asked to rise from a chair, walk three
meters, turn around, walk back to the chair and sit down. The physio- or
exercise therapist will measure the time required for this test with a
stopwatch. Three trials are done and the average of the last two is noted
(Podsiadlo, 1991)
3. Timed Chair Stand test (TCS): This test is used to assess the patient*s
muscle strength. The patient is asked to sit and stand as quick as possible
five times in a row from a chair without using their arms. The physio- or
exercise therapist will measure the time required for this test with a
stopwatch.
4. Tandem Stance test (TS): This test is used to assess the patient*s balance.
The patients is asked to stand in three positions (that increase in difficulty)
for 10 seconds. The physio- or exercise therapist will note the time and
positions the patients was able to complete.
5. Valgeschiedenis Vragenlijst: This questionnaire consists of five questions
regarding the patient*s fall history, fall-related injuries and health.
6. Short Falls Efficacy Scale-International (Short FES-I): A questionnaire of 7
items to measure fear of falling and self-efficacy to manage daily situations
(Kempen, 2007).
7. EQ-5D-5L: A standardised measure of health status developed by the EuroQol
Group in order to provide a simple, generic measure of health for clinical and
economic appraisal. The assessment consists of 5 multiple choice questions
regarding mobility, self-care, usual activities, pain/discomfort and
anxiety/depression. In addition it has a scale regarding once health on that
day (Van Reenen & Janssen, 2015)
8. Impact Intervention Questionnaire: This questionnaire consists of 5
questions corresponding to the EQ-5D-5L standardised measure. These questions
are about the patient feeling worse, the same or better regarding mobility,
self-care, usual activity, pain/discomfort and anxiety/depression compared to
before the intervention.
9. Activiteiten Vragenlijst: This questionnaire consists of 5 questions
regarding living environment, mobility, free time and social contact.
10. Falls-calendar: All participants receive a falls-calendar on which they can
write down on a day to day basis if they have had a fall or not. On this
calendar they write down a *N* for not fallen and an *F* for fallen. After each
month they can detach the page for that month and send it back to the research
team. No patient details will be on the calendar. No stamp is necessary.
In case the patient has fallen, the researcher will call the patient and ask
him/her a few questions about the cause of the fall, related injuries and
hospital admission. (See questionnaire Questions Falls-Calendar)
11. Vragenlijst Behandeling Valrisico: This questionnaire consists of three
questions about which interventions/treatment the participant received
regarding to their fall risk.
The patients from group 2 will conduct one questionnaire at baseline and a
questionnaire after 12 months. Furthermore they will be asked to keep track of
their fall-incidence during these 12 months (T0-T2). (See Figure 3. Timeline
assessment group 2, in the Protocol.) The following 2 questionnaires and
falls-calendar will be conducted/provided by the GP, practice nurse or home
care provider:
1. Valgeschiedenis Vragenlijst: This questionnaire consists of five questions
regarding the patient*s fall history, fall-related injuries and health.
2. Falls-calendar: All participants receive a Falls-calendar on which they can
write down on a day to day basis if they have had a fall or not. On this
calendar they write down a *N* for not fallen and an *F* for fallen. After each
month they can detach the page for that month and send it back to the research
team. No patient details will be on the calendar. No stamp is necessary.
In case the patient has fallen, the researcher will call the patient and ask
him/her a few questions about the cause of the fall, related injuries and
hospital admission. (See questionnaire Questions Falls-Calendar)
3. Vragenlijst Behandeling Valrisico: This questionnaire consists of three
questions about which interventions/treatment the participant received
regarding to their fall risk.
Secondary outcome
n.a.
Background summary
Falls are an important and increasing problem among increasing numbers of frail
older people. A further increase lies ahead because of the rising numbers of
independently living elderly (VeiligheidNL, 2015). There are treatments
available to prevent falls with a reasonable level of evidence. Exercise
therapy and addressing risk factors in the home environment seem the most
promising. These treatments are also available in the Dutch context. But a
general systematic implementation of these kind of treatments is missing.
Population based risk assessment does not take place. Furthermore there is no
complete coverage of service provision of fall treatment offered by qualified
physio- or exercise therapists in the region, whereas close to home
availability of these services is especially important for the target
population of vulnerable elderly. So, in general, there is a gap between
evidence and the day to day practice in primary and home care to date leading
to the unfavorable situation that elderly for which fall risk treatment is
potentially effective do not receive this treatment.
Study objective
The objective of this study is to evaluate if the implementation of a
systematic and targeted screening of fall risk among independently living frail
older people in primary care will result in more referrals to existing
evidence-based fall preventive care.
Study design
This prospective cohort study consists of 2 parts with 2 research designs. In
Part 1, we use a quasi-experimental design to evaluate the implementation
strategy at the level of the primary care provider. In Part 2, we use a
pretest-posttest design to evaluate the implementation strategy at the level of
the patient.
Intervention
A suitable and validated fall risk screening tool will be offered to GPs,
practice nurses and home care providers. They will identify frail older people
at risk of falling. Based on the patient*s risk profile, patients are offered
fall preventive treatment like referral to an exercise program, treatment of
urine incontinence, or perhaps an adjustment of medication. If the patient is
referred to an exercise program, the physio- or exercise therapist will offer a
qualified fall preventive intervention (Sight on Balance, Falls in the Past,
Wait you Fall, In Balance, OTAGO) tailored to the needs and wishes of the
patient. In this study, the group of patients who receive an exercise program
are called group 1. The group of patients who are treated by their GP in
example for urine incontinence or adjustment of medication, are called group 2.
Patients from both groups can receive several fall preventive treatments, yet
group 1 patients always receive an exercise program and group 2 patients do
not. (See Figure 1. Overview procedures fall prevention implementation study,
of the Protocol).
Study burden and risks
Since this project is in line with usual care, we do not anticipate any
disadvantages or risks for the elderly patients in being involved in this
project. The treatments which are offered to patients in this research are also
offered and used in usual care, they are only not well implemented in daily
practise. The older participants in this study will be supervised by their own
GP, practice nurse, home care provider and physio- or exercise therapist as in
usual care. We only strive for this usual care to be applied more often. The
only differences compared to usual care are the assessments for this research.
These assessments consist of four physical test, six short questionnaires and a
falls-calendar. The four physical tests have been conducted in previous
research and for as far the research team knows, there are no disadvantages of
conducting these assessments (except of the time required to complete the
assessments). Therefore the risks for taking part in this research does not
exceed that of usual care, and for this reason we have not undertaken any
measures to reduce the risk of participating in this study.
Laan van Nieuw Oost-Indië 334
Den Haag 2593 CE
NL
Laan van Nieuw Oost-Indië 334
Den Haag 2593 CE
NL
Listed location countries
Age
Inclusion criteria
Patients from GPs, practice nurses or home care providers who are frail and
have an increased fall risk.
Exclusion criteria
1. Not classified as frail according to the TFI, TRAZAG Startdocument, own
expertise or another frailty screening instrument,
2. Currently undertaking fall prevention interventions from a physio- or
exercise therapist,
3. Moderate to severe communication restrictions or impairments,
4. According to their GP not healthy enough to participate in this study (e.g.
life expectancy 2< year), or
5. Having a ZorgZwaartePakket (Care Intensity Package) of 5 or higher.
Design
Recruitment
Followed up by the following (possibly more current) registration
No registrations found.
Other (possibly less up-to-date) registrations in this register
No registrations found.
In other registers
| Register | ID |
|---|---|
| CCMO | NL61582.028.17 |