The design and development of a complex multifactorial falls assessment intervention for falls prevention: The Prevention of Falls Injury Trial (PreFIT).

Edge Project ID: 24431This paper describes the design and development of a complex multifactorial falls prevention (MFFP) intervention for implementation and testing within the framework of a large UK-based falls prevention randomised controlled trial (RCT).This article is freely available via Open Access. Click on the Additional Link above to access the full-text via the publisher's site.NIHR HTA 08/14/41Published

The relative age effect on physical fitness in preschool children

The aim of the present study was to investigate the existence of a relative age effect (RAE) on physical fitness of preschoolers. Anthropometry and physical fitness were assessed in 3147 children (3–5 years old) using the PREFIT battery. Based on the birth year, participants were divided into 3year groups (3-, 4- and 5-years). Within each year group, 4quarter groups were created: quarter 1, preschoolers born from January to March; quarter 2, from April to June; quarter 3, from July to September; quarter 4, from October to December. The MANCOVA analysis revealed a main effect of year group (Wilks’ λ = 0.383; F10,5996 = 369.64; p < 0.001, ηp 2 = 0.381) and of quarter (Wilks’ λ = 0.874; F15,8276.6 = 27.67; p < 0.001; ηp 2 = 0.044) over the whole battery of tests. To the best of our knowledge, this is the first study to report the existence of RAE at the preschool stage. In general, performance improved as the relative age increased (i.e., those born in quarter 1 performed better than those in the other quarters). Individualization strategies should be addressed within the same academic year not only in elementary or secondary years but also in preschoolers

Prevalence of severe/morbid obesity and other weight status and anthropometric reference standards in Spanish preschool children: The PREFIT project

BACKGROUND: Childhood obesity has become a major health problem in children under the age of 5 years. Providing reference standards would help paediatricians to detect and/or prevent health problems related to both low and high levels of body mass and to central adiposity later in life. Therefore, the aim of this study was to examine the prevalence of different weight status categories and to provide sex- and age-specific anthropometry reference standards for Spanish preschool children. METHODS: A total of 3178 preschool children (4.59±0.87 years old) participated in this study. Prevalence of different degrees of obesity (mild, severe, and morbid) and other weight status categories were determined. RESULTS: Reference standards were obtained. Prevalence of overweight and obese preschool children in the Spanish population ranged from 21.4 to 34.8%. Specifically, the obesity prevalence was 3.5, 1.2, and 1.3% of these subjects were categorized as mild, severe, and morbid obese. Sex- and age-specific reference standards for anthropometric parameters are provided for every 0.25 years (i.e. every trimester of life). CONCLUSION: Our results show a high prevalence of overweight/obese preschoolers. The provided sex- and age-specific anthropometric reference standards could help paediatricians to track and monitor anthropometric changes at this early stage in order to prevent overweight/obesity.We thank the participation of the preschoolers, parents, and teachers in this study. We are grateful to Ms. Carmen Sainz-Quinn for assistance with the English language. This work is part of a Ph.D. Thesis conducted in the Biomedicine Doctoral Studies of the University of Granada, Spain. The PREFIT project takes place owing to the funding of the Ramón y Cajal grant held by FBO (RYC-2011-09011). C.C.-S. is supported by a grant from the Spanish Ministry of Economy and Competitiveness (BES-2014-068829). E.G.A. and F.B.O. are supported by a grant from the Spanish Ministry of Science and Innovation (RYC-2014-16390 and RYC-2011-09011, respectively). C.A.-B., A.P.-B., and G.S.-D. are supported by the Spanish Ministry of Education (FPU13/03137, FPU15/ 05337, and FPU13/04365, respectively). Additional funding was obtained from the University of Granada, Plan Propio de Investigación 2016, Excellence actions: Units of Excellence; Unit of Excellence on Exercise and Health (UCEES) and by the Junta de Andalucia, Consejería de Conocimiento, Investigación y Universidades. In addition, funding was provided by the SAMID III network, RETICS, the PN I+D+I 2017-2021 (Spain), ISCIII-Sub-Directorate General for Research Assessment and Promotion, the European Regional Development Fund (ERDF) (RD16/0022, SOMM17/6107/UGR), the EXERNET Research Network on Exercise and Health in Special Populations (DEP2005- 00046/ACTI), the University of the Basque Country (GIU14/21), and the University of Zaragoza (JIUZ-2014-BIO-08)

The design and development of a complex multifactorial falls assessment intervention for falls prevention: The Prevention of Falls Injury Trial (PreFIT).

BACKGROUND: This paper describes the design and development of a complex multifactorial falls prevention (MFFP) intervention for implementation and testing within the framework of a large UK-based falls prevention randomised controlled trial (RCT). METHODS: A complex intervention was developed for inclusion within the Prevention of Falls Injury Trial (PreFIT), a multicentre pragmatic RCT. PreFIT aims to compare the clinical and cost-effectiveness of three alternative primary care falls prevention interventions (advice, exercise and MFFP), on outcomes of fractures and falls. Community-dwelling adults, aged 70 years and older, were recruited from primary care in the National Health Service (NHS), England. RESULTS: Development of the PreFIT MFFP intervention was informed by the existing evidence base and clinical guidelines for the assessment and management of falls in older adults. After piloting and modification, the final MFFP intervention includes seven falls risk factors: a detailed falls history interview with consideration of 'red flags'; assessment of balance and gait; vision; medication screen; cardiac screen; feet and footwear screen and home environment assessment. This complex intervention has been fully manualised with clear, documented assessment and treatment pathways for each risk factor. Each risk factor is assessed in every trial participant referred for MFFP. Referral for assessment is based upon a screening survey to identify those with a history of falling or balance problems. Intervention delivery can be adapted to the local setting. CONCLUSION: This complex falls prevention intervention is currently being tested within the framework of a large clinical trial. This paper adheres to TIDieR and CONSORT recommendations for the comprehensive and explicit reporting of trial interventions. Results from the PreFIT study will be published in due course. The effectiveness and cost-effectiveness of the PreFIT MFFP intervention, compared to advice and exercise, on the prevention of falls and fractures, will be reported at the conclusion of the trial.</p

Comparison of alternative falls data collection methods in the Prevention of Falls Injury Trial (PreFIT)

Background and Objective Prospective, monthly diaries are recommended for collecting falls data but are burdensome and expensive. The aim of the article was to compare characteristics of fallers and estimates of fall rates by method of data collection. Study Design and Setting A methodology study nested within a large cluster randomized controlled trial. We randomized 9,803 older adults from 63 general practices across England to receive one of three fall prevention interventions. Participants provided a retrospective report of falls in postal questionnaires mailed every 4 months. A separate randomization allocated participants to receive prospective monthly falls diaries for one simultaneous 4-month period. Results Falls diaries were returned by 7,762 of 9,375 (83%); of which 6,306 (67%) participants reported the same number of falls on both data sources. Diary nonresponders were older and had poorer levels of physical and mental health. Analysis of time points where both data sources were available showed the falls rate on diaries was consistently higher than on the questionnaire (mean rate: 0.16 vs. 0.12 falls per person-month observation). Diary allocation was associated with a higher rate of withdrawal from the main trial. Conclusion Diary completion was associated with sample attrition. We found on average a 32% difference in falls rates between the two data sources. Retrospective and prospective falls data are not consistently reported when collected simultaneously.</p

Patterns of Active Commuting to School in Spanish Preschool Children and Its Associations with Socio-Economic Factors: The PREFIT Project

The aims of this study were to describe patterns of active commuting to school (ACS) of preschool children, and to analyse the relationship between ACS and family socio-economic factors. A total of 2636 families of preschoolers (3-to-5 years old) were asked to complete a questionnaire at home about the mode of commuting to school of their children and marital status, educational level, and profession of both father and mother. Chi-square analyses were applied to compare ACS between school grades and gender of the children. To analyse the association of ACS with socio-economic factors, logistic regression analyses were performed. Almost 50% of participants reported ACS of their offspring, with a higher rate in 3rd preprimary grade (5 years old) than in 1st and 2nd preprimary grades (3- and 4-years old. All, p < 0.05). Those preschool children who had parents with lower educational level and no managerial work had higher odds to ACS than those who had parents with higher educational level and managerial work (all, p ≤ 0.001). Around half of the Spanish preschool children included in this study commuted actively to school and families with lower educational levels or worse employment situation were related to active commuting to school.Spanish Ministry of Economy, Industry and Competitiveness and the European Regional Development Fund (DEP2016-75598-R, MINECO/FEDER, UE)University of Granada, Plan Propio de Investigación 2016, Excellence actions: Units of Excellence; Unit of Excellence on Exercise and Health (UCEES)Junta de Andalucía, Consejería de Conocimiento, Investigación y Universidades and European Regional Development Fund (ERDF: ref SOMM17/6107/UGR)Spanish Ministry of Science and Innovation (FJC2018-037925-I)