Effectiveness of a multifactorial falls prevention program in community-dwelling older people when compared to usual care: study protocol for a randomised controlled trial (Prevquedas Brazil)

Background\ud Falling in older age is a major public health concern due to its costly and disabling consequences. However very few randomised controlled trials (RCTs) have been conducted in developing countries, in which population ageing is expected to be particularly substantial in coming years. This article describes the design of an RCT to evaluate the effectiveness of a multifactorial falls prevention program in reducing the rate of falls in community-dwelling older people.\ud \ud Methods/design\ud Multicentre parallel-group RCT involving 612 community-dwelling men and women aged 60 years and over, who have fallen at least once in the previous year. Participants will be recruited in multiple settings in Sao Paulo, Brazil and will be randomly allocated to a control group or an intervention group. The usual care control group will undergo a fall risk factor assessment and be referred to their clinicians with the risk assessment report so that individual modifiable risk factors can be managed without any specific guidance. The intervention group will receive a 12-week Multifactorial Falls Prevention Program consisting of: an individualised medical management of modifiable risk factors, a group-based, supervised balance training exercise program plus an unsupervised home-based exercise program, an educational/behavioral intervention. Both groups will receive a leaflet containing general information about fall prevention strategies. Primary outcome measures will be the rate of falls and the proportion of fallers recorded by monthly falls diaries and telephone calls over a 12 month period. Secondary outcomes measures will include risk of falling, fall-related self-efficacy score, measures of balance, mobility and strength, fall-related health services use and independence with daily tasks. Data will be analysed using the intention-to-treat principle.The incidence of falls in the intervention and control groups will be calculated and compared using negative binomial regression analysis.\ud \ud Discussion\ud This study is the first trial to be conducted in Brazil to evaluate the effectiveness of an intervention to prevent falls. If proven to reduce falls this study has the potential to benefit older adults and assist health care practitioners and policy makers to implement and promote effective falls prevention interventions.\ud \ud Trial registration ClinicalTrials.gov (NCT01698580)The PREVQUEDAS BRAZIL trial is supported by a grant from FAPESP (Sao Paulo Research Foundation, protocol number 12/51216-0).We are grateful to the multidisciplinary team of the Falls Prevention Program (Programa de Prevenção de Quedas do Hospital das Clínicas da FMUSP – PPQ) for providing their clinical and research support (Valmari Cristina Aranha, Maria Aquimara Zambone) and Luiz Eugenio Garcez Leme and Julia Maria D’Andrea Greve for providing institutional support.Salaries for CS and AT are funded by Australian National Health and Medical Research Council Fellowships

Exercise therapy for prevention of falls in people with Parkinson's disease: A protocol for a randomised controlled trial and economic evaluation

<p>Abstract</p> <p>Background</p> <p>People with Parkinson's disease are twice as likely to be recurrent fallers compared to other older people. As these falls have devastating consequences, there is an urgent need to identify and test innovative interventions with the potential to reduce falls in people with Parkinson's disease. The main objective of this randomised controlled trial is to determine whether fall rates can be reduced in people with Parkinson's disease using exercise targeting three potentially remediable risk factors for falls (reduced balance, reduced leg muscle strength and freezing of gait). In addition we will establish the cost effectiveness of the exercise program from the health provider's perspective.</p> <p>Methods/Design</p> <p>230 community-dwelling participants with idiopathic Parkinson's disease will be recruited. Eligible participants will also have a history of falls or be identified as being at risk of falls on assessment. Participants will be randomly allocated to a usual-care control group or an intervention group which will undertake weight-bearing balance and strengthening exercises and use cueing strategies to address freezing of gait. The intervention group will choose between the home-based or support group-based mode of the program. Participants in both groups will receive standardized falls prevention advice. The primary outcome measure will be fall rates. Participants will record falls and medical interventions in a diary for the duration of the 6-month intervention period. Secondary measures include the Parkinson's Disease Falls Risk Score, maximal leg muscle strength, standing balance, the Short Physical Performance Battery, freezing of gait, health and well being, habitual physical activity and positive and negative affect schedule.</p> <p>Discussion</p> <p>No adequately powered studies have investigated exercise interventions aimed at reducing falls in people with Parkinson's disease. This trial will determine the effectiveness of the exercise intervention in reducing falls and its cost effectiveness. This pragmatic program, if found to be effective, has the potential to be implemented within existing community services.</p> <p>Trial registration</p> <p>The protocol for this study is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12608000303347).</p

AMOUNT study deidentified dataset

This dataset includes an excel spreadsheet containing the de-identified data collected as part of the AMOUNT randomised controlled trial. This trial randomised 300 people aged between 18-101 years old undertaking inpatient aged care and neurological rehabilitation to the control group who received usual care alone, or to the intervention group who received usual care + digitally enabled rehabilitation. In addition to usual care, the intervention group used devices to target mobility and physical activity problems, individually-prescribed by a physiotherapist according to an intervention protocol, including virtual reality videogames, activity monitors and handheld computer devices for 6 months in hospital and at home. Co-primary outcomes were mobility (performance-based Short Physical Performance Battery (SPPB); continuous version; range 0 to 3) and upright time as a proxy measure of physical activity (proportion of the day upright measured with activPAL) at 6 months

A systematic review of the unit costs of allied health and community services used by older people in Australia

Abstract Background An economic evaluation of interventions for older people requires accurate assessment of costing and consideration of both acute and long-term services. Accurate information on the unit cost of allied health and community services is not readily available in Australia however. This systematic review therefore aims to synthesise information available in the literature on the unit costs of allied health and community services that may be utilised by an older person living in Australia. Method A comprehensive search of Medline, Embase, CINAHL, Google Scholar and Google was undertaken. Specialised economic databases were also reviewed. In addition Australian Government Department websites were inspected. The search identified the cost of specified allied health services including: physiotherapy, occupational therapy, dietetics, podiatry, counselling and home nursing. The range of community services included: personal care, meals on wheels, transport costs and domestic services. Where the information was not available, direct contact with service providers was made. Results The number of eligible studies included in the qualitative synthesis was fourty-nine. Calculated hourly rates for Australian allied health services were adjusted to be in equivalent currency and were as follows as follows: physiotherapy $157.75, occupational therapy$150.77, dietetics $163.11, psychological services$165.77, community nursing $105.76 and podiatry$129.72. Conclusions Utilisation of the Medicare Benefits Scheduled fee as a broad indicator of the costs of services, may lead to underestimation of the real costs of services and therefore to inaccuracies in economic evaluation.</p

Implementation of digital health interventions in rehabilitation: a scoping review

Background: Digital health interventions hold significant potential to address key rehabilitation issues such as accessibility, affordability, and scalability. However, such interventions are being implemented in rehabilitation settings inconsistently and with variable success. It is therefore important for research in this field to simultaneously evaluate the implementation and efficacy of digital health interventions in rehabilitation.Aims: To map the current evidence available regarding the implementation of digital health interventions in rehabilitation.Methods: Comprehensive searches of nine relevant electronic databases were performed. Inclusion criteria consisted of experimental studies in which rehabilitation clinicians delivered digital interventions (e.g., telerehabilitation, wearable devices, robotics, virtual reality, exergaming, smartphone apps) and methods of implementation were reported.Results: A total of 11,207 papers were retrieved through searches and are being screened by two independent reviewers. The screening and data extraction process are on track to be completed for analysis to commence in December 2021. Implementation strategies will be categorised based on grouped concepts. Implementation outcomes (adoption, dose delivered, reach, fidelity, sustainability), determinants (context, acceptability, adaptability, feasibility, compatibility, cost, culture, dose satisfaction, complexity, self-efficacy) and frameworks will also be reported. Decision-making processes for selecting implementation strategies will be analysed and a preliminary indication of the impact of specific implementation strategies on the adoption of digital interventions by rehabilitation clinicians will be reported.Conclusions: The findings of this scoping review will serve to guide future research in digital health implementation within rehabilitation and assist rehabilitation organisations and clinicians in evidence-based implementation of digital health interventions

The effect of walking on falls in older people: the 'Easy Steps to Health' randomized controlled trial study protocol

Abstract Background Falls in older people continue to be a major public health issue in industrialized countries. Extensive research into falls prevention has identified exercise as a proven fall prevention strategy. However, despite over a decade of promoting physical activity, hospitalisation rates due to falls injuries in older people are still increasing. This could be because efforts to increase physical activity amongst older people have been unsuccessful, or the physical activity that older people engage in is insufficient and/or inappropriate. The majority of older people choose walking as their predominant form of exercise. While walking has been shown to lower the risk of many chronic diseases its role in falls prevention remains unclear. This paper outlines the methodology of a study whose aims are to determine: if a home-based walking intervention will reduce the falls rate among healthy but inactive community-dwelling older adults (65 + years) compared to no intervention (usual activity) and; whether such an intervention can improve risk factors for falls, such as balance, strength and reaction time. Methods/Design This study uses a randomised controlled trial design. A total of 484 older people exercising less than 120 minutes per week will be recruited through the community and health care referrals throughout Sydney and neighboring regions. All participants are randomised into either the self-managed walking program group or the health-education waiting list group using a block randomization scheme. Outcome measures include prospective falls and falls injuries, quality of life, and physical activity levels. A subset of participants (n = 194) will also receive physical performance assessments comprising of tests of dynamic balance, strength, reaction time and lower limb functional status. Discussion Certain types of physical activity can reduce the risk of falls. As walking is already the most popular physical activity amongst older people, if walking is shown to reduce falls the public health implications could be enormous. Conversely, if walking does not reduce falls in older people, or even puts older people at greater risk, then health resources targeting falls prevention need to be invested elsewhere. Trial Registration Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12610000380099</p

The effect of walking on falls in older people: the 'Easy Steps to Health' randomized controlled trial study protocol

BACKGROUND: Falls in older people continue to be a major public health issue in industrialized countries. Extensive research into falls prevention has identified exercise as a proven fall prevention strategy. However, despite over a decade of promoting physical activity, hospitalisation rates due to falls injuries in older people are still increasing. This could be because efforts to increase physical activity amongst older people have been unsuccessful, or the physical activity that older people engage in is insufficient and/or inappropriate. The majority of older people choose walking as their predominant form of exercise. While walking has been shown to lower the risk of many chronic diseases its role in falls prevention remains unclear. This paper outlines the methodology of a study whose aims are to determine: if a home-based walking intervention will reduce the falls rate among healthy but inactive community-dwelling older adults (65 + years) compared to no intervention (usual activity) and; whether such an intervention can improve risk factors for falls, such as balance, strength and reaction time. METHODS/DESIGN: This study uses a randomised controlled trial design. A total of 484 older people exercising less than 120 minutes per week will be recruited through the community and health care referrals throughout Sydney and neighboring regions. All participants are randomised into either the self-managed walking program group or the health-education waiting list group using a block randomization scheme. Outcome measures include prospective falls and falls injuries, quality of life, and physical activity levels. A subset of participants (n = 194) will also receive physical performance assessments comprising of tests of dynamic balance, strength, reaction time and lower limb functional status. DISCUSSION: Certain types of physical activity can reduce the risk of falls. As walking is already the most popular physical activity amongst older people, if walking is shown to reduce falls the public health implications could be enormous. Conversely, if walking does not reduce falls in older people, or even puts older people at greater risk, then health resources targeting falls prevention need to be invested elsewhere. TRIAL REGISTRATION: Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN1261000038009