Development of an implementation plan for the 6-PACK falls prevention programme as part of a randomised controlled trial: protocol for a series of preimplementation studies

Barker, Anna; Morello, Renata; Ayton, Darshini; Landgren, Fiona; Brand, Caroline

doi:10.1136/injuryprev-2015-041915

Cited by 11 publications

(17 citation statements)

References 22 publications

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“…In particular, there was a high risk of performance bias for the majority of studies due to lack of blinding. Only three trials were considered at low risk of bias for all or the majority of domains (Bischoff 2003; Broe 2007; Flicker 2005), these all examined vitamin D supplementation in comparison with placebo. However, for many other types of interventions, blinding was generally not feasible (e.g.…”

Section: Resultsmentioning

confidence: 99%

“…Eight studies (9278 participants) examined vitamin D supplementation administered in some form (Bischoff 2003; Broe 2007; Chapuy 2002; Flicker 2005; Grieger 2009; Imaoka 2016; Kennedy 2015; Law 2006). Six trials (5561 participants) were individually randomised (Bischoff 2003; Broe 2007; Chapuy 2002; Flicker 2005; Grieger 2009; Imaoka 2016) and two trials (3717 participants) were cluster randomised (Kennedy 2015; Law 2006).…”

Section: Resultsmentioning

confidence: 99%

“…Six trials (5561 participants) were individually randomised (Bischoff 2003; Broe 2007; Chapuy 2002; Flicker 2005; Grieger 2009; Imaoka 2016) and two trials (3717 participants) were cluster randomised (Kennedy 2015; Law 2006). Four trials (4512 participants) tested the effect of vitamin D supplementation on falls (Bischoff 2003; Broe 2007; Flicker 2005; Law 2006), one trial (583 participants) tested the effect of vitamin D and calcium supplementation (Chapuy 2002), two trials (166 participants) tested multivitamin supplementation that included vitamin D plus calcium (Grieger 2009; Imaoka 2016), and one trial (4017 participants) tested an educational intervention aimed at increasing prescription of adequate levels of vitamin D, calcium and osteoporosis medications (Kennedy 2015). Seven of the eight studies reported serum vitamin D levels at baseline (Bischoff 2003; Broe 2007; Chapuy 2002; Flicker 2005; Grieger 2009; Imaoka 2016; Law 2006).…”

Section: Resultsmentioning

confidence: 99%

“…Other meta-analyses included in Stubbs 2015 and published since 2012 were Choi 2012, Guo 2014 and Santesso 2014. Choi 2012 pooled three studies conducted in care settings, all of which were included in this review: a vitamin D trial (Broe 2007), a multifactorial trial (Neyens 2009), and Rapp 2008, which is included as a subgroup analysis of Becker 2003 in our review. Guo 2014 conducted an 'exploratory meta-analysis' examining fall-prevention interventions for those with or without cognitive impairment in institutionalised and non-institutionalised settings.…”

Section: Discussionmentioning

confidence: 99%

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

Cameron

Dyer²,

Panagoda

et al. 2018

Cochrane Database of Systematic Reviews

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349

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%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

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

Cameron

Dyer²,

Panagoda

et al. 2018

Cochrane Database of Systematic Reviews

Self Cite

349

370

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“…This analysis was part of the 6‐PACK project – a multi‐centre cluster randomised controlled trial testing the effectiveness of the 6‐PACK fall prevention intervention on falls and fall injuries in six acute hospitals in New South Wales and Victoria . In the pre‐implementation phase of the project, nursing staff from 16 medical and eight surgical wards were invited to participate in focus groups to explore current fall prevention practices . Participants were 96 nurses working on participating wards.…”

Section: Methodsmentioning

confidence: 99%

Nurses’ perceptions of preventing falls for patients with dementia in the acute hospital setting

et al. 2017

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Functional Performances on Admission Predict In-Hospital Falls, Injurious Falls, and Fractures in Older Patients: A Prospective Study

Hars

Audet

Herrmann

et al. 2018

Journal of Bone and Mineral Research

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Falls are common among older inpatients and remain a great challenge for hospitals. Despite the relevance of physical impairments to falls, the prognostic value of performance-based functional measures for in-hospital falls and injurious falls remains unknown. This study aimed to determine the predictive ability and accuracy of various functional tests administered at or close to admission in a geriatric hospital to identify in-hospital fallers and injurious fallers. In this prospective study, conducted in a geriatric hospital in Geneva, Switzerland, 807 inpatients (mean age 85.0 years) were subjected to a battery of functional tests administered by physiotherapists within 3 days (interquartile range 1 to 6) of admission, including Short Physical Performance Battery (SPPB), simplified Tinetti, and Timed Up and Go tests. Patients were prospectively followed up for falls and injurious falls until discharge using mandatory standardized incident report forms and electronic patients' records. During a median length of hospital stay of 23 days (interquartile range 14 to 36), 329 falls occurred in 189 (23.4%) patients, including 161 injurious falls of which 24 were serious. In-hospital fallers displayed significantly poorer functional performances at admission on all tests compared with non-fallers (p < 0.001 for all). In multivariate analysis controlling for age, sex, previous falls, and fall as cause of admission, poorer functional performances on all functional tests predicted in-hospital falls and injurious falls (p < 0.001 for all). The SPPB only significantly predicted serious injurious falls (adjusted odds ratio [OR] = 0.76; 95% confidence interval [CI] 0.60-0.96) and fractures (adjusted OR = 0.76; 95% CI 0.59-0.98). In conclusion, poor functional performances, as assessed by SPPB, are independent predictors of in-hospital falls, injurious falls, and fractures in patients admitted to a geriatric hospital. These findings should help to design preventive strategies for in-hospital falls and support the adoption of objective performance-based functional measures into routine hospital practice. © 2018 American Society for Bone and Mineral Research.

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Development of an implementation plan for the 6-PACK falls prevention programme as part of a randomised controlled trial: protocol for a series of preimplementation studies

Abstract: The RCT is registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12611000332921.

Cited by 11 publications

References 22 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

Nurses’ perceptions of preventing falls for patients with dementia in the acute hospital setting

Functional Performances on Admission Predict In-Hospital Falls, Injurious Falls, and Fractures in Older Patients: A Prospective Study

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