On-site Physiotherapy in Older Emergency Department Patients Following a Fall: A Randomized Controlled Trial

Abstract

Purpose: Falls are a frequent cause of emergency department (ED) visits for individuals aged 65 years and older. Greater fear of falling (FOF) is associated with an increased risk of falling in older patients. This study aims to assess the impact of physiotherapy on FOF in older patients and investigates the feasibility of such an intervention in the ED setting. Methods: All patients aged 65 or older, who presented to the ED of the University Hospital Basel after a fall between January 2022 and June 2023 were screened for inclusion. Participants were assigned to an intervention or control group depending on the randomized presence or absence of a physiotherapist at inclusion. Results: One hundred four older adults with a recent fall were included (intervention: n = 44, control: n = 60); median age was 81 years and 59.1% were female. There was no between-group difference in FOF as measured by short International Falls Efficacy Scale within a week of inclusion (p = 0.663, effect size = 0.012 [95% confidence interval (CI) - 0.377 to 0.593]). Despite the intervention being deemed feasible from the physiotherapist’s perspective, the study encountered challenges, such as low recruitment and a notable dropout rate. Conclusion: A physiotherapy intervention in the ED showed no improvement in fear of falling when compared to a control group. Despite concerns about low recruitment and high dropout rates, both groups received a high standard of care, resulting in a reduction in FOF in both groups over the course of the study. Trial registration number and date: NCT05156944, 01.12.2021