‘Real world’ effectiveness of the Falls Management Exercise (FaME) programme: an implementation study

Abstract

Background Falls incidence increases with age alongside declines in strength and balance. Clinical trials show that the Falls Management Exercise (FaME) programme improves strength and balance, which can reduce falls and improve physical functioning. Objective To determine if the clinical trial efficacy of FaME translates into effectiveness in non-research settings. Design and setting An implementation study of FaME in 10 local authorities across the East Midlands region of England. Subjects Adults aged 65 and over enrolled on a FaME programme. Method Anonymised outcome data collected by the FaME providers were compared at baseline, end of programme and 6 months follow-up using univariate and multivariate analyses. Results For 348 adults enrolled in programmes and analysed, the mean age was 76.8, 73% were female and 143 (41%) completed ≥75% of classes. Overall confidence in balance, fear of falling, functional reach and timed-up-and-go (all P < 0.001), and turn 180° (P = 0.008) improved significantly at programme completion versus baseline, but improvements were not maintained 6 months later. Falls risk (FRAT score) and total minutes of physical activity did not change significantly though minutes of strength and balance activity increased by 55% at programme completion and was maintained at 6 months. The falls incidence rate ratio (IRR) was non-significantly lower at programme completion (IRR 0.76, 95% Confidence Interval (CI) 0.48,1.21) and follow-up (IRR 0.82 95% CI 0.48,1.39) versus baseline. Conclusions There is modest translation of FaME efficacy into effectiveness, but not all effects persist after completion. Strategies to aid adherence and exercise maintenance are important to maximise benefits.

The effectiveness of the Healthworks Staying Steady community-based falls prevention exercise programme to improve physical function in older adults: a 6-year service evaluation

“…In the absence of follow-up data for non-completers, we cannot exclude that some participants might have dropped out following an adverse intervention effect. The observed dropout, by our definition of completing measurements at baseline but not at follow-up, was similar to Orton and colleagues [ 12 ] who reported 348 people at baseline and 203 at follow-up.…”

“…This evaluation involves a large sample of data collected during routine practice, representing the effectiveness of Staying Steady at a local level. Recent service evaluations have demonstrated the effectiveness of falls prevention programmes based on the FaME intervention to improve physical function [ 11 , 12 ]. The present study complements and extends the findings of existing service evaluations, by providing novel insight into the influence of morbidity on outcome measures and into demographic characteristics influencing attrition and adherence.…”

“…Furthermore, pooled evidence from randomised controlled trials supports the use of exercise interventions to improve muscle strength, balance, and gait speed [7] and reduce incidence of fall in adults aged ≥ 60 years [8]. These data are promising; however, few service evaluations have assessed the effectiveness of these interventions in the UK [9][10][11][12] or globally [13]. Importantly, evaluation of community-delivered exercise programmes at a local level, using routinely collected data, has greater ecological validity than data collected in randomised controlled trials [14].…”

Implementation fidelity of the Falls Management Exercise Programme: a mixed methods analysis using a conceptual framework for implementation fidelity

“…A total of 143 (40%) people attended 75% or more of the 24 weekly classes (categorised as programme completers). 11 The number of people referred to the programme or invited to participate was not recorded.…”

“…10 We have previously shown that this efficacy is translated into effectiveness in practice, but with more modest outcomes. 11 We describe the fidelity of FaME in these same programmes using the framework described by Carroll et al…”