None listed
Conditions
Brief summary
Falls are a major public health issue for older people, and those in residential care falls most frequently and are at the highest risk for injury from falls. Costs related to fall and injury management are disproportionately spent in residential care. There is little evidence that exercise alone is effective in residential care and some trials show an increase in falls as a result of exercise. Multifactorial programmes do not consistently reduce falls in residential care, however exercise seems to be a necessary component in those that have been successful. A promising exercise programme has been developed based on the Otago Exercise Programme and a successful programme used in Germany as part of a mulitfactorial intervention has been adapted for New Zealand use. It would be of great benefit to know whether exercise, delivered as a single intervention, is more or less effective than a multifactorial facility based intervention, or whether the combination of the two is better than each delivered individually. This study aims: 1) To refine an exercise programme aimed at preventing falls in residential care and test its effect on strength and balance (impairments of these two biological parameters are closely related to an increased risk of falls) 2) To establish feasibility for a large 2x2 factorial randomised controlled trial that will test the question “Does a multifactorial programme reduce falls in New Zealand rest homes or is an exercise programme alone sufficient to reduce falls?”
Interventions
The study design is a 2x2 Factorial study; the 4 arms of the study being
1) Usual care facility with Flex and Stretch (control) exercise programme
b) Usual care facility with Staying UpRight exercise programme
c) Multifactorial programme facility with Flex and Stretch (control) exercise programme
d) Multifactorial programme facility with Staying UpRight programme
Facility level intervention
Multifactorial falls prevention intervention consisted of a training programme for a falls champio
The study design is a 2x2 Factorial study; the 4 arms of the study being 1) Usual care facility with Flex and Stretch (control) exercise programme b) Usual care facility with Staying UpRight exercise programme c) Multifactorial programme facility with Flex and Stretch (control) exercise programme d) Multifactorial programme facility with Staying UpRight programme Facility level intervention Multifactorial falls prevention intervention consisted of a training programme for a falls champion. Resources and training given to the champion were taken form Australian Commission on Safety and Quality in Health Care (with their permission in 2008) and included: environmental audit, risk assessment information, fact sheets for nurses doctors, caregivers, allied health professionals and managers, a DVD of case studies for caregivers, best practice guidelines, an implementation guide for a falls prevention and management programme, and a training package for caregivers. Hip protectors were supplied free of charge for all enrolled residents in multifactorial homes, and Vitamin D was recommended for all, with GP support obtained. The training was delivered face to face at a one day training session by members of the research team and included registered nurses and registered physiotherapists. Ongoing telephone support and face to face meetings (as required) continued through out the 6 month intervention period. Resident level intervention The UpRight exercise programme consisted of strength, balance, sensory integration and dual tasking exercises, progressing over time. The class was delivered by a physiotherapist in two sessions of one hour each per week over a 6 month period in the recreation room in the Residential Aged Care facility in which the participant lived. Exercises examples: be Hip extension in standing holding onto the back of a chair with both hands, progressing to one had, progressing to not holding on at all; Knees bends in standing holding onto the back of a chair with both hands, progressing to one had, progressing to not holding on at all;Triceps chair press up The physiotherapists attended a one day face to face training session on how to deliver the Staying UpRight and Flex and Stretch classes and received a manual which detailed the proposed structure of both classes, attendance sheets and an excel template on which to plan and record the Staying UpRight class. Classes were twice a week for an hour each time. The physiotherapist completed attendance sheets for each Staying UpRight and Flex and Stretch class and returned them to the research team at the end of each month.
Sponsors
Prof Ngaire Kerse
Study design
Allocation
Randomised controlled trial
Intervention model
Factorial
Primary purpose
Prevention
Masking
Blinded (masking used) (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
65 Years to No maximum
Healthy volunteers
No
Inclusion criteria
To identify residential aged care facilities The sampling was from a list of residential aged care facilities in the Waitemata District Health Board area. Residents 65 years or older, living in residential aged care, mobile with or without an assistive device.
Exclusion criteria
Facilities All private hospitals for continuing care, facilities under 20 beds and facilities already running the Life Programme, which incorporates an activity programme, were excluded. Residents Were excluded if they were under 65 years, were admitted for palliative care, respite care, at their registered nurse’s or clinical nurse coordinator’s discretion, if they were unable to give informed consent and relatives were uncontactable to do so on their behalf, or if they were not in the facility at the time(s) of recruitment.
Outcome results
None listed