Feasibility and impact of SAIFR (Systematic Approach to the Implementation of Falls Recommendations) for older clients in community rehabilitation: a pilot cluster randomised trial

This is a hybrid type 2 pilot stepped wedge randomised controlled trial comprising two sites. It will evaluate the feasibility and impact of SAIFR (Systematic Approach to the Implementation of Falls Recommendations) in the community rehabilitation program setting. The World Guidelines for Falls Prevention and Management for Older Adults and the Preventing Falls and Harm from Falls in Older People: Best Practice Guidelines for Community Care in Australia will be implemented, following the SAIFR approach. The trial coordinator implementing the falls guidelines is a physiotherapist with over 20 years clinical experience. The target population of this study will be clients of the community rehabilitation program who are seen by occupational therapy or physiotherapy and are aged 65 years or over from whom routinely collected data and survey responses will be analysed. These clients will also be invited to participate in a semi-structured interview to describe their experience with the SAIFR implementation intervention, as will the occupational therapists and physiotherapists of the community rehabilitation program. As part of the intervention, in comparison to usual care, clients will receive fall prevention care that more closely and consistently aligns to the recommendations in the World Falls Guidelines and Australian Falls Guidelines for community dwelling older people, including tailored education on physical activity, tailored education on falls prevention, progressive balance, strength and mobility exercises, home hazard reduction and interventions tailored according to fall risk assessment. They will receive behaviour change support from their therapists to help make necessary changes to reduce their falls risk. The pilot trial will commence with a period of usual care that will extend for 3 months at one community rehabilitation program site (site 1) and 6 months for the second community rehabilitation program site (site 2). Pre-implementation (baseline) data will be collected during this time. The order of commencement of implementation will be randomly determined with a coin toss. The implementation intervention will be delivered in site 1 over a 3-month period and then, in turn, will be delivered in site 2, also over a 3-month period. The implementation strategies for therapists will involve: -1 hour training and education session about the World Falls Guidelines and Australian Falls Guidelines (broadly and specifically aligned to the community settings). One training and education session will occur per site, during the implementation phase. The training and education session will be conducted in-person and a recording will also be made available for therapists who cannot attend on the day. Attendance at the training and education session will be recorded. The education session will include an introduction regarding the trial, the problem of falls, the challenge of implementing fall prevention guidelines in health services, orientation to the World Falls Guidelines, strength and source of recommendations, a summary of general falls prevention recommendations from the World Falls Guidelines, key themes from recommendations in the World Falls Guidelines, orientation to the Australian Falls Guidelines, differences between the World Falls Guidelines and Australian Falls Guidelines, a summary of general falls prevention recommendations from the Australian Falls Guidelines, key themes from recommendations in the Australian Falls Guidelines, community-specific recommendations from both the World Falls Guidelines and Australian Falls Guidelines. -2 hour training and planning workshop. One workshop will occur per site, during the implementation phase. The workshop will be conducted in-person. Attendance at the training and planning workshop will be recorded. The workshop will include an introduction regarding the trial, recap of key points from training and education session, mapping of the current journey of clients at risk of falls in the Community Rehabilitation Program, consideration of current gaps according to the COM-B framework of behaviour change, consideration of integration of recommendations within existing processes, sharing of possible resources/training/support that could be considered, planning for next steps. -development and enhancement of local processes, including documentation. For example, existing assessment forms may require edits to improve adherence with recommendations, existing telephone triage questions may need to be adapted, processes for referrals for other health professional input may need to be streamlined. This will be determined in collaboration with the therapists working in the Community Rehabilitation Program. -promotion of the World Falls Guidelines and Australian Falls Guidelines by the project lead, including responding to questions, attending appropriate team meetings and providing regular updates in-person and via email. Other promotional material and/or strategies will be determined in collaboration with the therapists working in the Community Rehabilitation Program. Implementation strategies will be guided by the COM-B model of behaviour change. A post-implementation period of 6 months at site 1 and 3 months at site 2 will follow implementation at each site, during which time post-implementation data will be collected, including semi-structured interviews of clients and therapists.