To assess the effectiveness of a community-based falls-and-fracture nurse coordinator and multifactorial intervention in reducing falls in older people.
Randomized, controlled trial.
Screening for previous falls in family practice followed by community-based intervention.
Three hundred twelve community-living people aged 75 and older who had fallen in the previous year.
Home-based nurse assessment of falls-and-fracture risk factors and home hazards, referral to appropriate community interventions, and strength and balance exercise program. Control group received usual care and social visits.
Primary outcome was rate of falls over 12 months. Secondary outcomes were muscle strength and balance, falls efficacy, activities of daily living, self-reported physical activity level, and quality of life (Medical Outcomes Study 36-item Short Form Questionnaire).
Of the 3,434 older adults screened for falls, 312 (9%) from 19 family practices were enrolled and randomized. The average age was 81+/-5, and 69% (215/312) were women. The incidence rate ratio for falls for the intervention group compared with the control group was 0.96 (95% confidence interval=0.70-1.34). There were no significant differences in secondary outcomes between the two groups.
This nurse-led intervention was not effective in reducing falls in older people who had fallen previously. Implementation and adherence to the fall-prevention measures was dependent on referral to other health professionals working in their usual clinical practice. This may have limited the effectiveness of the interventions.
"One study investigated a model of intervention to prevent falls in collaboration with general practitioners and community health services in New Zealand (Elley et al., 2008). This practice-based randomised trial tested a multifaceted intervention consisting of general practitioner referral to a variety of community agencies compared to a control no-referral group, but was not effective in reducing falls. "
"This definition sub-classifies falls according to severity (serious, moderate) by using both symptomatic features (fractures, bruising, sprains, cuts, abrasions, reduction in physical function) and healthcare use (hospital, any wounds needed stitches, medical help). Referencing for this definition was inconsistent as some papers gave other primary sources  and some no reference at all [36,38,39]. "
[Show abstract][Hide abstract] ABSTRACT: The standardisation of the assessment methodology and case definition represents a major precondition for the comparison of study results and the conduction of meta-analyses. International guidelines provide recommendations for the standardisation of falls methodology; however, injurious falls have not been targeted. The aim of the present article was to review systematically the range of case definitions and methods used to measure and report on injurious falls in randomised controlled trials (RCTs) on fall prevention.
An electronic literature search of selected comprehensive databases was performed to identify injurious falls definitions in published trials. Inclusion criteria were: RCTs on falls prevention published in English, study population ≥ 65 years, definition of injurious falls as a study endpoint by using the terms "injuries" and "falls".
The search yielded 2089 articles, 2048 were excluded according to defined inclusion criteria. Forty-one articles were included. The systematic analysis of the methodology applied in RCTs disclosed substantial variations in the definition and methods used to measure and document injurious falls. The limited standardisation hampered comparability of study results. Our results also highlight that studies which used a similar, standardised definition of injurious falls showed comparable outcomes.
No standard for defining, measuring, and documenting injurious falls could be identified among published RCTs. A standardised injurious falls definition enhances the comparability of study results as demonstrated by a subgroup of RCTs used a similar definition. Recommendations for standardising the methodology are given in the present review.
BMC Medical Research Methodology 04/2012; 12:50. DOI:10.1186/1471-2288-12-50 · 2.27 Impact Factor
"Curran's  study of opinions leaders indicated that the success of an opinion leader in leading change was influenced by acceptance of the role, developmental level of the social networks within organizations clarity of role expectations and perceptions of organizational context. Although positive perceptions of patient safety culture have influenced increased use of practice guidelines as reported by Estabrooks et al.  and Cummings et al. , there may be challenges to smooth implementation when confronted with differences in perceptions of organizational context experienced by change champions  . To disentangle the effects of nurses' perceptions of patient safety culture on the use of evidencebased practice guidelines, it may be necessary to determine whether differences in perceptions do exist between charge and noncharge nurses. "
[Show abstract][Hide abstract] ABSTRACT: The implementation of evidence-based practice guidelines can be influenced by nurses' perceptions of the organizational safety culture. Shift-by-shift management of each nursing unit is designated to a subset of staff nurses (charge nurses), whom are often recruited as champions for change. The findings indicate that compared to charge nurses, noncharge nurses were more positive about overall perceptions of safety (P = .05) and teamwork (P < .05). Among charge nurses, significant differences were observed based on the number of years' experience in charge: perception of teamwork within units [F(3, 365) = 3.52, P < .01]; overall perceptions of safety, [F(3, 365) = 4.20, P < .05]; safety grade for work area [F(3, 360) = 2.61, P < .05]; number of events reported within the last month [F(3, 362) = 3.49, P < .05]. These findings provide important insights to organizational contextual factors that may impact effectiveness outcomes research in the future.
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