DEVELOPMENT AND IMPLEMENTATION OF A FALLS PREVENTION PROGRAMME IN GUYANA: AN INTERNATIONAL COLLABORATION

S. Pires¹, M. Pascal², B. Lawrence¹, E. Newton¹, D. Babulall¹, K. Pearage², K. Saroka², M. Schanzlin², M. Shaver², A. Jack¹, A. Fraser¹, G. Bacchus¹, D. McAllister¹

¹Guyana Ministry of Health, Palms Rehabilitation Department, Georgetown, Guyana, ²Misericordia University, Physical Therapy, Dallas, PA, United States

Background: Stroke is one of the leading causes of disability in Guyana. Although many persons return home after sustaining a stroke, reports of falls are common. Therapists from the Palms Rehabilitation Department in Georgetown, Guyana collaborated with a group of researchers from Misericordia University in the U.S. to address this problem. The groups shared information about falls incidence and occurrence post-stroke, and worked together to develop and study an exercise programme designed to help reduce falls.

Purpose: The purpose of this study was to investigate the effectiveness of an exercise programme to reduce falls and improve function.

Methods: The group developed an exercise programme designed to be performed during therapy sessions and as a home programme. The programme was developed after a review of literature and discussions about feasibility of specific exercises. Discussions included the need to include exercises that would address both balance and function, considering the Guyanese culture and the physical environment in Georgetown, Guyana. Because patients often report difficulty obtaining transportation to the rehabilitation department, the programme was designed to be completed at home and in the department. The programme included exercises to improve core strength, balance and function, with exercises in quadruped, and standing, as well as transfer and gait activities. The department programme included both individual and group activities. Twenty participants provided informed consent to participate in an eight-week trial of the exercise programme. Participants attended one session per week at the department. Outcomes were determined using a pre-test post-test design, using results from the Five Times Sit to Stand and the 10 Meter Walk Test. Participants completed a questionnaire to rate their fear of falling and the incidence of falls at the beginning and end of the study.

Results: All twenty participants completed the programme. Participant age ranged from 50 to 89 years. Time since stroke ranged from two weeks to ten years. One participant developed medical complications, so their data was excluded. All participants reported a history of falls prior to the study. Fifteen participants (78.9%) demonstrated improvements in self-selected and fast gait speed. For those whose fast walking speed improved, five (31.25%) demonstrated a clinically important improvement, and seven (43.75%) met the threshold for a minimal detectable change from pre-test to post-test. Twelve participants completed the Five Times Sit to Stand Test. Eleven (91.67%) improved their time at post-test, with nine (81.8%) demonstrating a clinically important improvement. No falls occurred during the programme.

Conclusions: Collaboration to develop an evidence-based, culturally appropriate falls prevention programme can help reduce fall risk and improve function and confidence for adults with acute or chronic stroke . Future research at other rehabilitation departments in Guyana would help increase the generalizability of the programme.

Implications: The exercise programme used in this study can be used clinically by physiotherapists in Guyana in the department and as a home programme to help improve function and reduce fall risk in persons post-stroke. Shared knowledge and experience of all researchers considering research evidence and the environmental, social, and economic conditions of patients were important in developing an effective programme.

Funding acknowledgements: This study was not funded.

Keywords:
Stroke
Falls prevention
Guyana

Topics:
Neurology: stroke
Disability & rehabilitation
Professional practice: other

Did this work require ethics approval? Yes

Institution: Guyana Ministry of Health

Committee: Institutional Review Board

Ethics number: FWA00030719