Ackerman I1, Soh S-E1,2, Barker A1,3
1Monash University, School of Public Health and Preventive Medicine, Melbourne, Australia, 2Monash University, Department of Physiotherapy, Melbourne, Australia, 3Medibank Private Limited, Melbourne, Australia
Background: Osteoarthritis (OA) and falls commonly affect older people. Falls are a leading cause of injury and hospitalisation among older people, and can result in a cascade of functional decline and need for residential care. While international OA clinical guidelines consider pain management, weight loss and exercise, they do not incorporate recommendations around falls risk screening or falls prevention. Clinician knowledge about falls prevention for people with OA is not well understood; nor is it known whether falls prevention forms a part of usual OA management. There is a need to establish the current practice behaviours and level of knowledge among clinicians who routinely manage OA.
Purpose: This study aimed to investigate physiotherapists' knowledge, beliefs, and current practices around falls prevention in the setting of hip or knee OA, and preferred methods for receiving information.
Methods: Currently registered, practicing Australian physiotherapists who provide care for people with hip or knee OA were invited to participate in this study. A comprehensive online questionnaire was developed to collect data on falls prevention training and beliefs, falls risk screening practices, and provision of falls prevention activities. All data were analysed descriptively.
Results: Responses were received from 490 physiotherapists across all Australian states. Of these, 436 were eligible and provided data for analysis. Most participants were female (72%), aged 20-59 years (94%) and practising for at least 6 years (69%). Participants worked in public hospital, private hospital, community health centre, private practice and aged care settings. Only a small proportion had not received specific training or accessed educational resources relating to falls risk screening (18%) or prevention interventions (15%). Most participants (73%) perceived falls risk was higher among people with hip or knee OA than for the general older population, but physiotherapists reported moderate confidence in assessing falls risk (median score 7, interquartile range (IQR) 6-8; scale 0 (not at all confident) - 10 (extremely confident)) and delivering falls prevention care (median 7, IQR 6-8). Only 37% of participants reported using falls risk screening tools as part of OA care, although most (81%) asked about falls history. Standing balance was usually assessed as part of an overall functional assessment (69%) rather than using specific tests (16%). Approximately half the sample had referred a patient with hip or knee OA to a falls prevention program (51%) or falls and balance clinic (46%). Sixty-five per cent of participants considered falls screening and falls prevention activities should be included in OA clinical guidelines. Preferred methods for receiving falls prevention information and training included via clinical guidelines (24%), face-to-face practical courses (17%), online courses and webinars (14% each).
Conclusion(s): This nationally representative snapshot of contemporary OA practice has shown that key aspects of falls prevention are being addressed, although there is scope to optimise falls risk factor screening, balance assessment, and delivery of prevention interventions.
Implications: These data will guide the development of targeted resources for physiotherapists to enhance falls prevention confidence, and encourage the uptake of strategies for identifying falls risk factors and falls prevention opportunities within routine OA care.
Keywords: Osteoarthritis, Falls prevention
Funding acknowledgements: This study was supported by a 2018 Arthritis Australia Project Grant (Arthritis Australia and State/Territory Affiliate Grant)
Purpose: This study aimed to investigate physiotherapists' knowledge, beliefs, and current practices around falls prevention in the setting of hip or knee OA, and preferred methods for receiving information.
Methods: Currently registered, practicing Australian physiotherapists who provide care for people with hip or knee OA were invited to participate in this study. A comprehensive online questionnaire was developed to collect data on falls prevention training and beliefs, falls risk screening practices, and provision of falls prevention activities. All data were analysed descriptively.
Results: Responses were received from 490 physiotherapists across all Australian states. Of these, 436 were eligible and provided data for analysis. Most participants were female (72%), aged 20-59 years (94%) and practising for at least 6 years (69%). Participants worked in public hospital, private hospital, community health centre, private practice and aged care settings. Only a small proportion had not received specific training or accessed educational resources relating to falls risk screening (18%) or prevention interventions (15%). Most participants (73%) perceived falls risk was higher among people with hip or knee OA than for the general older population, but physiotherapists reported moderate confidence in assessing falls risk (median score 7, interquartile range (IQR) 6-8; scale 0 (not at all confident) - 10 (extremely confident)) and delivering falls prevention care (median 7, IQR 6-8). Only 37% of participants reported using falls risk screening tools as part of OA care, although most (81%) asked about falls history. Standing balance was usually assessed as part of an overall functional assessment (69%) rather than using specific tests (16%). Approximately half the sample had referred a patient with hip or knee OA to a falls prevention program (51%) or falls and balance clinic (46%). Sixty-five per cent of participants considered falls screening and falls prevention activities should be included in OA clinical guidelines. Preferred methods for receiving falls prevention information and training included via clinical guidelines (24%), face-to-face practical courses (17%), online courses and webinars (14% each).
Conclusion(s): This nationally representative snapshot of contemporary OA practice has shown that key aspects of falls prevention are being addressed, although there is scope to optimise falls risk factor screening, balance assessment, and delivery of prevention interventions.
Implications: These data will guide the development of targeted resources for physiotherapists to enhance falls prevention confidence, and encourage the uptake of strategies for identifying falls risk factors and falls prevention opportunities within routine OA care.
Keywords: Osteoarthritis, Falls prevention
Funding acknowledgements: This study was supported by a 2018 Arthritis Australia Project Grant (Arthritis Australia and State/Territory Affiliate Grant)
Topic: Musculoskeletal: lower limb; Health promotion & wellbeing/healthy ageing
Ethics approval required: Yes
Institution: Monash University
Ethics committee: Human Research Ethics Committee
Ethics number: 13952
All authors, affiliations and abstracts have been published as submitted.
