FEASIBILITY OF FALLS RISK PATIENT-REPORTED AND PHYSICAL ASSESSMENTS IN AN OSTEOPOROSIS CLINIC: TO INCREASE EVIDENCE-BASED MANAGEMENT

G. Bullock¹, P. Duncan², E. McMurtrie³, K. Henry³, B. Graves³, A. Lake³, C. McDonough⁴

¹Wake Forest University School of Medicine, Orthopaedic Surgery & Rehabilitation, Winston-Salem, United States, ²Wake Forest University School of Medicine, Neurology, Winston-Salem, United States, ³Wake Forest University School of Medicine, Orthopaedic Surgery and Rehabilitation, Winston-Salem, United States, ⁴University of Pittsburgh, Physical Therapy, Pittsburgh, United States

Background: Falls are the leading cause of injury in older adults. There is strong evidence that progressive exercise is effective in reducing falls rates in efficacy trials. However, pragmatic clinical trials have not found that effects are translated to real-world clinical application. One potential explanation is that outside of efficacy trials, clinicians require improved tailored risk information to provide appropriate physical therapy referrals. Self-report and physical assessments can inform evidence-based fall risk management. Feasibility of completing assessment in primary care specialty clinics is unknown.

Purpose: To assess the feasibility of implementing electronic and in person falls risk screening and physical performance assessment in a primary care osteoporosis clinic.

Methods: A feasibility study was performed in a Fracture Liaison Clinic from August to December 2022. Inclusion criteria were: 1) patient at the Fracture Liaison Clinic; 2) consented to participate. Exclusion criteria were: 1) neurological disorder; 2) diagnosis of cognitive impairment; 3) prisoners; 4) non-ambulatory. Patients were contacted electronically through their health portal for electronic consent. Patients were invited to complete consent, the STopping Elderly Accidents, Deaths, and Injuries (STEADI) Falls Risk Tool, and the visual analog pain scale (VAS) three days prior to clinic visit. A reminder was sent one day prior to clinic visit. If patients did not consent electronically, patients were consented and completed out the STEADI and VAS in person. The Short Physical Performance Battery (SPPB) was performed by a research coordinator at the clinic visit. Descriptive statistics were calculated with median (range) and count (percent).

Results: Among 310 patients who were contacted electronically, 200 (65%) were included (43 (14%) declined, and 67 (21%) were ineligible based on non-ambulatory status). No patients consented via health portal or text message. Characteristics of the sample were: [Age 74 (56-94); BMI: 25.7 (17.9-52.2); Female: 91%; Caucasian: 88%; Rural Address: 21%; distance from Clinic: 14.2 km (1.8-143.2)]; Medicare insurance: 59%; private insurance: 41%; worker’s compensation: <1%. The median scores were: STEADI: 6 (1-12); VAS: 1 (1-10); SPPB: 7 (1-12). Median self-report and physical assessment administration time was 12 minutes (6-31).

Conclusions: Using electronic means to contact and acquire patient reported outcomes prior to clinic visit was not feasible in this older adult osteoporosis patient population. However,these resultssuggest that it is feasible to incorporate in-person patient-reported and physical fall risk assessments into a primary care osteoporosis clinic. A score of 9 or below on the Short Physical Performance Battery and a score at or above 4 on the STEADI Falls Risk Screening Tool suggest that these patients are at a high risk for falls.

Implications: Integrating in-person patient-reported and physical assessments can help better identify patients at high risk for falls and improve utilization of evidence-based management such as physical therapy referral for exercise for this vulnerable patient population.

Funding acknowledgements: The study was funded by Centre on Health Services Training and Research (CoHSTAR) Faculty Fellowship, Foundation for Physical Therapy Research

Keywords:
Short Physical Performance Battery
STEADI Falls Risk Screening Tool
VAS Pain Scale

Topics:
Older people
Orthopaedics

Did this work require ethics approval? Yes

Institution: Wake Forest University School of Medicine

Committee: Wake Forest University School of Medicine

Ethics number: IRB00080995