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R. Dawson1, J. Suen2, C. Sherrington1, J. Olivera1, I. Cameron3, V. Kwok1, D. Kneale4, K. Sutcliffe4, S. Dyer2
1University of Sydney, Institute for Musculoskeletal Health, Sydney, Australia, 2Flinders University, Flinders Health and Medical Research Institute, Adelaide, Australia, 3University of Sydney, John Walsh Centre of Rehabilitation Research, Sydney, Australia, 4University College London, EPPI Centre, UCL Social Research Institute, London, United Kingdom
Background: Falls and their consequences are a leading problem in residential care settings. Identification and implementation of effective interventions to reduce falls have the potential to benefit older people. The 2018 Cochrane review update on interventions to prevent falls in older people in care facilities concluded that there is uncertainty regarding effects of exercise on rate of falls, and exercise may make little or no difference to the risk of falling. The review concluded that there was low quality evidence and the substantial heterogeneity among the trials remained requiring further analysis.
Purpose: This research used Intervention Component Analysis (ICA) and Qualitative Comparative Analysis (QCA) to identify configurations of trial components in effective exercise interventions in residential aged care.
Methods: Trials from the 2018 Cochrane review plus additional trials identified in a systematic search to December 2021 examining fall prevention exercise trials in older people aged 65+ years living in residential care, compared to any control group and reporting outcomes of the total number of falls or people falling were included. Two authors used the Prevention of Falls Network Europe (ProFaNE) taxonomy to map trial characteristics and intervention components.
In the ICA, two authors independently conducted line by line coding of author’s discussions of effective elements (excluding studies with <20 participants/treatment arm). An inductive thematic analysis approach was used to identify dominant themes, which were examined for consistency against trial fall outcomes, to develop theories describing a successful fall prevention program. Theories were tested through QCA of all trials with meta-analysis falls data at the end of the intervention period. Configurations of trial components suggested by the ICA theories were systematically examined for association with trial effectiveness using the QCA package in R Project (version 4.1.2).
In the ICA, two authors independently conducted line by line coding of author’s discussions of effective elements (excluding studies with <20 participants/treatment arm). An inductive thematic analysis approach was used to identify dominant themes, which were examined for consistency against trial fall outcomes, to develop theories describing a successful fall prevention program. Theories were tested through QCA of all trials with meta-analysis falls data at the end of the intervention period. Configurations of trial components suggested by the ICA theories were systematically examined for association with trial effectiveness using the QCA package in R Project (version 4.1.2).
Results: The updated search included 32 trials from 16 countries involving 3,864 participants; 15 new studies were identified since the 2018 Cochrane Review. The primary intervention component was exercises involving strength training combined with gait, balance, and functional training in 18 (58%) trials.
Our ICA (n=17) found that authors emphasised both intervention and implementation factors as drivers of reduced falls. Effective fall prevention exercise delivers ‘right exercise’ through individualized exercise prescriptions, that target strength and balance, and are delivered at a moderate intensity; and that successful implementation requires ‘exercise engagement supports’such as sufficient funding to support exercise programs that incorporate socialisation and educational opportunities.
The QCA (n=18) preliminary findings found exercise tailored to individual residents conducted at moderate intensity reduced falls. Additionally, amongst ambulant residents, group exercise that allowed for socialization opportunities alone could reduce falls.
Our ICA (n=17) found that authors emphasised both intervention and implementation factors as drivers of reduced falls. Effective fall prevention exercise delivers ‘right exercise’ through individualized exercise prescriptions, that target strength and balance, and are delivered at a moderate intensity; and that successful implementation requires ‘exercise engagement supports’such as sufficient funding to support exercise programs that incorporate socialisation and educational opportunities.
The QCA (n=18) preliminary findings found exercise tailored to individual residents conducted at moderate intensity reduced falls. Additionally, amongst ambulant residents, group exercise that allowed for socialization opportunities alone could reduce falls.
Conclusions: Information about critical features of exercise intervention and its implementation can guide the development of optimal fall prevention program in residential aged care. Future large-scale clinical trials are required to validate the outcomes of our ICA and QCA.
Implications: This research gives physiotherapists the best evidence to assist with their management of falls in residential aged care. Tailored exercise delivered at a moderate intensity has potential to be an effective fall prevention program for older people.
Funding acknowledgements: This work is supported by the Centre for Research Excellence in the prevention of falls and fall-related injuries.
Keywords:
Aged care
Fall prevention
Exercise
Aged care
Fall prevention
Exercise
Topics:
Older people
Community based rehabilitation
Research methodology, knowledge translation & implementation science
Older people
Community based rehabilitation
Research methodology, knowledge translation & implementation science
Did this work require ethics approval? No
Reason: This is a systematic review which does not need ethics approval.
All authors, affiliations and abstracts have been published as submitted.
