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Bjerk M1, Brovold T1, Bergland A1
1OsloMet - Oslo Metropolitan University, Physiotherapy, Oslo, Norway
Background: In the population of older adults, about 30 percent experience a fall once a year. Falls have serious consequences, both immediate and long-term, affecting the fallers' quality of life and functional independence leading to substantial costs for the health care system. Home care recipients have higher incidence of falls, poorer physical function and lower level of health-related quality of life (HRQOL) compared to the general population of older adults. Exercise is effective to prevent falls in community-dwelling older people, but the more vulnerable group of home care recipients is generally understudied. The literature on falls has requested studies on the long-term effects of falls prevention interventions.
Purpose: The objective of this study was to examine long-term effects of a falls prevention exercise programme on HRQOL in older adults receiving home care.
Methods: This study is a parallel-group randomised controlled trial. The intervention group performed a falls prevention programme based on the Otage Exercise Programme (OEP), while the control group received usual care. The design was pragmatic and clinical physiotherapists in six Norwegian municipalities conducted the intervention. Participants were 155 adults above 67 years, who experienced a fall in the previous twelve months and who received home care from the primary health care services. The intervention lasted three months. After this period, participants in both groups were encouraged to exercise independently. Assessments were performed at baseline, following intervention and at a six months follow-up. HRQOL was the primary outcome, measured by the Short Form 36 Health Survey (SF-36). Exercise between three and six months was reported at six months follow-up. The statistical analysis was performed using linear mixed models and t-tests.
Results: Intention-to treat analysis showed that, compared to the control group, the intervention group improved on SF-36´s Physical Component Summary (PCS) [3.0; CI: 0.5-5.5] at six months follow-up. In the intervention group, 80.3% continued exercising after three months, a share significantly higher than in the control group, 63.5%, (p=0.030). At six months those performing exercise improved their PCS by 7.1 points compared to those who did not exercise (p≤0.001). Exercising between three and six months mediates the long-term effect of the intervention on PCS.
Conclusion(s): By participating in a falls prevention exercise programme older fallers receiving home care improved their physical HRQOL on long term. Participating in the exercise programme increased the chance of exercising later and thereby maintaining an improved physical HRQOL. Future research should explore if including falls efficacy in falls prevention interventions could improve mental HRQOL.
Implications: Due to the pragmatic design of this study, including local physiotherapists, and adjusting it to clinical provision, it is replicable to clinical practice in other settings. The intervention is low-cost requiring only limited personal resources and equipment. Effective interventions to improve HRQOL in older adults are emphasised in both national and international guidelines, and the results could be of interest to policy makers planning primary health care services for home care recipients.
Keywords: Falls prevention, Home care, Health-related quality of life
Funding acknowledgements: This study has not received external funding. Internal funding was provided by OsloMet - Oslo Metropolitan University.
Purpose: The objective of this study was to examine long-term effects of a falls prevention exercise programme on HRQOL in older adults receiving home care.
Methods: This study is a parallel-group randomised controlled trial. The intervention group performed a falls prevention programme based on the Otage Exercise Programme (OEP), while the control group received usual care. The design was pragmatic and clinical physiotherapists in six Norwegian municipalities conducted the intervention. Participants were 155 adults above 67 years, who experienced a fall in the previous twelve months and who received home care from the primary health care services. The intervention lasted three months. After this period, participants in both groups were encouraged to exercise independently. Assessments were performed at baseline, following intervention and at a six months follow-up. HRQOL was the primary outcome, measured by the Short Form 36 Health Survey (SF-36). Exercise between three and six months was reported at six months follow-up. The statistical analysis was performed using linear mixed models and t-tests.
Results: Intention-to treat analysis showed that, compared to the control group, the intervention group improved on SF-36´s Physical Component Summary (PCS) [3.0; CI: 0.5-5.5] at six months follow-up. In the intervention group, 80.3% continued exercising after three months, a share significantly higher than in the control group, 63.5%, (p=0.030). At six months those performing exercise improved their PCS by 7.1 points compared to those who did not exercise (p≤0.001). Exercising between three and six months mediates the long-term effect of the intervention on PCS.
Conclusion(s): By participating in a falls prevention exercise programme older fallers receiving home care improved their physical HRQOL on long term. Participating in the exercise programme increased the chance of exercising later and thereby maintaining an improved physical HRQOL. Future research should explore if including falls efficacy in falls prevention interventions could improve mental HRQOL.
Implications: Due to the pragmatic design of this study, including local physiotherapists, and adjusting it to clinical provision, it is replicable to clinical practice in other settings. The intervention is low-cost requiring only limited personal resources and equipment. Effective interventions to improve HRQOL in older adults are emphasised in both national and international guidelines, and the results could be of interest to policy makers planning primary health care services for home care recipients.
Keywords: Falls prevention, Home care, Health-related quality of life
Funding acknowledgements: This study has not received external funding. Internal funding was provided by OsloMet - Oslo Metropolitan University.
Topic: Older people; Primary health care; Health promotion & wellbeing/healthy ageing
Ethics approval required: Yes
Institution: The Regional Committee for Medical Research Ethics
Ethics committee: South East Norway
Ethics number: 2014/2051
All authors, affiliations and abstracts have been published as submitted.
