Establishing frailty and falls risk assessment screening in an MSK outpatient physiotherapy department

Abstract Background Multifactorial falls risk assessment is an evidence-based practice recommended to prevent falls among older people. Previous research has identified cultural, practical and professional challenges to implementing complex fall prevention interventions. Fall prevention interventions are frequently delivered by multidisciplinary teams (MDTs). This requires multiple health professionals, who practice under different professional norms and governance structures, to accommodate new ways of working. Our aim is to explore disciplinary differences in the perceived acceptability, appropriateness and feasibility of community-based multifactorial falls risk assessment clinics during initial implementation. Methods A mixed methods study is being conducted with analysis of administrative data on delivery of risk assessments (2016-2018), and semi-structured interviews staff involved in multidisciplinary teams (physiotherapists (PT, n=5), occupational therapists (OT, n=6), and public health nurses (n=4)]. Interviews were conducted prior to implementation and at 6 months (n=30 interviews total). Framework-driven thematic analysis was used to identify factors influencing implementation and explore perceptions of acceptability, appropriateness and feasibility. Results Implementation varied across disciplines; 28% of assessments were conducted by nurses (n=83), 36% (n=111) by physiotherapists, and 36% (n=108) by OTs. Preliminary qualitative analysis suggests that OTs welcomed the opportunity to expand their scope of practice. Conducting assessments at set times in static clinics was incompatible with public health nurses’ workflow. Their limited availability and time-sensitive competing priorities were barriers to the feasibility of an MDT-approach. Physiotherapists questioned the relative advantage of a broad assessment, and whether it was an appropriate use of resources given waiting lists for physiotherapy intervention. Data analysis is ongoing. Conclusion The study results have already been used to inform service adaptations including the introduction of dedicated intervention sessions. Training and implementation support for multidisciplinary teams may need to be tailored to the needs of different professional groups to enhance adoption and fidelity.

Download Full-text

A associação de técnicas de equilíbrio e condicionamento cardiorrespiratório diminui o risco de quedas e melhora a capacidade funcional em mulheres

Fisioterapia e Pesquisa ◽

10.1590/1809-2950/16953224012017 ◽

2017 ◽

Vol 24 (1) ◽

pp. 83-88

Author(s):

Mariana de Ávila Maciel ◽

Elizabeth Rodrigues de Morais ◽

Flavia Martins Gervasio ◽

Marcelo Silva Fantinati ◽

Adriana Marcia Monteiro Fantinati

Keyword(s):

Risk Assessment ◽

Physical Performance ◽

Short Physical Performance Battery ◽

Falls Risk

RESUMO Verificou-se a efetividade da associação do treino de equilíbrio no solo com o treino cardiorrespiratório na água sobre a capacidade funcional e o risco de quedas em mulheres adultas. Esse ensaio clínico não controlado unicego foi composto por 24 mulheres (60,79±5,51), submetidas a três meses de treinamento. Instrumentos: Short Physical Performance Battery (SPPB), Quick Screen Clinical Falls Risk Assessment (QSCFRA) e Teste de Caminhada de Seis Minutos (TC6). Houve melhora dos índices de equilíbrio, mas sem significância estatística. Ocorreu melhora significativa para o risco de quedas (p<0,001) e TC6 (p=0,049), com aumento médio de 39,58±95,5 m na distância percorrida. Houve correlações significativas entre TC6 e SPPB pré-treinamento (r=0,56, p=0,008), idade e QSCFRA (r=0,538, p=0,012) e comorbidades e QSCFRA (r=0,696; p=0,006). Verificou-se efetividade na associação dos treinos propostos sobre a diminuição do risco de quedas e melhora da capacidade funcional.

Download Full-text