RESUMO
Background: Half of Canadians living in long-term care (LTC) homes will fall each year resulting in consequences to independence, quality of life, and health. The objective in this study was to analyze factors that contribute to, or are protective against, falls in Canadian LTC homes. Methods: We analyzed of a retrospective cohort of a stratified random sample of Canadian LTC homes in Western Canada from 2011-2017. We accessed variables from the RAI-MDS 2.0 to assess the association of the dependent variable "fall within the last 31-180 days" with multiple independent factors, using generalized estimating equation models. Results: A total of 28,878 LTC residents were analyzed. Factors found to increase the odds of falling were other fractures (OR 3.64 [95% confidence interval; CI 3.27, 4.05]), hip fractures (OR 3.58 [3.27, 3.93]), moderately impaired cognitive skills (OR 2.45 [2.28, 2.64]), partial support to balance standing (OR 2.44 [2.30, 2.57]), wandering (OR 2.31 [2.18, 2.44]). Conclusion: A range of factors identified were associated with falls for people living in LTC homes. Individual physical ability represented the largest group of independent factors contributing to falls. Residents who experience any fracture or an acute change in behaviour, mobility, or activities of daily living (ADL) should be considered at increased risk of falls.
RESUMO
Study Design: Systematic Literature Review.Background: The McKenzie Method (MDT) is a comprehensive conservative approach commonly used for the management of low back pain (LBP); however, its association with psychosocial outcomes in this population is less clear.Objectives: Evaluate whether MDT has an association with psychosocial outcomes for individuals with LBP.Methods: The following electronic databases were searched: Medline, Pubmed, Cochrane, CINAHL, Embase and AMED. They were systematically searched from the date of inception to August 2019. Included studies had to have participants experiencing LBP who were over 18 years old, utilize MDT as an assessment or intervention, and report outcomes for at least one psychosocial variable. Three reviewers independently evaluated methodological quality of randomized control trials (RCT) using the PEDro scale and observational studies using the GRACE scale.Results: The initial search resulted in 181 articles to review. After screening abstracts, then full articles, a total of 16 studies were included, 5 of which were RCTs rated 5-8/10 on the PEDro scale. A qualitative review was performed and the studies' results were synthesized into five main findings: fear-avoidance beliefs, depression symptoms, pain self-efficacy, psychological distress, and return to work (RTW).Conclusions: There is evidence that MDT has an association with improving fear-avoidance beliefs, pain self-efficacy, depression, and psychological distress. These results should be interpreted with caution as further high-quality randomized control trials addressing this topic are necessary due to the varying methodological and statistical constructs of the included studies.
