The impact of fall risk assessment on nurse fears, patient falls, and functional ability in long-term care.

PURPOSE: The purpose of this study was to determine whether providing fall risk information to long-term care (LTC) nurses affects restraint use, activities of daily living (ADL), falls, and nurse fears about patient falls. METHODS: One-hundred and fifty LTC residents were randomized to a fall risk assessment intervention or care-as-usual group. Hypotheses were tested using analyses of variance and path analyses. RESULTS: Restraint use was associated with lower ADL scores. In the intervention group, there ceased to be significant relationships between nurse fears about falls and patient falls (after controlling for actual patient risk; post-intervention, nurse fears about falls were based on realistic appraisals), and between fears and restraints (i.e. unjustified nurse fears became less likely to lead to unjustified restraint use). No group differences in falls were identified. CONCLUSION: Despite a lack of group differences in falls, results show initial promise in potentially impacting resident care. Increasing intervention intensity may lead to fall reductions in future research. IMPLICATIONS FOR REHABILITATION: Given the high prevalence rates of falls in LTC and associated injuries, prevention programs are important. Nurse fears about patient falls may impact upon restraint use which, when excessive, can interfere with the patient's ability to perform ADL. Excessive restraint use, due to unjustified nurse fears, could also lead to falls. Providing accurate, concise information to nursing staff about patient fall risk may aid in reducing the association between unjustified nurse fears and the resulting restraint use that can have potential negative consequences.

The effects of a long-term care walking program on balance, falls and well-being.

BACKGROUND: The effects of a regular and graduated walking program as a stand-alone intervention for individuals in long-term care are unclear. Exercise and fall prevention programs typically studied in long-term care settings tend to involve more than one exercise mode, such as a combination of balance, aerobic, strengthening, and flexibility exercises; and, measures do not always include mental health symptoms and behaviors, although these may be of even greater significance than physical outcomes. METHODS/DESIGN: We are randomly assigning residents of long-term care facilities into one of three intervention groups: (1) Usual Care Group--individuals receive care as usual within their long-term care unit; (2) Interpersonal Interaction Group--individuals receive a comparable amount of one-on-one stationary interpersonal interaction time with study personnel administering the walking program; and, (3) Walking Program Group--individuals participate in a supervised, progressive walking program five days per week, for up to half an hour per day. Assessments completed at baseline, 2 and 4 months during intervention, and 2 and 4 months post-intervention include: gait parameters using the GAITRite® computerized system, grip strength, the Berg Balance Scale, the Senior Fitness Test, the Older Adult Resource Services Physical Activities of Daily Living, the Geriatric Depression Scale Short Form, the Cornell Scale for Depression in Dementia, the Revised Memory and Behavior Problems Checklist, the Short Portable Mental Status Questionnaire, the Coloured Analogue Scale, pain assessment scales, and the number and nature of falls. Sophisticated data analytic procedures taking into account both the longitudinal nature of the data and the potential for missing data points due to attrition, will be employed. DISCUSSION: Residents in long-term care have a very high number of comorbidities including physical, mental health, and cognitive. The presence of dementia in particular makes standardized research protocols difficult to follow, and staff shortages, along with inconsistencies related to shift changes may impact on the accuracy of caregiver-rated assessment scales. Practical challenges to data collection validity and maintenance of inter-rater reliability due to the large number of research staff required to implement the interventions at multiple sites are also posed. TRIAL REGISTRATION: ClinicalTrials.gov NCT01277809.

A qualitative investigation of injurious falls in long-term care: perspectives of staff members.

PURPOSE: Although falls often result in serious injury among seniors residing in long-term care (LTC), there is a paucity of research about LTC staff perceptions about falls. Our purpose was to elicit opinions of LTC staff about falls and fall prevention given 'least restraint' policies. We also aimed to identify obstacles for optimal falls prevention. METHOD: Data were collected from administrators and a wide variety clinical staff (N = 98; 7 LTC facilities) using 11 focus groups and 28 interviews. Questions were asked about clinical practices related to falls. We employed thematic analysis to ascertain primary and secondary themes within the data. RESULTS: Participants viewed falls as a major challenge. They expressed concerns about their ability to control falls and manage consequences. Participants were conflicted about the role of restraints in falls management. Although they acknowledged beneficial effects of least restraint in terms of resident independence and increased activity, they also noted that in some instances, restraints may prevent falls, especially when individuals with dementia are considered. CONCLUSIONS: Participants were highly attentive to issues surrounding falls. However, many were unaware of clinically important findings from relevant research and misperceived fall-related (restraint) policies. Physical therapists have a role to play in education initiatives targeting these areas.

Scoring of the physical therapist clinical performance instrument (PT-CPI): analysis of 7 years of use.

PURPOSE: The aims of this study were to (1) describe the completion rates of the 24 performance criteria (PCs) from the Physical Therapist Clinical Performance Instrument (PT-CPI) by clinical instructors; (2) evaluate change in PC visual analogue scores (VAS) with students' clinical experience; and (3) evaluate scoring patterns over time. METHODS: Final VAS scores for 208 physiotherapy (PT) students (seven cohorts) from 1,039 clinical placements between 2001 and 2008 were analyzed. Completion rates were calculated for each PC. Kruskal-Wallis tests evaluated differences in VAS scores between cohorts. Friedman's tests were used to compare VAS scores for each PC over time. RESULTS: Completion rates were above 90% for 18 PCs. Data from the seven cohorts were combined. All PC scores showed significant change from 10 to 15 weeks and from 15 to 20 weeks of clinical experience (p≤0.001). Although differences in scores decreased over time, 19 PCs showed significant differences between 20 and 25 weeks, and 11 PCs showed significant differences between 25 and 31 weeks of clinical experience (p<0.01). CONCLUSIONS: Certain PCs had lower completion rates. The PT-CPI was used consistently by clinical instructors to evaluate student performance over time. A continual progression in acquisition of clinical competencies was illustrated by PT-CPI scoring patterns as students advanced through their PT education programme.

An exploratory study of two measures of free-living physical activity for people with multiple sclerosis.

OBJECTIVE: To examine the ability of two measures of physical activity (tri-axial accelerometer and activity diary) to discriminate among groups of inactive, moderately active and active individuals with multiple sclerosis and to explore the relationship between these two measures. DESIGN: Exploratory, descriptive study. SUBJECTS: Thirty individuals with multiple sclerosis and nine controls. PROTOCOL: Individuals with multiple sclerosis were recruited to inactive, moderately active and active groups as defined by Adjusted Activity Scores from the Human Activity Profile. Control participants were recruited to an active group. Free-living physical activity was recorded over four consecutive days. MAIN MEASURES: A TriTrac RT3 accelerometer and a self-report physical activity diary were used to measure activity. RESULTS: Thirty-six participants completed data collection. For the participants with multiple sclerosis, both the accelerometer (P = 0.004) and the diary (P = 0.006) detected significant differences between inactive and active groups. The accelerometer also detected a significant difference between moderately active and active groups (P = 0.04). In contrast, the diary detected a significant difference between inactive and moderately active groups (P = 0.05). Accelerometer and diary scores were significantly correlated (r = 0.59). Accelerometer scores were significantly correlated with neurological status (r(s) = -0.64). CONCLUSIONS: Both measures readily differentiated least active from most active groups. The accelerometer also differentiated moderately active from active groups, suggesting suitability for use in detecting change in more active client groups, while the diary differentiated inactive from moderately active groups, suggesting suitability for use in detecting change in less active groups.

Effectiveness of a community-based Tai Chi program and implications for public health initiatives.

OBJECTIVES: To establish whether the reported beneficial physiologic effects of Tai Chi when performed under stringent experimental conditions can be generalized to the community. DESIGN: Phase 1: pre-post comparison in a group inexperienced in Tai Chi. Phase 2: baseline comparison between inexperienced and experienced Tai Chi groups. SETTING: A community in Hong Kong. PARTICIPANTS: Phase 1: 51 subjects inexperienced in Tai Chi (novice group) participated in the program. Phase 2: baseline measures of the novice group were compared with those of an experienced group (n=49) who had practiced Tai Chi for at least 6 months. INTERVENTION: A Cheng 119 style program was taught by a Tai Chi master for 1.5 hours, 3 times weekly, for 12 weeks. MAIN OUTCOME MEASURES: Lung function and physical activity evaluated before and after the completion of the program. Resting heart rate, blood pressure, oxygen saturation, handgrip strength, flexibility, and balance measured at the program commencement, 6 weeks, and 12 weeks. RESULTS: Phase 1: after the program, the novice group had increased handgrip strength, flexibility, and peak expiratory flow rate. Phase 2: the experienced group had greater flexibility, lower resting heart rate but higher diastolic blood pressure than the novice group prior to training. CONCLUSIONS: A community-based Tai Chi program produces beneficial effects comparable to those reported from experimental laboratory trials of Tai Chi; therefore, it should be considered as a public health strategy.

Comparison of balance in older people with and without visual impairment.

OBJECTIVE: a cross-sectional study was used to compare the balance ability of older people with and without visual impairment. SETTING: Tung Wah Group of Hospitals Jockey Club Rehabilitation Complex and the Pok Oi Hospital Jockey Club care and attention homes for aged individuals. SUBJECTS: a total of 66 subjects, 65 years of age and older were divided into three groups based on their degree of visual impairment. METHODS: the directional Es chart was used to test the subjects ' visual acuity. Functional balance ability was measured using the Berg balance scale. Demographic characteristics and baseline variables such as lower extremity range of motion, muscle strength, and joint pain was assessed and compared between the groups. RESULTS: 66 older adults (43 women, 23 men) aged 69-94 years of age participated in the study. The one-way ANOVA showed that the mean Berg balance scores were significantly different (F(2,63) = 19.19, P < 0.001). Post hoc tests showed that the group with no visual impairment had higher mean balance scores than the group with mild visual impairment (P = 0.04) and those with moderate visual impairment (P < 0.001). The balance scores for the group with mild visual impairment were also shown to be significantly difference from those of the group with moderate visual impairment (P = 0.003). Control of factors related to balance, such as range of motion, pain and strength, did not affect the analysis of variance analyses. CONCLUSIONS: balance was shown to be more impaired with greater visual impairment, which could result in falls and resultant injury. The findings suggest that early intervention to improve visual acuity in older people may be important.

Concurrent validity of an electronic descriptive pain scale.

The study objective was to assess the concurrent validity of the Electronic Descriptive Pain Scale (EDPS), a pain scale built into a transcutaneous electrical nerve stimulation device. One hundred patients in an outpatient physiotherapy (PT) clinic participated (mean age 41.30 years, SD 13.95). Before and after a PT treatment, subjects rated their current pain intensity with the EDPS, a visual analogue scale, a numerical pain rating scale, and the McGill Pain Questionnaire's Present Pain Intensity. The results showed relatively high significant correlations between the EDPS and each of the other pain scales.