A patient education program supported by staff training can reduce the rate of falls for older people during inpatient rehabilitation [commentary]

摘要

Summary of: Hill A-M, McPhail SM, Waldron N, Etherton-Beer C, Ingram K, Flicker L, et al. Fall rates in hospital rehabilitation units after individualised patient and staff education programmes: a pragmatic, stepped-wedge, cluster-randomised controlled trial. Lancet. 2015; 385: 2591-2599. Question: Does a fall prevention patient education program in addition to staff training reduce the rate of falls in hospital rehabilitation units? Design: A stepped-wedge cluster random- ised, controlled trial with blinding of staff collecting falls data. Setting: Eight rehabilitation units in Australia. Participants: After enrolment of the eight inpatient rehabilitation units (clusters), patients were eligible if aged > 60 years, had a projected length of stay of at least 3 days, and had basic cognitive functioning, defined as having a Mini-Mental State Examination score of > 23/30. All multidisciplinary staff in the unit were eligible to participate. After a 10-week control phase, two of the units were randomly allocated to the intervention, with two units added at 10-week intervals until all units had crossed over to the intervention phase. During the trial 1983 patients were admitted during the control phase and 1623 patients were admitted during the intervention phase. Interventions: During control and intervention phases, patients received usual care inpatient rehabilitation management from a multidisciplinary team. In addition, during the intervention period, patients received an individualised fall prevention education program based on changes to health behaviour principles. The program was delivered by a physiotherapist and included a1836-9553/ 2015 Australian Physiotherapy Association. Published by Elsevier B.V. Almultimedia education package with individual follow-up that included goal setting for a median of two sessions and 45 minutes. The physiotherapy educators also provided information and weekly feedback to staff at each unit for about 2 hours per week. Outcome measures: The primary outcomes were patient rate of falls (per 1000 patient-days), the proportion of patients who had injurious falls, and length of stay. Results: A total of 3606 patients were admitted to the rehabilitation units during the control phase (n = 1983) and intervention phase (n = 1623). During the interven- tion phase, the fall rate reduced from 13.78 to 7.80 falls per 1000 patient-days (incident rate ratio (IRR) 0.60, 95% CI 0.42 to 0.94). During the intervention phase, the rate of injurious falls reduced from 4.75 to 2.63 falls per 1000 patient-days (IRR 0.65, 95% CI 0.42 to 0.88). A planned analysis of patients with lower cognition scores (< 23 on the Mini-Mental State Examination) who did not receive the individualised intervention, showed they also had a reduced fall rate, from 16.46 to 10.70 falls per 1000 patient-days (IRR 0.65, 95% CI 0.40 to 1.05). There was no difference in length of stay between the two phases. Conclusion: A patient education program in addition to staff training reduced the falls rate in [1_T$DDFIoF] lder patients admitted for inpatient rehabilitation. Provenance: Invited. Not peer-reviewed.Nicholas Taylor Section Editor, Journal of Physiotherapy http://dx.doi.org/10.1016/j.jphys.2015.07.016.