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Falls prevention services are not evidence-based

RCP recommends improvements to services and exercise programmes

OnMedica staff

Thursday, 25 February 2010

Most people have positive experiences of falls prevention services, but problems remain with communication between healthcare professionals and patients and exercise programmes are often not effective.

The Royal College of Physicians questioned 1028 people about their overall experience of their local falls prevention services, and three-quarters (76%) said that it had been useful.

The quarter of respondents with a less positive experience most commonly complained of poor communication between patients and healthcare professionals, or between healthcare professionals. Patients said, for example, that they had had delays in referral, been given no estimate of waiting time once referral was made, had a poor explanation of check up, and been uncertain about whether their GP had been told about their attendance at the falls prevention service.

The RCP conducted the postal survey on behalf of the Healthcare Quality Improvement Partnership (HQIP), and were supported by Age Concern and Help the Aged.

Although nearly two-thirds (63%) of respondents were participating in an exercise programme of some sort, the programmes that they described were often not evidence-based, and therefore of limited effectiveness.

The RCP says that many patients’ involvement in exercise programmes is limited by factors such as pain, tiredness or other health problems, and patients would like more exercise classes, longer courses, options for home visits, follow up from courses, more local classes and help with transport. Participants found self-motivation to exercise at home harder than when attending a class.

The RCP is concerned that many people are participating in exercise programmes that have no evidence base for reducing risk of falls. They are not, for example, sufficiently specific, frequent, challenging or progressive. Evidence-based programmes include Otago, FaME and Strength and Balance classes.

The findings have led the RCP to issue new recommendations, available on the College website, for falls prevention services on better communication, both verbal and written, at each stage of the process – assessment, investigation and intervention, including taking more account of individual concerns at each stage of the programme.

Falls prevention services should, for example: 

• provide information about the specific types of exercise needed to reduce the risk of falls, to both professionals and the public 

• promote evidence-based courses and train health and exercise professionals to deliver these programmes 

• provide education programmes to promote the benefits of healthy, active ageing to help prevent the onset of falls and maintain the benefits from attending classes following a fall.

Jackie Riglin MCSP, falls prevention coordinator and clinical specialist physiotherapist, and RCP clinical associate for falls, said: “The findings from this report raise important issues for improving the delivery of a timely, appropriate and effective local falls prevention service. I do hope that both service providers and commissioners will take on board the recommendations around communication and provision of local, long-term, evidence-based exercise interventions.”

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