PMID- 28608776
OWN - NLM
STAT- MEDLINE
DCOM- 20181107
LR  - 20181107
IS  - 1464-5165 (Electronic)
IS  - 0963-8288 (Linking)
VI  - 40
IP  - 20
DP  - 2018 Oct
TI  - Short-term effectiveness of a community-implemented falls prevention referral 
      service.
PG  - 2466-2474
LID - 10.1080/09638288.2017.1337241 [doi]
AB  - PURPOSE: To evaluate the effectiveness of the 16-week evidence-based Steady Steps 
      exercise referral scheme at improving physical function, balance confidence, and 
      quality of life (QoL) of community-dwelling older adults at risk of falling. 
      METHOD: A non-experimental, practice-based study involving a retrospective 
      analysis of participant outcomes. Pre-post comparisons of three performance-based 
      measures of gait and balance and of person-reported outcomes for balance 
      confidence and QoL were performed. Effectiveness was evaluated in terms of 
      statistically significant changes and relative to published fall-risk thresholds 
      and minimal detectable changes (MDCs) or minimum clinically important 
      differences. RESULTS: One hundred and thirty-six participants completed the 
      program over 19 months. Statistically significant differences were observed for 
      all outcomes (p < 0.001), translating to an overall 42.6% reduction in 
      falls-related risk. Approximately 63% of participants achieved an 
      improvement >/=MDC in at least one of the performance-based tests. Greater than 55% 
      achieved self-reported improvements in balance confidence >/= MDC, while >40% 
      reported clinically important improvements in QoL. CONCLUSIONS: While the 
      non-experimental design precludes conclusive evidence of causation, the highly 
      significant and clinically meaningful improvements observed in individuals who 
      completed the evidence-based Steady Steps program support its translation of 
      evidence into effective practice. Continued implementation and evaluation of such 
      practices and their longer-term effects are warranted. Implications for 
      Rehabilitation Falls in older adults represent an escalating public health 
      problem, and rehabilitation professionals are charged with developing and/or 
      identifying feasible and effective evidence-based programs that target and reduce 
      falls risk in this population. Our findings support Steady Steps as an effective 
      third-sector referral rehabilitation service that successfully translates 
      research evidence-based exercise interventions into effective practice, 
      positively impacting physical function, balance confidence and quality of life 
      (QoL) in community-dwelling older adults. Our study provides practice-based 
      evidence of the effectiveness of exercise interventions that are progressively 
      challenging, deliver a high dose of moderate to high intensity and target the 
      main falls risk factors of muscle weakness and gait and balance impairment. In 
      spite of their limitations, non-experimental, practice-based approaches provide 
      rehabilitation professionals with feasible opportunities for evaluating existing 
      services, such as Steady Steps, and contributing to the overall evidence-base for 
      falls prevention and management.
FAU - Christoforou, Andrea
AU  - Christoforou A
AD  - a Centre of Health Activity and Rehabilitation Research, School of Health 
      Sciences , Queen Margaret University , Edinburgh , UK.
FAU - van der Linden, Marietta L
AU  - van der Linden ML
AD  - a Centre of Health Activity and Rehabilitation Research, School of Health 
      Sciences , Queen Margaret University , Edinburgh , UK.
FAU - Koufaki, Pelagia
AU  - Koufaki P
AD  - a Centre of Health Activity and Rehabilitation Research, School of Health 
      Sciences , Queen Margaret University , Edinburgh , UK.
LA  - eng
PT  - Journal Article
DEP - 20170613
PL  - England
TA  - Disabil Rehabil
JT  - Disability and rehabilitation
JID - 9207179
SB  - IM
MH  - Accidental Falls/*prevention & control
MH  - Aged
MH  - Aged, 80 and over
MH  - Evidence-Based Practice/methods
MH  - Exercise Therapy/*methods
MH  - Female
MH  - Gait
MH  - Humans
MH  - Independent Living/statistics & numerical data
MH  - Male
MH  - Patient Reported Outcome Measures
MH  - *Postural Balance
MH  - Program Evaluation
MH  - *Quality of Life
MH  - Retrospective Studies
MH  - United Kingdom
OTO - NOTNLM
OT  - Falls
OT  - balance confidence
OT  - community-based
OT  - older adults
OT  - physical function
OT  - quality of life
EDAT- 2017/06/14 06:00
MHDA- 2018/11/08 06:00
CRDT- 2017/06/14 06:00
PHST- 2017/06/14 06:00 [pubmed]
PHST- 2018/11/08 06:00 [medline]
PHST- 2017/06/14 06:00 [entrez]
AID - 10.1080/09638288.2017.1337241 [doi]
PST - ppublish
SO  - Disabil Rehabil. 2018 Oct;40(20):2466-2474. doi: 10.1080/09638288.2017.1337241. 
      Epub 2017 Jun 13.