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No description available.

Abstract Background: Physiotherapists’ knowledge, attitude and practice patterns in falls prevention are studied mainly in middle- and high-income countries. This study aims to develop and validate a questionnaire for studying the attitude, self-reported knowledge and clinical practice of Rwandan physiotherapists in falls prevention of older adults.  Method: In a cross sectional design the content, face and cross-cultural validity was tested on four Swedish experts and four Rwandan physiotherapists. Test-retest was performed with 20 Rwandan physiotherapists and descriptive data was summarized for these physiotherapists. Content validity index (CVI) was calculated per item and scale, and face validity index with face validity index (FVI) per item and scale. Interviews complemented the face validity scorings for cross-cultural validation. Test-retest was analysed with intraclass correlation coefficient(ICC). Results were categorized into individual, behavioural and environmental factors, in line with the Social Cognitive Theory.  Results:  The questionnaire attained a satisfactory degree of content validity with content validity index per item(I-CVI) and scale-level content validity index based on the average method (S-CVI/Ave) of 0.96. Questionnaire had satisfactory face validity with a face validity index per item (I-FVI) and scale-level face validity index based on the average method (S-FVI/Ave) of 0.89. The questionnaire was shown to be pertinent to Rwandan physiotherapists’ context. The test-retest stability of the questionnaire was non-significant. Most physiotherapists emphasized individual rather than environmental or behavioral risk factors for falls and in falls prevention treatment.  Conclusion: The content and face validity as well as cross-culture validity of preliminary questionnaire of falls prevention were acceptable. Further research in this area is essential to complete validation and to improve the reliability of the questionnaire. The study highlights the importance of application of social cognitive theory in studying how physiotherapists consider the complexity of factors contributing to falls.

No description available.

No description available.

Bakgrund: Fall är vanligt förekommande hos äldre personer och har stora konsekvenser för både individen och samhället. Fallförebyggande multifaktoriella interventioner rekommenderas för äldre personer som bor hemma men det saknas stark evidens för vilka kombinationer av fallpreventiva interventioner som är effektiva. För att få en bättre bild av fördelarna med att inkludera andra interventioner tillsammans med träning är det av vikt att undersöka kombinationen av patientutbildning tillsammans med träning hos hemmaboende äldre. Syfte: Att undersöka effekten av patientutbildning i kombination med träning på antalet fall hos hemmaboende äldre samt redovisa innehållet i patientutbildningarna och träningsinterventionerna. Metod: En systematisk litteraturstudie där sökningen genomfördes i PubMed. Åtta RCT-studier valdes ut. Studiernas kvalitet granskades med PEDro-skalan och tillförlitligheten av det sammanvägda resultatet bedömdes utifrån GRADEstud.   Resultat: Åtta studierna inkluderades med totalt 1557 deltagare där den lägsta medelåldern var 71 år. Fem studier sammanvägdes. Alla studier innehöll patientutbildning och träning, dock varierade komponenterna i interventionerna. Kontrollgrupperna innehöll ingen intervention, sedvanlig vård eller icke fallpreventiva interventioner. Jämfört med kontrollgruppen hade interventionsgruppen ingen effekt av patientutbildning i kombination med träning på antalet fall. De fem studier som sammanvägdes hade bra kvalitet (6-8 poäng) enligt PEDro-skalan medan det sammanvägda resultatet hade låg tillförlitlighet enligt GRADEstud. Konklusion: Patientutbildning i kombination med träning visade ingen fallreducerande effekt på hemmaboende äldre och innehållet i interventionerna skilde sig åt i samtliga studier. Fler framtida studier behövs då tillförlitligheten av det sammanvägda resultatet bedömdes vara låg. / Background: Falling is common among older people and has severe consequences for both the individual and the society. Multifactorial interventions are recommended for community-dwelling elderly, although there is a lack of strong evidence for which combinations of fall preventive interventions that are effective. To get a better picture of the benefits of including other interventions together with exercise it is of most importance to investigate the combination of patient education together with exercise for community-dwelling elderly.   Aim: To investigate the effect of patient education in combination with exercise on the number of falls amongst community-dwelling elderly, and to present the content in the patient education and the exercise interventions.  Method: A systematic literature study was carried out in PubMed. Eight RCT-studies were chosen. The quality was assessed using the PEDro-scale and the combined reliability of the studies was assessed using GRADEstud.  Results: Out of the eight studies five of them were combined with a total of 1557 participants and the lowest average age was 71 years. All of the studies contained patient education and exercise, although the components in the interventions varied. The control groups contained; no intervention, usual care or non-fall preventive interventions. No effects of the patient education in combination with exercise was demonstrated on the number of falls in comparison to the control groups. The five studies that were combined had good quality (6-8 points) according to the PEDro-scale while the combined result had low reliability according to GRADEstud.  Conclusion: Patient education in combination with exercise had no fall reducing effect on community-dwelling elderly and the content in the interventions varied in all the studies. More future studies are needed since the reliability in this study was low.

Bakgrund Omvårdnadspersonalen är viktig för fallpreventivt arbete inom särskilt boende för äldre då de arbetar närmast patienterna. Det är viktigt att undersöka omvårdnadspersonalens syn på fallpreventivt arbete för att få ökad förståelse för hur omvårdnadspersonal kan stöttas i det fallpreventiva arbetet. Syfte Att utforska omvårdnadspersonalens upplevelser av fallprevention och samarbete med fysioterapeut i det fallpreventiva arbetet på särskilt boende. Metod En kvalitativ metod med semistrukturerade intervjuer. 11 personer som arbetade på särskilda boenden ingick i studien. Databearbetning genomfördes i form av en kvalitativ innehållsanalys. Resultat Analysen gav fem kategorier och tjugo subkategorier, De fem huvudkategorierna bestod av: Miljöfaktorer påverkar fallrisk, Individfaktorer påverkar fallrisk, Strategier som omvårdnadspersonalen använder vid ökad fallrisk direkt gentemot kunden, Samarbetsstrategier som omvårdnadspersonalen använder vid ökad fallrisk, Samarbete mellan omvårdnadspersonal och fysioterapeut. Konklusion Studien visade att omvårdnadspersonalens upplevelser av det fallpreventiva arbetet innefattade identifiering av riskfaktorer hos individ och miljö. De använde strategier vid ökad fallrisk direkt gentemot kund och ett bra kommunikativt samarbete med fysioterapeut, anhöriga och övrig vårdpersonal var betydelsefullt för det fallpreventiva arbetet på särskilt boende. Omvårdnadspersonal önskade stöd från fysioterapeut i form av praktisk hjälp med fallriskbedömning och information om specifika och generella fallpreventiva åtgärder.

Falling among older adults is a leading cause of concern due to the known impacts including physical injury, loss of independence, increased health care costs, and mortality. In efforts to decrease the numbers of falls experienced by older adults, healthcare providers assess individuals’ fall risks and provide corresponding fall prevention recommendations. The effectiveness however, of these recommendations, is only as strong as the level of adherence to those recommendations; which has proven low in recent research. Using the theoretical foundation of the Health Belief Model, this study quantified adherence to environmental fall prevention recommendations. Twenty-two community-dwelling older adults participated in this randomized control group study that took place across three home visits, scheduled approximately 30 days apart. Participants were interviewed regarding their recent falls and perceived susceptibility to future falls; then a home evaluation was conducted. Treatment group participants were provided personalized education explaining how and why environmental fall prevention recommendations were important to decrease their risk of falls while control group participants were provided general recommendations. A two-sample t-test for independent groups determined a statistically significant relationship: participants who received personalized education intervention were more likely to follow recommendations than those who received general education intervention. Multiple regressions were conducted to review relationships between an individual’s recent falls, and their perceived susceptibility to future falls, with their extent of adherence with fall prevention recommendations. No statistically significant relationship was found. This study suggests that providing personalized education for community-dwelling older adults regarding environmental fall prevention recommendations increases their extent of adherence with such recommendations.

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Thesis (MCur)--University of Stellenbosch, 2011. / ENGLISH ABSTRACT: The Joint Commission International Accreditation (JCIA) has included a patient safety goal as part of the standards for the accreditation of hospitals. Goal number six states the need to “reduce the risk of patient harm resulting from falls”. An acute care hospital setting in Abu Dhabi, United Arab Emirates had implemented a multifaceted, multidisciplinary fall prevention programme (FPP) in preparation for accreditation by the JCIA. The achievement of the above goal is dependent on compliance with JCIA standard requirements and the hospital’s FPP. This study was undertaken to identify the factors preventing the successful implementation of the existing FPP in an acute care setting. The FPP is recognised to be in its development stages and therefore has opportunities for improvement for better patient safety outcomes, more so by reducing the incidence of falls and the severity of injuries from falls. Literature studies by Gowdy and Godfrey (2003:365) and Hathaway, Walsh, Lacey and Saenger (2001:172) suggests that the most successful approach to reducing falls and the severity of injuries from falls among patients in an acute care setting is that of a multifaceted, multidisciplinary approach. The nurses, who were primarily responsible for completing the initial fall risk assessment, expressed feelings of being overwhelmed by more safety standards being required for the JCIA. Patients with a high risk for falls were not referred to the physicians and physical therapists, nor were they referred to the clinical pharmacists for the review of high-risk medications. In addition, fall risk assessments were sometimes not done in the afternoon and during the night shift. The existing programme also did not consider bedbound, long-term patients, who require less frequent assessment. There furthermore was observer evidence to suggest that the existing FPP was not being implemented correctly. The aim of this study was to describe factors preventing the successful implementation of the existing FPP. The objectives were to identify areas being implemented successfully, to identify any barriers to successful implementation and to identify aspects of the existing FPP that may need revision. A quantitative descriptive approach was applied. The population was healthcare providers (HCPs), including both registered and practical nurses, physicians, physical therapists and pharmacists, working in an acute care setting in the United Arab Emirates. The respondents were 118 (86%) from a stratified sample of n = 137 (20%) from 684 HCPs. A specifically developed structured questionnaire was used for data collection. Reliability and validity were assured through the use of experts in questionnaire design and statistical consulting, in addition to pre-testing of the questionnaire. Ethical approval was obtained from the University of Stellenbosch Committee for Human Research and the Ethics Committee of the hospital where the study was undertaken. The respondents’ completion of the questionnaire served as voluntary consent to participate. The data were analysed and are presented in frequency tables. The mean and standard deviation were used for the statistical analysis. Correlational analyses were not done because of the descriptive approach to the study. It was considered most practical to focus on the professional groups and not on the variables, as the initial analysis indicated weak correlations. The results show those aspects of the FPP that were successfully implemented and those areas that need improvement if the JCIA requirements are to be met. Policy revision to include a clearly defined referral process for the high-risk patients, in addition to consistency of the environmental safety rounds and greater involvement and support of the unit managers/supervisors, will contribute to the greater success of the FPP. The hallmark of a successful FPP is staff education, which should be the key step in addressing the identified barriers. The human need for safety and the patient’s right to safe care and a safe environment must be integrated into staff orientation, and education and safety training programmes for all HCPs. Increased compliance may occur when HCPs are more aware of the hospital’s commitment to the patient’s right to safety. Compliance with JCIA standards and the FPP will contribute in the achievement of the accreditation. / AFRIKAANSE OPSOMMING: Die Joint Commission International Accreditation (JCIA) het ’n pasiëntveiligheidsdoelwit as deel van die standaarde vir die akkreditasie van hospitale ingesluit. Doelwit nommer ses lui: “verminder die risiko vir leed aan die pasiënt as gevolg van val”. ’n Akute sorg hospitaal in die Verenigde Arabiese Emirate het ’n veelvuldig gefasetteerde, multidissiplinêre program vir die voorkoming van val (fall prevention programme (FPP)) geïmplementeer ter voorbereiding vir akkreditasie deur die JCIA. Die bereiking van bogenoemde doelwit is afhanklik van nakoming van die standaardvereistes van die JCIA en die hospitaal se FPP. Hierdie studie is onderneem om die faktore wat die suksesvolle implementering van die bestaande FPP in die akute sorg omgewing verhinder, te identifiseer. Daar word erken dat die FPP nog in die ontwikkelingstadium is en dat daar dus geleenthede vir beter pasiëntveiligheidsuitkomstes is, veral deur die aantal valvoorvalle en die erns van beserings as gevolg van val te verminder. Literatuurstudies deur Gowdy en Godfrey (2003:365) en Hathaway, Walsh, Lacey en Saenger (2001:172) stel voor dat die suksesvolste benadering tot die vermindering van val en die erns van die gevolglike beserings onder pasiënte in ’n akute sorg omgewing ’n veelvuldig gefasetteerde, multidissiplinêre benadering behels. Verpleërs, wat die primêre verantwoordelikheid vir die voltooiing van die aanvanklike assessering van die risiko vir val het, het daarop gewys dat hulle oorweldig voel deur bykomende veiligheidstandaarde wat vir die JCIA vereis word. Pasiënte met ’n hoë risiko vir val is nie na die geneeshere en fisiese terapeute verwys nie, en ook nie na die kliniese aptekers vir die beoordeling van hoë-risiko medikasie nie. Assessering van die risiko vir val is soms ook nie in die middag en tydens die nagskof gedoen nie. Die bestaande program het ook nie bedlêende, langtermyn pasiënte wat minder gereelde assessering benodig, oorweeg nie. Daar is verder ook waargeneem dat die bestaande FPP nie korrek geïmplementeer word nie. Die doel van hierdie studie was om die faktore te beskryf wat die suksesvolle implementering van die bestaande FPP verhoed. Die doelwitte was om areas wat suksesvol geïmplementeer word, te identifiseer, sowel as hindernisse tot suksesvolle implementering en aspekte van die bestaande FPP wat hersiening benodig. ’n Kwantitatiewe beskrywende benadering is gebruik. Die populasie was gesondheidsorgverskaffers, insluitend beide geregistreerde en praktiese verpleërs, geneeshere, fisiese terapeute en aptekers wat in ’n akute sorg omgewing in die Verenigde Arabiese Emirate werk. Daar war 118 (86%) respondente uit ’n gestratifiseerde steekproef van n = 137 (20%) uit 684 gesondheidsorgverskaffers. ’n Spesiaal ontwikkelde, gestruktureerde vraelys is vir dataversameling gebruik. Betroubaarheid en geldigheid is verseker deur die gebruik van kundiges in vraelysontwerp en statistiese raadgewing, sowel as die vooraftoetsing van die vraelys. Etiese goedkeuring is van die Universiteit Stellenbosch se Komitee vir Menslike Navorsing, en die Etiekkomitee van die hospitaal waar die studie onderneem is, verkry. Die voltooiing van die vraelys deur die respondente het gedien as vrywillige toestemming om deel te neem. Die data is geanaliseer en in frekwensietabelle voorgesit. Die gemiddelde en standaardafwyking is vir die statistiese analises gebruik. Korrelasie-analises is as gevolg van die beskrywende benadering nie onderneem nie. Daar is besluit dat die mees praktiese benadering sou wees om op die professionele groeperinge te fokus en nie op die veranderlikes nie, aangesien die aanvanklike analise swak korrelasies aangedui het. Die resultate identifiseer daardie aspekte van die FPP wat die suksesvolste geïmplementeer is, sowel as dié gebiede wat verbetering benodig om aan die JCIA-vereistes te voldoen. Faktore wat sal bydra tot die groter sukses van die FPP is beleidshersiening wat ’n duidelik bepaalde verwysingsproses vir hoë-risiko pasiënte insluit, sowel as konsekwentheid in die omgewingsveiligheidsrondtes, en meer betrokkenheid en ondersteuning deur die eenheidsbestuurders/toesighouers Die waarmerk van ’n suksesvolle FPP is personeelopvoeding, wat die belangrikste stap in die aanspreek van die geïdentifiseerde hindernisse moet wees. Die menslike behoefte aan veiligheid en die pasiënt se reg op veilige sorg en ’n veilige omgewing moet in personeeloriëntering, personeelopvoeding- en veiligheidsopleidingsprogramme vir alle gesondheidsorgverskaffers ingesluit word. Verhoogde nakoming sou moontlik plaasvind indien gesondheidsorgverskaffers meer bewus was van die hospitaal se verbintenis tot die pasiënt se reg op veiligheid. Nakoming van JCIA-standaarde en die FPP sal bydra tot die verkryging van die akkreditasie.