2/10/2013

1

Falls prevention exercise in

Glasgow

Lesley Goldie and Margaret

Anderson

Community Falls Prevention

ProgrammeIn association with Fiona Neil and Dr Dawn Skelton,

HealthQWest, GCU

CFPP

• Specialist falls service which aims to prevent further

falls by providing a comprehensive falls screening,

health education, exercise, rehabilitation and onward

referral

• The service is available to individuals who are over 65,

live at home and have had a fall in the last year

• 221 referrals a month in 2008

• Telephone triage completed within 24 hours of

receiving referral

• Home screening completed within 5 working days of

triage

2/10/2013

2

Onward referral

Fall in past year.

Community dweller.

Aged 65+

FallsAdmin centre-triage (within 24

hours)

Open Referral

Multi-factorial Falls Risk ScreeningHome visit

within 5

working

days.

HFPP Physio assessment and falls exercise classesPharmacy review

1to1 Physio at community site for musculoskeletal

problem

Community older peoples team (COPT)

Dietician

Podiatry

OT

Optician

Sensory Impairment

Dexa Scan

GP/Audiology

Community Alarms

Handy Persons

Benefits Advisor

Social Work/Home Care

Falls Clinic/ Medical review and gateway to

day hospital

Multifactoral interventions

COPT/IRIS/DART

Pathway

Home Falls Prevention Programme

Deliver

Physiotherapy Intervention

• 12 Strength & Balance Classes

• Classes locally delivered

• Free transport service (70% utilise)

• 12-18 week attendance

• Home Exercises

• Partnership working with Day hospital and

Leisure services (Glasgow Culture & Sport)

2/10/2013

3

Hospital Falls

Clinics

COPT/IRIS/DART

(ref made by

physiotherapist)

CFPP

Physiotherapy

assessment

Level 1 Day Hospital class Tinetti 15-18 Physio led

VITALITY community classes levels 1-4 Instructor led

Level 2 CFPP community class Tinetti 19-28 Physio led.

Osteoporosis and Ozone classes for low risk fallers

Referral Pathways for Exercise Classes– exit and entry routes

Strength & Balance

Programmes

• Evidence based exercises– (Skelton 2005; Robertson 2001; Campbell 1999)

• Evidence based “deliverers”

– Physiotherapists and trained Postural Stability

Instructors (Skelton 2004)

• Evidence based duration

– Dose of 50 hours of balance challenging

exercise (Sherrington 2008)

2/10/2013

4

Attendance at classes

277

17 15

245

0

50

100

150

200

250

300

Number of

people

Tota

l att

endee

s/m

onth

New P

atients

Ass

esse

d at C

FPP

New P

atie

nts S

tart

ing C

lass

Regula

r att

endees

CFPP Exercise Class Attendance- average

per month citywide 2007

2/10/2013

5

Evaluation of effect

• N= 274 clients considered over a time period in 2007.

• Attended on average 11.9 (sd 3.8) weeks

• Outcome measures:

– Duration of attendance

– Functional tests

• Tinetti Mobility and Balance Score

• Timed Up and Go

• 180 degree turn

• Functional Reach

• Confidence in Maintaining Balance

• Tinetti’s Falls Efficacy Scale (FES)

– Patient Satisfaction Questionnaires (N=91)

• Same assessor throughout - not all tests completed on

all clients

Outcome measures

Test

Mean (sd)

Number

of clients

Before

exercise

sessions

After

exercise

sessions

P-value

Tinetti Balance

Score

274 23.1 (3.3) 24.8 (3.1) 0.000

180 deg turn (deg) 253 5.5 (1.9) 5.0 (1.6) 0.000

Functional Reach

(cm)

112 19.2 (5.9) 20.9 (6.9) 0.000

TUAG (sec) 137 18.6 (6.7) 16.3 (5.9) 0.000

ConFBal 162 19.4 (3.9) 16.9 (3.4) 0.000

Tinetti FES 43 29.3 (16.5) 21.5 (11.6) 0.0002

2/10/2013

6

Balance improvements are

duration dependent• The Tinetti Mobility and Balance

Score showed considerable

improvement, but the change was

dependent on duration of exercise

attendance.

• Those attendees that drop out of

sessions before 12 weeks are

unlikely to see clinically significant

changes in their balance.

• This is in line with the recent

systematic review of exercise

(Sherrington et al. 2008) where a

dose of at less than 50 hours confers

little benefit to fall risk reduction.

Client Satisfaction

• Satisfaction forms at week 10 of their exercise programme (n=117

issued).

• 91 patients returned the forms (response rate 78%).

• 85% had received information about the class before the sessions

started and most (83%) found the pre-class information useful.

• Only 1% thought the class was not in a suitable location; the staffs

were not helpful; the exercises were rushed, too short or not well

explained (showing a high degree of satisfaction with facilities and

delivery).

• 98% felt the exercise classes were beneficial and 94% thought the

sessions were good or very good.

• Open response questions showed good improvements to wellbeing

(see next slide) however, many people just wrote “enjoyed” in this

section!

2/10/2013

7

Open responses to feedback

Open responses to any improvements felt as

a result of exercise sessions (n=91)

0

5

10

15

20

25

30

35

Improvement/Benefit

Number of patients

Confidence /

wellbeing / mood

Balance

Walking / stamina /

fitness / mobility

Strength / muscle

tone

Social benefits

Flexibility

Summary

• The CFPP exercise service to prevent falls in Glasgow

does improve many of the known risk factors for falls

• The benefits are duration dependent

– clients should be encouraged to adhere for at least 12 weeks,

ideally to the maximum 18 weeks and then to move into normal

community exercise sessions for older people to maintain the

improvements

• High degree of client satisfaction (though questionnaire

could have been designed better)