Intervention and Outcome Measures by xyd32971


									EVIDENCE TABLE TOPIC: What is the evidence for the effect of interventions to prevent falls in persons with dementia? Intervention
approaches to consider include adaptation, remediation, prevention, and maintenance. Performance areas to examine include self-care, (work?),
leisure, and social participation. (Client Factors)
    Author/      Study Objectives Level/Design/Subje           Intervention and               Results        Study Limitations      Implications for
      Year                                     cts            Outcome Measures                                                              OT
  Detweiler,    To determine the     Level: III             Intervention: Plan to     There was a           The total baseline    Supervision and
  M. B., Kim, effectiveness of                              have 2 Certified          statistically         and intervention      involvement in
  K. Y., &      having a intense     Design: Non-           Nursing Assistants        significant decrease  period was limited. activity-based
  Taylor, B.    fall-focused         randomized control     (CNAs) provide care       in the number of                            intervention may be
  Y. (2005).    program provided trial, one group,          on the day and evening falls during the         One of the CNAs       effective in reducing
                by regular care      pretest and posttest.  shift to the residents on intervention period.  left after the end of the number of falls
                providers            Eight dementia         consistent basis          The total number of   the study period      by high-risk
                                     patients with the      everyday for intense      falls during baseline The 8 study           dementia patients
                                     highest fall incidence fall-focused              period was 112,       participants lived
                                     were chosen for the    supervision. Included     during intervention   scattered among
                                     study.                 are in-services related   period was 62, and    other residents
                                                            to fall prevention and    the mean reduction    Small sample size
                                                            keeping participants      in fall number was
                                                            occupied during the       6.26. There was not
                                                            shift.                    difference in fall
                                                                                      severity between
                                                            Outcome Measures:         baseline and
                                                            Number of falls           intervention.
  Hauer, K.,    To determine         Level: 1               Intervention:             The results of 11     Dementia diagnosis This area is
  Becker, C., whether older                                 physical training for     RCTs indicate that    was not performed     understudied and
  Lindemann, cognitively             Systematic review      fall prevention for       the evidence for the  Screening tests       further research is
  U., &         impaired people                             older adults with         effectiveness of      didn’t give specific needed. Although
  Beyer, N.     benefit from         Published              cognitive impairments physical training in      diagnoses.            conclusions are
  (2006).       physical training    randomized             living in a variety of    patients with         Review addressed      tentative, physical
                with regard to       controlled             settings.                 cognitive impairment cognitive              interventions such
                motor                intervention trials                              is unclear. Training  impairment not        as gait,
                performance or       (RCTs) from 1966       Outcome Measures:         effects on motor      Alzheimer’s           strengthening,
                fall risk reduction through 2004 that       Outcome measures          performance and       dementia              balance and
                and to critically    focused on persons     included measurements consequently on           specifically.         flexibility training
                evaluate the         with cognitive         of muscle strength,       reduction of falls,   Homogenous study had a positive effect
                methodologic         impairment             flexibility, and specific when reported, were samples.                on gait variables
                approach in                                 functional                most often related to Some articles had     and, therefore,

                                                              American Occupational Therapy Association Evidence-Based Literature Review Project/Evidence Table.5-06
             randomized          Literature search     performances such as           improvements in gait small sample size             indirectly may result
             controlled trials.  using Cochrane        walking, postural              variables.           Meta-analysis could           in reduction of
                                 Central Register of   control, global motor                               not be performed              number of falls. OT
                                 controlled trials,    or functional                                       due to                        practitioners should
                                 MEDLINE,              performance scores                                  heterogeneity of              embed features of
                                 CINAHL, and           (e.g., activities of daily                          studies                       these interventions
                                 GEROLIT published living), physical                                                                     in occupation based
                                 between 1993 and      activity, or falls/fall-                                                          programs.
                                 2004.                 related outcomes.
Mackintosh   To assess the       Level III            Baseline assessments           No significant             High dropout rate        More research needs
&            value and                                included medical               differences in             due a variety of         to be conducted on
Sheppard,    feasibility of a    Pretest-Posttest     history, medications,          outcomes measured          reasons including        this type of
(2005)       falls-prevention    single group design number of falls last 12         between baseline and       transfer to              program, but limited
             program for                              months, falls-risk             6-month follow-up          residential care and     evidence suggests a
             community-         64 community-         assessment.                                               death, resulting in a    falls-prevention
             dwelling older     dwelling participants                                                           small sample size        program embedded
             people with        who were at least 50 Intervention:                                                                       in respite day
             moderate to severe y.o, had a history of  15 month falls-                                          Feasibility of           programs may be a
             levels of dementia dementia and were      prevention program                                       intervention             useful model to
             and prevalent      medically stable. 21 embedded within                                            indicated by             prevent falls and
             Italian background female / 43 male.      healthy lifestyle                                        authors, but how         decrease caregiver
                                                       dementia respite                                         authors came to          burden if
                                                       (HLDR) program.                                          their conclusions        transportation,
                                                       Participants generally                                   unclear                  language assistance,
                                                       attended once per                                                                 small group size,
                                                       week. Although                                           People who               and individual
                                                       occasionally did so                                      examined                 supervision are
                                                       with greater frequency.                                  assessments also         available.
                                                         Outcome Measures:                                      intervention

                                                         Fall status (based on
                                                         number of falls within
                                                         past 12 months at
                                                         baseline and past 6
                                                         months at follow-up);

                                                             American Occupational Therapy Association Evidence-Based Literature Review Project/Evidence Table.5-06
                                                               Berg Balance Scale;
                                                               Aerobic capacity (6
                                                               Min. walk)
Oliver,         To evaluate the       Level I                  Interventions:              Multifaceted              Likely recorder bias     Results of this meta-
Connelly,       evidence for                                                               interventions             for outcomes             analysis suggest that
Victor,         strategies to         Systematic Review,       Studies were single- or     moderately reduce         measures in some         evidence is
Shaw,           prevent falls or      Meta-analysis            multifaceted, and           rate of falls in          studies include din      inconclusive that
Whitehead,      fractures in                                   included hip protector,     hospital settings.        the review;              multifaceted
Genc, et al.,   residents in care     43 randomized            removal of physical                                   Multifaceted             interventions are
(2006).         homes and             control trials (RCTs)    restraint, fall alarm,      Inconclusive              interventions            effective overall in
                hospital inpatients   / case-control studies   exercise, change in         evidence for              undefined;               reducing the rate of
                and to investigate    focused on people        environment,                multifaceted              Authors believe          falls, with exception
                the effect of         with dementia /          calcium/vitamin D,          intervention in care      RCT design               of hospital settings.
                dementia and          cognitive                medication review; in       home setting and for      insufficient within      While the evidence
                cognitive             impairments              care home and/or            single faceted            same setting,            is limited for people
                impairment.           published between        hospital.                   interventions in          leading to               with dementia,
                                      1982 and 2005                                        hospital and care         corruption of            occupational therapy
                                                                                           home settings.            control group            professionals should
                                                                                                                                              participate in
                                                                                           Results of meta-          Only one study           inclusion of such
                                                                                           regressions to assess     focused on persons       strategies in hospital
                                                                                           effect of dementia        with dementia, and       settings where they
                                                                                           insignificant.            authors made             are more likely to be
                                                                                                                     assumption that if       effective.
                                                                                                                     prevalence was not
                                                                                                                     mentioned in
                                                                                                                     article, the
                                                                                                                     prevalence was

                                                                                                                     Dementia and
                                                                                                                     impairment were
Stenval,        This study            Level I                  Intervention:          Intervention group             Fall registration was Although the sample
Olofsson,       evaluates whether                                                     had overall fewer              not blinded           of participants with
Lundstroo       a postoperative       Randomized Control       Intervention group was number of falls                according to group dementia was small,

                                                                  American Occupational Therapy Association Evidence-Based Literature Review Project/Evidence Table.5-06
m,            multidisciplinary,     Trial (RCT)             in a hospital unit          distributed over fewer    allocation      results suggest that
Englund,      intervention                                   specializing in geriatric   fallers. Fewer                            occupational therapy
Borssén,      program,               199 participants ≥70 orthopedic patients. A         number of serious     Small study sample, professionals should
Svensson,     including              years old; 74           multidisciplinary team      injuries and shorter  particularly of     advocate for and be
Nyberg &      systematic             females, 125 males;     [nurses (RN), licensed      overall hospital stay people with         part of
Gustafson .   assessment and         patients with           practical nurses (LPN),     (28.0±17.9 days       dementia.           multidisciplinary,
(2007).       treatment of fall      undisplaced femoral physiotherapists (PT),          intervention                              post-operative
              risk factors, active   neck fracture,          occupational therapists     compared to                               intervention
              prevention,            operated on with        (OT), dietician, and        38.0±40.6 days                            programs during in-
              detection, and         internal fixation (IF); geriatricians] received     control).                                 patient stays to
              treatment of           patients with           a 4 day course in                                                     reduce the number
              postoperative          displaced fracture      caring, rehabilitation,     Fewer number of falls                     of falls and fall-
              complications,         operated on with        teamwork, and               and fallers among                         related injuries
              could reduce           hemiarthroplasty        medical knowledge           people with dementia                      following a femoral
              inpatient falls and    (HAP).                  including sessions                                                    neck fracture.
              fall-related           36/199 patients with about how to prevent,                                                    Occupational
              injuries after a       dementia.               detect, and treat                                                     therapy
              femoral neck                                   various postoperative                                                 professionals can
              fracture.              Exclusion criteria:     complications such as                                                 particularly provide
                                     -Patients with:         postoperative delirium                                                basic ADL routine
                                     rheumatoid arthritis, and falls. All team                                                     training with
                                     severe hip              members assessed                                                      particular attention
                                     osteoarthritis,         patients within 24                                                    to fall risk factors.
                                     pathological fracture, hours of arrival. Team
                                     severe renal failure,   met for goal setting                                                           There appears to be
                                     bedridden before        twice per week and                                                             very little increased
                                     fracture occurred       provided active                                                                costs associated with
                                                             prevention, detection,                                                         this intervention
                                                             treatment of post-                                                             program, with
                                                             operative rehabilitation                                                       exception of
                                                             with a focus on                                                                education hours.
                                                             prevention, daily
                                                             routine, and nutrition.
                                                             Home visit by
                                                             occupational therapist
                                                             and/or physical

                                                                American Occupational Therapy Association Evidence-Based Literature Review Project/Evidence Table.5-06
                                                         Control Group also was
                                                         on a specialist
                                                         orthopedic geriatric
                                                         unit, received usual
                                                         care, team goals and
                                                         assessment once per

                                                         Outcome Measures:

                                                         Abbreviated Injury
                                                         Scale (AIS);
                                                         Maximum injury
                                                         connected with each
                                                         incident recorded
                                                         Mini Mental State
                                                         Examination (MMSE);
                                                         Organic Brain
                                                         Syndrome Scale (OBS
                                                         Geriatric Depression
                                                         Scale (GDS-15); OBS

1. Detweiler, M. B., Kim, K. Y., & Taylor, B. Y. (2005). Focused supervision of high-risk fall dementia patients: a simple method to reduce fall
   incidence and severity. American Journal of Alzheimer’s Disease and Other Dementias, 20, 97-104.
2. Hauer, K., Becker, C., Lindemann, U. & Beyer, N. (2006). Effectiveness of physical training on motor performance and fall prevention in
   cognitively impaired older persons: A systematic review. American Journal of Physical Medicine & Rehabilitation, 85, 847-857.
3. Mackintosh, S.F & Sheppard, L.A. (2005) A pilot falls-prevention programme for older people with dementia from a predominantly Italian
   background. Hong Kong Physiotherapy Journal, 23, 20-26.
4. Oliver D, Connelly JB, Victor CR, Shaw FE, Whitehead A, Genc Y et al. (2007). Strategies to prevent falls and fractures in hospitals and effect of
   cognitive impairment: systematic review and meta-analyses. British Medical Journal, 334(7584): 82
5. Stenval, M., Olofsson, B., Lundstroom, M., Englund, U., Borssén, B., Svensson, O., Nyberg, L., & Gustafson, Y. (2007). A multidisciplinary,
   multifactorial intervention program reduces postoperative falls and injuries after femoral neck fracture. Osteoporos International, 18, 167-175.

                                                            American Occupational Therapy Association Evidence-Based Literature Review Project/Evidence Table.5-06

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