P4R2W7: Standing up to falls

The final week of the research rotation is over. I'm once again on a one week break. This research rotation has been productive. Our group has completed a full draft copy of our research project, our supervisors are currently giving it a read over and then we will make some final adjustments before we submit the final copy later this year.

Our draft submission was about 38 pages long (not including 20-odd pages for one appendix, and references, cover page, or our research log, etc)... and no, we didn't use double line spacing. So there is much to show for our six weeks of research. But 'what about the content...', you say? '...is it of good quality and useful - did you make any discoveries?' Our research project hasn't yielded any Nobel Prize worthy discoveries, but it is a nice succinct review of the literature (with a number of limitations). Here's a brief overview of our drafted article (expect some level of self-plagiarism):

Falls self-management by people with long-term conditions and their support worker/s: An integrative review.

Research by Awesome research group that Phil's in, et al, 2016. 

(We haven't yet decided on an order for our names to be published, knowing that the first person listed will be the famous one of the group if we ever get published e.g. Butler et al., 2016 if alphabetical order is chosen... and it'll likely be 2017 if it is going to be published). 

Introduction

Currently falls prevention is popularised in community level healthcare for older persons. We problematise the narrow conception of falls, instead suggesting that 'fall prevention' should target a collective population of people that are at risk of falls. Falls affect people of different health statuses (long term illness / disability), as well as across the lifespan. 

We then discuss the global and local burden of falls from an economic perspective - this seems to be the current language that is spoken at a political / policy level, so we have added this because falls prevention is important and we want to see improvements in healthcare. Furthermore, with reflection to the booming population, we foresee an increased burden of falls in NZ. 

• Did you know that a fall that incurs cost (not all falls directly cost our health system, but of the ones that do) on average cost $500 per fall. That cost is doubled when we exclusively look at the average cost of a fall for people older than 85 years of age!!

An argument is made that all healthcare practitioners play a role in falls prevention, and physiotherapists are particularly well placed to bring about meaningful change - to reduce the risk of falls. Two New Zealand interventions (The Otago Exercise Programme, and it's modified 'Steady as you go' programme) are two economically viable means to reduce falls for older people at risk of falls (n.b. the Otago Exercise Programme is no longer funded by the government, instead they fund TaiChi). We know that a large number of people that would benefit from falls prevention information do not receive it - this includes information for informal caregivers. In summary, it is our opinion that falls prevention literacy should be improved in the country.

The purpose of our integrative review was to explore the literature for self-management and confidence strategies used for falls prevention ('common sense' strategies) by community-dwelling people with long term conditions (i.e. with greater falls risks) and the strategies used by the people who support these people (their informal caregivers e.g. family, friends, neighbours).

Methods

We searched for articles that fulfilled our research purpose (using keywords, MESH terms etc) then screened the results using the title / abstracts. Selected articles were then critically appraised (we used JBI, but there are other tools out there CASP, Pedro, QUADAS-2, STARD... depends on the type of study you're critically appraising e.g. qualitative vs quantitative. We pooled information (age, sex, country etc) from all of the studies into a table, then in another table we summarised the aims, results and limitations for each study. We described the process of extracting the data for another table in our results section - this table illustrates quotes and themes from each of these studies.

Results (Spoiler Alert!!!)

We presented self-management strategies used by individuals, and their informal caregivers separately.

We came up with the following categories (then described and illustrated each of these):

Discussion
We discuss the results with respect to our aim. A discussion about the current falls prevention climate (prevention policies and strategies pushed by policy makers around the world; the reach of falls information to people at falls risk; falls literacy and the general population). Etc.

A suggestion for future research, limitations, strengths of our study and implications of our study for rehabilitation were then made.

Conclusion
We conclude, as all good research studies inevitably do, that falls is a problem and we should do something about it. Lets stand up to falls!! p.s. Stand up to falls is a campaign to increase awareness of falls - it's not specifically mentioned in our study.

...And that, my friends, is what research looks like! There is plenty of fall prevention information online - health professionals will find these three links useful...

http://www.health.govt.nz/publication/self-management-support-people-long-term-conditions

http://www.hqsc.govt.nz/our-programmes/reducing-harm-from-falls/
https://www.nice.org.uk/guidance/cg161
http://www.anzfallsprevention.org/tripp/

...whilst the general public will find these links useful:
http://www.healthinfo.org.nz/Falls.htm
http://www.acc.co.nz/preventing-injuries/falls/index.htm
http://physiotherapy.org.nz/your-health/how-physio-can-help/falls-prevention/

As with all of our rotations, we have to write a reflective statement. The reflective statement for the research rotation had to integrate working as a team and the University of Otago graduate attributes. These graduate attributes include: a global perspective, interdisciplinary perspective, lifelong learning, scholarship, communication, critical thinking, cultural understanding, ethics, environmental literacy, information literacy, research, self-motivation and of course teamwork. 

See: http://www.otago.ac.nz/courses/otago078325.html

Our group will continue to work on this research project over the next few rotations.