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Open Access Highly Accessed Study protocol

Intervention to prevent further falls in older people who call an ambulance as a result of a fall: a protocol for the iPREFER randomised controlled trial

A Stefanie Mikolaizak1, Paul M Simpson2, Anne Tiedemann3, Stephen R Lord1, Gideon A Caplan4, Jason C Bendall2, Kirsten Howard5 and Jacqueline CT Close14*

Author Affiliations

1 Neuroscience Research Australia, University of New South Wales, Barker Street, Randwick, 2031 Sydney, NSW, Australia

2 Ambulance Service of New South Wales, Sydney, Australia

3 The George Institute for Global Health, The University of Sydney, Sydney, Australia

4 Prince of Wales Clinical School, University of New South Wales, Sydney, Australia

5 School of Public Health, University of Sydney, Sydney, Australia

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BMC Health Services Research 2013, 13:360  doi:10.1186/1472-6963-13-360

Published: 27 September 2013

Abstract

Background

An increasing number of falls result in an emergency call and the subsequent dispatch of paramedics. In the absence of physical injury, abnormal physiological parameters or change in usual functional status, it could be argued that routine conveyance by ambulance to the Emergency Department (ED) is not the most effective or efficient use of resources. Further, it is likely that non-conveyed older fallers have the potential to benefit from timely access to fall risk assessment and intervention. The aim of this randomised controlled trial is to evaluate the effect of a timely and tailored falls assessment and management intervention on the number of subsequent falls and fall-related injuries for non-conveyed older fallers.

Methods

Community dwelling people aged 65 years or older who are not conveyed to the ED following a fall will be eligible to be visited at home by a research physiotherapist. Consenting participants will receive individualised intervention strategies based on risk factors identified at baseline. All pre-test measures will be assessed prior to randomisation. Post-test measures will be undertaken by a researcher blinded to group allocation 6 months post-baseline. Participants in the intervention group will receive individualised pro-active fall prevention strategies from the clinical researcher to ensure that risk factors are addressed adequately and interventions carried out. The primary outcome measure will be the number of falls recorded by a falls diary over a 12 month period. Secondary outcome measures assessed six months after baseline will include the subsequent use of medical and emergency services and uptake of recommendations. Data will be analysed using the intention-to-treat principle.

Discussion

As there is currently little evidence regarding the effectiveness or feasibility of alternate models of care following ambulance non-conveyance of older fallers, there is a need to explore assessment and intervention programs to help reduce subsequent falls, related injuries and subsequent use of health care services. By linking existing services rather than setting up new services, this pragmatic trial aims to utilise the health care system in an efficient and timely manner.

Trial registration

Australian New Zealand Clinical Trials Registry: ACTRN 12611000503921

Keywords:
Ambulance; Accidental falls; Aged; Prevention; Intervention