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Geriatric medicine
Protocol
A stepped-wedge cluster randomised controlled trial for evaluating rates of falls among inpatients in aged care rehabilitation units receiving tailored multimedia education in addition to usual care: a trial protocol
  1. Anne-Marie Hill1,
  2. Nicholas Waldron2,3,
  3. Christopher Etherton-Beer4,5,
  4. Steven M McPhail6,7,
  5. Katharine Ingram8,
  6. Leon Flicker4,5,
  7. Terry P Haines9,10
  1. 1School of Physiotherapy, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
  2. 2Department of Rehabilitation and Aged Care, Armadale Kelmscott Memorial Hospital, Perth, Western Australia, Australia
  3. 3Health Strategy and Networks, Strategic System, Policy and Planning, Department of Health, Government of Western Australia, Perth, Western Australia, Australia
  4. 4School of Medicine and Pharmacology, WA Centre for Health & Ageing CMR, University of Western Australia, Perth, Western Australia, Australia
  5. 5Royal Perth Hospital, Perth, Western Australia, Australia
  6. 6Institute of Health and Biomedical Innovation and School of Public Health & Social Work, Queensland University of Technology, Kelvin Grove, Queensland, Australia
  7. 7Centre for Functioning and Health Research, Metro South Health, Brisbane, Australia
  8. 8Department of Rehabilitation and Aged Care, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
  9. 9Physiotherapy Department, Monash University, Frankston, Victoria, Australia
  10. 10Allied Health Research Unit, Monash Health, Cheltenham, Victoria, Australia
  1. Correspondence to Dr Anne-Marie Hill; anne-marie.hill{at}nd.edu.au

Abstract

Introduction Falls are the most frequent adverse event reported in hospitals. Approximately 30% of in-hospital falls lead to an injury and up to 2% result in a fracture. A large randomised trial found that a trained health professional providing individualised falls prevention education to older inpatients reduced falls in a cognitively intact subgroup. This study aims to investigate whether this efficacious intervention can reduce falls and be clinically useful and cost-effective when delivered in the real-life clinical environment.

Methods A stepped-wedge cluster randomised trial will be used across eight subacute units (clusters) which will be randomised to one of four dates to start the intervention. Usual care on these units includes patient's screening, assessment and implementation of individualised falls prevention strategies, ongoing staff training and environmental strategies. Patients with better levels of cognition (Mini-Mental State Examination >23/30) will receive the individualised education from a trained health professional in addition to usual care while patient's feedback received during education sessions will be provided to unit staff. Unit staff will receive training to assist in intervention delivery and to enhance uptake of strategies by patients. Falls data will be collected by two methods: case note audit by research assistants and the hospital falls reporting system. Cluster-level data including patient's admissions, length of stay and diagnosis will be collected from hospital systems. Data will be analysed allowing for correlation of outcomes (clustering) within units. An economic analysis will be undertaken which includes an incremental cost-effectiveness analysis.

Ethics and dissemination The study was approved by The University of Notre Dame Australia Human Research Ethics Committee and local hospital ethics committees.

Results The results will be disseminated through local site networks, and future funding and delivery of falls prevention programmes within WA Health will be informed. Results will also be disseminated through peer-reviewed publications and medical conferences.

Trial registration The study is registered with the Australian New Zealand Clinical Trials registry (ACTRN12612000877886).

  • Geriatric Medicine
  • Health Economics

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/3.0/

https://doi.org/10.1136/bmjopen-2013-004195

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