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PT combined with patient education reduces falls in older hospitalized patients

Clinical Question:
Does the use of a multimedia patient education program reinforced by a physical therapy consultation reduce the rate of falls in older hospitalized patients?

Bottom Line:
Personalized sessions with a physical therapist combined with a multimedia patient education program reduced the rate of falls in older hospitalized patients with intact cognitive function. These results did not apply to cognitively impaired patients. (LOE = 1b)

Reference:
Haines TP, Hill A, Hill KD, et al. Patient education to prevent falls among older hospital inpatients. Arch Intern Med 2010 Nov 22 [Epub ahead of print].  [PMID:21098343]

Study Design:
Randomized controlled trial (single-blinded)

Funding:
Government

Allocation:
Concealed

Setting:
Inpatient (ward only)

Synopsis:
Using concealed allocation, investigators randomized patients older than 60 years who were admitted to subacute rehabilitation wards and acute orthopedic or medicine inpatient wards into 1 of 3 groups: complete patient education program combined with physical therapist reinforcement (n = 401), patient education program with written and video-based materials only (n = 424), and usual care (n = 381). The complete program consisted of written and video-based presentations on falls frequency and outcome data, fall risks and causes, fall prevention strategies, and goal setting. This was followed by individual sessions with a trained physical therapist who provided further reinforcement of the program. Median time spent by the therapist with each patient was 25 minutes. Usual care varied between centers but consisted primarily of falls risk screening; risk alert items, such as arm bands; and generic nursing interventions. Patients in each study group had an average age of 75 years and more than 90% were community dwellers prior to hospitalization. Although there was a disproportionate number of subacute ward patients in each group, this factor was adjusted for in the final analysis. No difference was detected in the rate of falls or the number of fallers when comparing any of the 3 groups with one another. However, when only including patients with intact cognitive function (approximately 75% of each group), those who received the complete program had a decreased rate of falls compared with the materials-only group (odds ratio [OR] = 0.51; 95% CI, 0.28-0.93; P = .03) or the control group (OR = 0.43; 0.24-0.78; P = .006). Although overall falls were decreased, there was no difference in the rate of injurious falls between the different groups of cognitively intact patients. When the analysis was limited to cognitively impaired patients, the rate of injurious falls was actually higher in the complete program group than in the control group (OR = 2.63; 1.19-5.84; P = .02). Ideally, a fourth arm of physical therapy consultation alone would have been included in this study as it is unclear whether the multimedia portion contributed at all to the benefits seen.

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