Dale Avers, PT, DPT, PhD, FAPTA
RESEARCH PROGRAMS AND AFFILIATIONS
Qualitative: Exploring elements of PT practice and critical thinking. Quantitative: Exploring the effectiveness of exercise interventions for mobility disability in aging adults, especially in frail individuals. Specifically exploring the best time to intervene to prevent and remediate frailty.
ASSOCIATIONS / MEMBERSHIPS
Impact of a circuit-style task specific activity program on falls and injurious falls in a PACE program.
Background: A major concern of the Program of All Inclusive Care (PACE) program is falls and injuries from falls. Thirty-five percent of participants fall within one month of admission. The purpose of this study was to investigate the effects of a circuit-style, task-specific activity program on frequency of falls and injurious falls.
Methods: Subjects were newly admitted participants of the PACE program. Forty one individuals participated in the 6-month program, 38 completed the intervention. Two participants died and one participant was excluded due to marked clinical deterioration during the program period. The control group consisted of all of the consecutive admissions from another local, PACE site during the same time period as well as the participants from the intervention site who chose not to participate in the group.
Data analysis: Administrative data from the 38 program participants and 36 comparison observations were analyzed. Demographic characteristics were compared using independent t-test (age) or chi-square test (sex). Incident falls and falls resulting in injury occurring over a 180 day period following the start of the program, or following admission to the PACE program were enumerated. The mean number of any falls and of injurious falls in the program and comparison groups were compared using the Wilcoxon rank sum test. Associations between participation in the training program and incident falls were adjusted for age and sex using multivariate analysis.
Results: Over 80% of subjects in both groups were female. Mean age was slightly higher in the training group than in the comparison group, (84.1 ± 7.4 and 81.0 ± 8.9, respectively, p=.104). Mean number of any falls did not differ in treatment and comparison groups, however, among those who fell, the mean number in the comparison group was 3.06 ± 1.73 vs 2.17 ± 1.59 in the treatment group (p=.104). Significantly fewer injurious falls occurred in the treatment group (sp=.002). Relative risk of having an injurious fall in the comparison group was 1.69 (95% CI = 1.10-2.60). The association among fallers, between participation in the treatment group and number of falls, persisted after multivariate adjustment for age and sex.
Discussion: These findings suggest a novel task-specific program can reduce injurious falls and may reduce frequency of falls in a group of PACE participants.
Authors: Dale Avers, PT, DPT, PhD & Gary Brooks, PT, Dr.PH, CCS