Can occupational therapist-led home environmental assessment prevent falls in older people? A modified cohort randomised controlled trial protocol

Cockayne, Sarah, Pighills, Alison, Adamson, Joy, Fairhurst, Caroline, Drummond, Avril, Hewitt, Catherine, Rodgers, Sara, Ronaldson, Sarah J., Lamb, Sarah E., Crossland, Shelley, Boyes, Sophie, Gilbody, Simon, Relton, Clare, and Torgerson, David J. (2018) Can occupational therapist-led home environmental assessment prevent falls in older people? A modified cohort randomised controlled trial protocol. BMJ Open, 8 (9). e022488. pp. 1-11.

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Abstract

Introduction Falls and fall-related injuries are a serious cause of morbidity and cost to society. Environmental hazards are implicated as a major contributor to falls among older people. A recent Cochrane review found an environmental assessment, undertaken by an occupational therapist, to be an effective approach to reducing falls. However, none of the trials included a cost-effectiveness evaluation in the UK setting. This protocol describes a large multicentre trial investigating the clinical and cost-effectiveness of environmental assessment and modification within the home with the aim of preventing falls in older people.

Methods and analysis A two-arm, modified cohort randomised controlled trial, conducted within England, with 1299 community-dwelling participants aged 65 years and above, who are at an increased risk of falls. Participants will be randomised 2:1 to receive either usual care or home assessment and modification. The primary outcome is rate of falls (falls/person/time) over 12 months assessed by monthly patient self-report falls calendars. Secondary self-reported outcome measures include: the proportion of single and multiple fallers, time to first fall over a 12-month period, quality of life (EuroQoL EQ-5D-5L) and health service utilisation at 4, 8 and 12 months. A nested qualitative study will examine the feasibility of providing the intervention and explore barriers, facilitators, workload implications and readiness to employ these interventions into routine practice. An economic evaluation will assess value for money in terms of cost per fall averted.

Ethics and dissemination This study protocol (including the original application and subsequent amendments) received a favourable ethical opinion from National Health Service West of Scotland REC 3. The trial results will be published in peer-reviewed journals and at conference presentations. A summary of the findings will be sent to participants.

Trial registration number ISRCTN22202133; Pre-results.

Item ID: 56585
Item Type: Article (Research - C1)
ISSN: 2044-6055
Keywords: falls prevention, home environmental assessment and modification, modified cohort randomised controlled trial, occupational therapist
Copyright Information: This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
Funders: National Institute for Health Research (NIHR)
Projects and Grants: NIHR Health Technology Assessment Programme 14/49/149
Date Deposited: 12 Dec 2018 07:38
FoR Codes: 11 MEDICAL AND HEALTH SCIENCES > 1199 Other Medical and Health Sciences > 119999 Medical and Health Sciences not elsewhere classified @ 100%
SEO Codes: 92 HEALTH > 9202 Health and Support Services > 920201 Allied Health Therapies (excl. Mental Health Services) @ 100%
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