Neuroscience Research Australia, University of New South Wales, Barker Street, Randwick, 2031 Sydney, NSW, Australia.
BMC Health Serv Res. 2013 Sep 27;13:360. doi: 10.1186/1472-6963-13-360.
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.
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.
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.
Australian New Zealand Clinical Trials Registry: ACTRN 12611000503921.
越来越多的跌倒导致紧急呼叫和随后派遣护理人员。在没有身体损伤、异常生理参数或通常功能状态改变的情况下，可以认为常规通过救护车送往急诊部（ED）不是最有效的或最有效的资源利用方式。此外，未被送往医院的老年跌倒者有可能从及时获得跌倒风险评估和干预中受益。本随机对照试验的目的是评估及时和量身定制的跌倒评估和管理干预对未被送往医院的老年跌倒者随后跌倒和跌倒相关伤害的数量的影响。
符合条件的研究对象是年龄在 65 岁或以上、跌倒后未被送往 ED 的社区居住者，他们将有资格接受研究物理治疗师的家访。同意参与的参与者将根据基线时确定的危险因素接受个体化的干预策略。所有预测试量将在随机分组前进行评估。基线后 6 个月，将由一名对分组分配不知情的研究人员进行随访测试。干预组的参与者将从临床研究人员那里获得个体化的积极预防跌倒策略，以确保充分解决风险因素并实施干预措施。主要结局指标是 12 个月内通过跌倒日记记录的跌倒次数。基线后 6 个月评估的次要结局指标包括随后使用医疗和紧急服务以及接受建议的情况。将使用意向治疗原则分析数据。
由于目前关于救护车不运送老年跌倒者的替代护理模式的有效性或可行性几乎没有证据，因此需要探索评估和干预方案，以帮助减少随后的跌倒、相关伤害和随后使用医疗保健服务。通过链接现有服务而不是建立新服务，这项实用试验旨在以高效和及时的方式利用医疗保健系统。
澳大利亚新西兰临床试验注册中心：ACTRN 12611000503921。
