RESPOND——一项以患者为中心的项目，旨在预防因跌倒前来急诊科就诊的老年人再次跌倒：多中心随机对照试验方案
RESPOND--A patient-centred programme to prevent secondary falls in older people presenting to the emergency department with a fall: protocol for a multicentre randomised controlled trial.
作者信息
Barker A L, Cameron P A, Hill K D, Flicker L, Haines T P, Lowthian J A, Waldron N, Arendts G, Redfern J, Forbes A, Brand C A, Etherton-Beer C D, Hill A M, Hunter P, Nyman S R, Smit D
机构信息
Health Services Research Unit, Centre of Research Excellence in Patient Safety, Division of Health Services and Global Health Research, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
School of Physiotherapy and Exercise Science, Curtin University of Technology, Perth, Western Australia, Australia.
出版信息
Inj Prev. 2015 Feb;21(1):e1. doi: 10.1136/injuryprev-2014-041271. Epub 2014 Jun 23.
INTRODUCTION
Participation in falls prevention activities by older people following presentation to the emergency department (ED) with a fall is suboptimal. This randomised controlled trial (RCT) will test the RESPOND programme, an intervention designed to improve older persons' participation in falls prevention activities through delivery of patient-centred education and behaviour change strategies.
DESIGN AND SETTING
A RCT at two tertiary referral EDs in Melbourne and Perth, Australia.
PARTICIPANTS
528 community-dwelling people aged 60-90 years presenting to the ED with a fall and discharged home will be recruited. People who require an interpreter or hands-on assistance to walk; live in residential aged care or >50 km from the trial hospital; have terminal illness, cognitive impairment, documented aggressive behaviour or a history of psychosis; are receiving palliative care or are unable to use a telephone will be excluded.
METHODS
Participants will be randomly allocated to the RESPOND intervention or standard care control group. RESPOND incorporates (1) a home-based risk factor assessment; (2) education, coaching, goal setting and follow-up telephone support for management of one or more of four risk factors with evidence of effective interventions and (3) healthcare provider communication and community linkage delivered over 6 months. Primary outcomes are falls and fall injuries per person-year.
DISCUSSION
RESPOND builds on prior falls prevention learnings and aims to help individuals make guided decisions about how they will manage their falls risk. Patient-centred models have been successfully trialled in chronic and cardiovascular disease; however, evidence to support this approach in falls prevention is limited.
TRIAL REGISTRATION NUMBER
The protocol for this study is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12614000336684).
介绍
老年人在因跌倒就诊于急诊科（ED）后参与跌倒预防活动的情况并不理想。这项随机对照试验（RCT）将对RESPOND项目进行测试，该干预措施旨在通过提供以患者为中心的教育和行为改变策略，提高老年人参与跌倒预防活动的程度。
设计与地点
在澳大利亚墨尔本和珀斯的两家三级转诊急诊科进行的随机对照试验。
参与者
将招募528名年龄在60 - 90岁之间、因跌倒就诊于急诊科且已出院回家的社区居民。需要口译员或步行时需实际协助的人；居住在老年护理机构或距离试验医院超过50公里的人；患有晚期疾病、认知障碍、有记录的攻击性行为或有精神病病史的人；正在接受姑息治疗或无法使用电话的人将被排除。
方法
参与者将被随机分配到RESPOND干预组或标准护理对照组。RESPOND包括（1）基于家庭的风险因素评估；（2）针对四种有有效干预证据的风险因素中的一种或多种进行管理的教育、指导、目标设定和后续电话支持；（3）在6个月内进行医疗服务提供者沟通和社区联系。主要结局是每人每年的跌倒次数和跌倒受伤情况。
讨论
RESPOND基于先前的跌倒预防经验，旨在帮助个人就如何管理跌倒风险做出有指导的决策。以患者为中心的模式已在慢性疾病和心血管疾病中成功进行了试验；然而，支持这种方法用于跌倒预防的证据有限。
试验注册号
本研究方案已在澳大利亚新西兰临床试验注册中心注册（ACTRN12614000336684）。
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