社区居住老年人跌倒的管理：美国物理治疗协会老年物理治疗学会的临床指导声明
Management of falls in community-dwelling older adults: clinical guidance statement from the Academy of Geriatric Physical Therapy of the American Physical Therapy Association.
作者信息
Avin Keith G, Hanke Timothy A, Kirk-Sanchez Neva, McDonough Christine M, Shubert Tiffany E, Hardage Jason, Hartley Greg
机构信息
K.G. Avin, PT, PhD, Department of Physical Therapy, Indiana University School of Health and Rehabilitation Sciences, Indianapolis, Indiana.
T.A. Hanke, PT, PhD, Physical Therapy Program, College of Health Sciences, Midwestern University, Downers Grove, Illinois.
出版信息
Phys Ther. 2015 Jun;95(6):815-34. doi: 10.2522/ptj.20140415. Epub 2015 Jan 8.
BACKGROUND
Falls in older adults are a major public health concern due to high prevalence, impact on health outcomes and quality of life, and treatment costs. Physical therapists can play a major role in reducing fall risk for older adults; however, existing clinical practice guidelines (CPGs) related to fall prevention and management are not targeted to physical therapists.
OBJECTIVE
The purpose of this clinical guidance statement (CGS) is to provide recommendations to physical therapists to help improve outcomes in the identification and management of fall risk in community-dwelling older adults.
DESIGN AND METHODS
The Subcommittee on Evidence-Based Documents of the Practice Committee of the Academy of Geriatric Physical Therapy developed this CGS. Existing CPGs were identified by systematic search and critically appraised using the Appraisal of Guidelines, Research, and Evaluation in Europe II (AGREE II) tool. Through this process, 3 CPGs were recommended for inclusion in the CGS and were synthesized and summarized.
RESULTS
Screening recommendations include asking all older adults in contact with a health care provider whether they have fallen in the previous year or have concerns about balance or walking. Follow-up should include screening for balance and mobility impairments. Older adults who screen positive should have a targeted multifactorial assessment and targeted intervention. The components of this assessment and intervention are reviewed in this CGS, and barriers and issues related to implementation are discussed.
LIMITATIONS
A gap analysis supports the need for the development of a physical therapy-specific CPG to provide more precise recommendations for screening and assessment measures, exercise parameters, and delivery models.
CONCLUSION
This CGS provides recommendations to assist physical therapists in the identification and management of fall risk in older community-dwelling adults.
背景
老年人跌倒因其高发生率、对健康结果和生活质量的影响以及治疗成本，成为主要的公共卫生问题。物理治疗师在降低老年人跌倒风险方面可发挥重要作用；然而，现有的与跌倒预防和管理相关的临床实践指南（CPG）并非针对物理治疗师。
目的
本临床指导声明（CGS）的目的是为物理治疗师提供建议，以帮助改善社区居住老年人跌倒风险识别和管理的结果。
设计与方法
老年物理治疗学会实践委员会循证文献小组委员会制定了本CGS。通过系统检索确定现有的CPG，并使用欧洲指南、研究与评价评估工具II（AGREE II）进行严格评估。通过这一过程，推荐了3份CPG纳入CGS，并进行了综合和总结。
结果
筛查建议包括询问所有与医疗服务提供者接触的老年人，他们在上一年是否跌倒，或者是否对平衡或行走有担忧。随访应包括筛查平衡和活动能力障碍。筛查呈阳性的老年人应进行有针对性的多因素评估和有针对性的干预。本CGS对该评估和干预的组成部分进行了综述，并讨论了与实施相关的障碍和问题。
局限性
差距分析支持需要制定一份针对物理治疗的CPG，以提供关于筛查和评估措施、运动参数和提供模式的更精确建议。
结论
本CGS提供了建议，以协助物理治疗师识别和管理社区居住老年人的跌倒风险。
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