Shier Victoria, Trieu Eric, Ganz David A
Pardee RAND Graduate School, RAND Corporation, 1776 Main St, Santa Monica, CA, 90407, USA.
Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA.
Inj Epidemiol. 2016 Dec;3(1):16. doi: 10.1186/s40621-016-0081-8. Epub 2016 Jul 4.
The United States Preventive Services Task Force recommends exercise to prevent falls in community-dwelling adults aged ≥ 65 years at increased fall risk. However, little is known about how best to implement exercise programs in routine care when a patient's need for exercise is identified within the healthcare system.
Using a qualitative approach, we reviewed the literature to determine how exercise programs to prevent falls are implemented from the vantage point of a health care setting. We synthesized descriptive information about each program with data on program features and implementation difficulties and facilitators.
We found that programs sponsored by primary care providers (PCPs) or specialists may help with recruitment into exercise programs. PCPs have the opportunity to identify people at risk and promote participation since most older adults regularly visit, and inquire about exercise from, their physicians. In terms of referral options, both home-based and group-based exercise programs have been shown effective in preventing falls; however, each approach carries strengths and limitations. Home-based programs can include participants who are reluctant or unable to attend group classes and can be individually tailored, but provide less opportunity for supervision and socialization than classes. Adherence to programs can be encouraged, and attrition minimized, through positive reinforcement. Successful programs ranged in expense for exercise sessions: a weekly class combined with exercises at home cost < $2 per participant per week, while frequent individual sessions cost > $100 per participant per week.
With increasing attention to population-based health management in the United States, clinicians and health system leaders need a deeper understanding of how to link patients in their healthcare systems with appropriate community programs. This review identifies key characteristics of successful fall prevention exercise programs that can be used to determine which local options conform to clinical evidence. In addition, we highlight tradeoffs between program options, such as home versus group exercise programs, to allow referrals to be tailored to local conditions and patient preferences. Finally, our work highlights the key role of the PCP in recruiting patients to participate in exercise programs, and identifies options, such as registries, to support referrals to the community.
美国预防服务工作组建议，对于社区居住的、年龄≥65岁且跌倒风险增加的成年人，进行锻炼以预防跌倒。然而，当在医疗系统中确定患者的锻炼需求时，对于如何在常规护理中最佳地实施锻炼计划，人们知之甚少。
我们采用定性方法，回顾文献以确定从医疗保健机构的角度如何实施预防跌倒的锻炼计划。我们将每个计划的描述性信息与有关计划特征、实施困难和促进因素的数据进行了综合。
我们发现，由初级保健提供者（PCP）或专科医生发起的计划可能有助于招募人员参加锻炼计划。初级保健提供者有机会识别有风险的人群并促进参与，因为大多数老年人会定期就诊并向医生咨询锻炼情况。在转诊选择方面，家庭锻炼计划和团体锻炼计划在预防跌倒方面均已显示出有效性；然而，每种方法都有优点和局限性。家庭锻炼计划可以包括那些不愿意或无法参加团体课程的参与者，并且可以进行个性化定制，但与团体课程相比，监督和社交机会较少。通过积极强化可以鼓励对计划的依从性，并将损耗降至最低。成功的计划每次锻炼的费用各不相同：每周一次的团体课程加上在家锻炼，每位参与者每周花费不到2美元，而频繁的个人课程每位参与者每周花费超过100美元。
随着美国对基于人群的健康管理的关注度不断提高，临床医生和卫生系统领导者需要更深入地了解如何将其医疗系统中的患者与适当的社区计划联系起来。本综述确定了成功的预防跌倒锻炼计划的关键特征，可用于确定哪些当地选项符合临床证据。此外，我们强调了不同计划选项之间的权衡，例如家庭锻炼计划与团体锻炼计划，以便根据当地情况和患者偏好进行转诊。最后，我们的工作突出了初级保健提供者在招募患者参加锻炼计划方面的关键作用，并确定了诸如登记册等选项，以支持向社区的转诊。
