Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle-Upon-Tyne, UK.
Department of Mathematics, Physics and Electrical Engineering, Northumbria University, Newcastle-Upon-Tyne, UK.
BMC Public Health. 2022 Aug 1;22(1):1457. doi: 10.1186/s12889-022-13832-3.
Falls prevention exercise programmes are evidence-based and recommended for improving physical function in older adults. However, few service evaluations exist to assess the effectiveness of community-delivered interventions in practice.
We conducted a six-year, retrospective evaluation of the community-delivered Staying Steady programme (Healthworks, United Kingdom). Staying Steady is a 27-week, tailored strength and balance programme delivered in a group setting (1-h, once/week) and at home (30-40 min, 2-3 times/week). Participants were referred by healthcare professionals, or self-referred, due to a history or risk of falling. Routinely collected outcome measures (30-s chair stand, Timed Up and Go, four-stage balance test, and patient reported outcomes; including 'fear of falling' and 'ability to manage health') were analysed. Factors associated with programme completion were reported. The intervention effect on physical function was analysed in subgroups: participants used arms to chair-stand or a walking-aid at both ('aided'), neither ('unaided'), or one assessment timepoint ('aided at baseline only' or 'aided at follow-up only').
There were 1,426 referrals; 835 (67.3%) participants enrolled on to the Staying Steady programme, 406 (32.7%) declined, 185 (13.0%) were inappropriately referred and excluded from analysis. After enrolling, 451 (54.0%) participants completed, and 384 (46.0%) dropped out. Chair stand performance improved in participants who were unaided (n = 264; median 2.0 [1.0, 4.0] repetitions; P < 0.001), or aided at baseline, follow-up or both (n = 170, P < 0.05). Timed Up and Go performance improved in the unaided (n = 387; median -3.1 [-5.4, -1.4] s, P < 0.001), and aided at baseline only (n = 32; median -4.9 [-10.8, -3.4] s, P < 0.001) groups. Four-stage balance performance improved (n = 295; median 1.0 [0.0, 1.0] points, P < 0.001). After programme completion, participants self-reported an improved ability to manage their health and daily activities, improved confidence, and a reduced fear of falling. Presence of chronic obstructive pulmonary disease, fear of falling, prescribed nutritional support, disability and social deprivation influenced non-completion of Staying Steady.
Completing Staying Steady improved physical function in older adults. Methods to encourage retention of participants from groups associated with low uptake and adherence should be investigated.
预防跌倒的运动方案是基于证据的，并被推荐用于改善老年人的身体功能。然而，很少有服务评估来评估在实践中实施的社区提供的干预措施的有效性。
我们对社区提供的 Staying Steady 方案（Healthworks，英国）进行了六年的回顾性评估。Staying Steady 是一项为期 27 周的个性化力量和平衡方案，在小组环境中进行（1 小时，每周一次）和在家中进行（30-40 分钟，每周 2-3 次）。参与者是由医疗保健专业人员推荐，或因跌倒史或跌倒风险而自行推荐。定期收集的结果测量指标（30 秒椅子站立、计时起立行走、四步平衡测试和患者报告的结果；包括“害怕跌倒”和“管理健康的能力”）进行了分析。报告了与方案完成相关的因素。在亚组中分析了身体功能的干预效果：参与者在椅子站立时使用手臂或助行器（“辅助”），或者两者都不使用（“非辅助”），或者仅在一个评估时间点使用（“仅在基线时辅助”或“仅在随访时辅助”）。
有 1426 次转介；835 名（67.3%）参与者注册参加了 Staying Steady 方案，406 名（32.7%）拒绝，185 名（13.0%）被不恰当地转介并排除在分析之外。注册后，451 名（54.0%）参与者完成，384 名（46.0%）退出。在非辅助（n=264）或在基线、随访或两者均辅助（n=170）的参与者中，椅子站立表现得到改善（中位数 2.0 [1.0，4.0] 次；P<0.001）。在非辅助（n=387）和仅在基线辅助（n=32）的参与者中，计时起立行走表现得到改善（中位数-3.1 [-5.4，-1.4] s，P<0.001）。四步平衡表现得到改善（n=295）（中位数 1.0 [0.0，1.0] 分；P<0.001）。方案完成后，参与者自我报告称他们管理健康和日常活动的能力得到提高，信心增强，对跌倒的恐惧减少。慢性阻塞性肺疾病、害怕跌倒、规定的营养支持、残疾和社会贫困等因素会影响对 Staying Steady 方案的完成。
完成 Staying Steady 可改善老年人的身体功能。应研究鼓励从低参与度和依从性群体中保留参与者的方法。
