Translating and Implementing Fall Prevention Research through Clinical Practice

描述(由申请人提供)：跌倒是对老年人生命、健康和独立性的主要威胁。与日益老龄化的人口相对应的降幅预期增加，可能会给本已紧张的医疗体系带来负担。然而，跌倒是可以预防的。越来越多的证据支持以锻炼为基础的预防计划的有效性，如太极，以提高力量、平衡和灵活性，降低跌倒的风险。太极：寻求更好的平衡是一项以证据为基础的预防跌倒计划，目标是有跌倒风险的老年人。该计划还经过了社区评估，具有广泛采用的良好潜力。然而，这种以证据为基础的计划可以在多大程度上通过医疗保健提供者传播尚不清楚。虽然患者经常接受有关降低跌倒风险的措施的咨询，包括体力活动，但医疗专业人员往往缺乏关于被证明有效的干预措施的足够信息；其他人可能有信息，但在与患者的工作中没有使用这些信息。这项拟议的研究解决了医疗保健环境中从研究到临床实践的问题。在我们之前工作的基础上，我们提出了一个传播项目，以评估提供太极对公共健康的潜在影响：通过当地医疗保健提供者：初级保健医生、执业护士和理疗师，推动更好的平衡计划。利用每周两次(每次90分钟)、为期4个月的单组设计，我们将就以下几个方面对我们的计划进行启动、过程和结果评估：REACH(患者的参与率)、有效性(功能能力和生活质量的改善、跌倒发生率的减少)、采纳性(医疗保健提供者的参与率)、实施(干预部分按预期交付的程度)和维护(转诊到该计划的提供者和接受该计划的患者之间该计划的可持续性)。为了更好地了解翻译过程，我们还将讨论计划保真度评估和促进者/障碍等问题。预计这项传播研究的结果将增加对在社区范围内传播基于证据的、社区评估的太极跌倒预防计划对提供者和老年患者的影响的了解，最终目标是实施和维持以社区为基础的锻炼计划，以实现2010年健康人目标，即预防和减少伤害，并增强老年人的生活独立性。 与公共健康相关：在美国，每年有超过三分之一的65岁及以上的成年人跌倒。与跌倒相关的伤害会导致严重的过早死亡、残疾、丧失独立性和过早进入养老院。这项研究将确定是否可以通过医疗保健提供者转介有摔倒风险的老年患者来传播基于证据的太极摔倒预防计划。如果在医疗保健专业人员对该计划的采用程度和该计划对目标人群的影响方面被证明是成功的，拟议的工作将提供一个有效、低成本、易于实施的预防跌倒计划，该计划可以通过简单的提供者推荐程序获得，并在一般社区环境中提供，以解决老年人跌倒的问题。

DESCRIPTION (provided by applicant): Falls are a major threat to the lives, health, and independence of older adults. An expected increase in falls corresponding to a growing aging population threatens to burden an already strained healthcare system. However, falls are preventable. Increasing evidence supports the effectiveness of exercise-based prevention programs such as Tai Chi to improve strength, balance, and mobility, which reduce the risk of falling. Tai Chi: Moving for Better Balance is an evidence-based fall prevention program that targets older adults at risk of falling. The program has also undergone community evaluation with good potential for widespread adoption. However, the extent to which such an evidence-based program can be disseminated via healthcare providers is unknown. While patients are often being counseled on measures to reduce the risk of falling, including physical activity, healthcare professionals often lack adequate information regarding interventions demonstrated to be effective; others might have the information but do not use it in their work with patients. This proposed study addresses this research-to-clinical-practice issue in healthcare settings. On the basis of our prior work, we propose a dissemination project to assess the potential public health impact of delivering the Tai Chi: Moving for Better Balance program through local healthcare providers: primary care physicians, nurse practitioners, and physical therapists. Utilizing a twice weekly (90 minutes per session), 4-month, single-group design, we will conduct an initiation, process, and outcome evaluation of our program with respect to Reach (participation rate of patients), Effectiveness (improvement in functional ability and quality of life, reductions in fall incidence), Adoption (participation rates of healthcare providers), Implementation (degree to which intervention components are delivered as intended), and Maintenance (sustainability of the program among providers who make referrals to the program and among patients who receive the program). To better understand the translational process, we will also address issues such as program fidelity evaluation and facilitators/barriers. It is expected that outcomes from this dissemination study will increase understanding of the impact of community-wide diffusion of an evidence-based, community-evaluated Tai Chi fall prevention program on providers and older adult patients, with the ultimate objective of implementing and sustaining community-based exercise programs to meet Healthy People 2010 goals for preventing and reducing injuries and enhancing life independence among older adults. PUBLIC HEALTH RELEVANCE: In the U.S.A, more than one of every three adults aged 65 and older falls each year. Fall-related injuries cause significant premature mortality, disability, loss of independence, and early admission to nursing homes. This study will determine whether an evidence-based Tai Chi fall prevention program can be disseminated through healthcare provider referrals of older patients who are at risk of falling. If shown to be successful in regard to the degree of adoption of the program by healthcare professionals and the program's reach into the target population, the proposed work will provide an effective, low-cost, easy-to-implement fall prevention program that could be accessed through a simple provider referral process and delivered in a general community setting to address the problem of falls among older adults.