Translating and Implementing Fall Prevention Research through Clinical Practice

描述（由申请人提供）：跌倒是老年人生命、健康和独立的主要威胁。随着人口老龄化的加剧，预计跌倒的人数将会增加，这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运动为基础的预防项目的有效性，比如太极拳，可以提高力量、平衡和机动性，从而降低跌倒的风险。太极拳：为更好的平衡而运动是一个以证据为基础的跌倒预防项目，针对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方案在多大程度上可以通过医疗保健提供者传播是未知的。虽然经常向患者提供关于减少跌倒风险的措施的咨询，包括身体活动，但保健专业人员往往缺乏关于已被证明有效的干预措施的充分信息；其他人可能有这些信息，但不会在与患者的工作中使用它。本研究旨在解决医疗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，以评估通过当地医疗保健提供者：初级保健医生，护士从业人员和物理治疗师提供太极拳：更好的平衡计划的潜在公共卫生影响。采用每周两次（每次90分钟）、为期4个月的单组设计，我们将对我们的项目进行启动、过程和结果评估，包括Reach（患者参与率）、有效性（功能能力和生活质量的改善、跌倒发生率的减少）、采用（医疗保健提供者的参与率）、实施（干预成分按预期交付的程度）、和维护（项目在转诊到项目的提供者和接受项目的患者之间的可持续性）。为了更好地理解翻译过程，我们还将讨论诸如程序保真度评估和促进因素/障碍等问题。预期这项传播研究的结果将增加对以证据为基础的、社区评估的太极拳跌倒预防项目在社区范围内对提供者和老年患者的影响的理解，其最终目标是实施和维持社区运动项目，以实现健康人2010的目标，即预防和减少伤害，增强老年人的生活独立性。

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.