Abstract
BackgroundLasting disability and further falls are common and costly problems in older people following fall-related lower limb and pelvic fractures. Exercise interventions can improve mobility after fracture and reduce falls in older people, however the optimal approach to rehabilitation after fall-related lower limb and pelvic fracture is unclear. This randomised controlled trial aims to evaluate the effects of an exercise and fall prevention self-management intervention on mobility-related disability and falls in older people following fall-related lower limb or pelvic fracture. Cost-effectiveness of the intervention will also be investigated.Methods/DesignA randomised controlled trial with concealed allocation, assessor blinding for physical performance tests and intention-to-treat analysis will be conducted. Three hundred and fifty people aged 60 years and over with a fall-related lower limb or pelvic fracture, who are living at home or in a low care residential aged care facility and have completed active rehabilitation, will be recruited. Participants will be randomised to receive a 12-month intervention or usual care. The intervention group will receive ten home visits from a physiotherapist to prescribe an individualised exercise program with motivational interviewing, plus fall prevention education through individualised advice from the physiotherapist or attendance at the group based “Stepping On” program (seven two-hour group sessions). Participants will be followed for a 12-month period. Primary outcome measures will be mobility-related disability and falls. Secondary outcomes will include measures of balance and mobility, falls risk, physical activity, walking aid use, frailty, pain, nutrition, falls efficacy, mood, positive and negative affect, quality of life, assistance required, hospital readmission, and health-system and community-service contact.DiscussionThis study will determine the effect and cost-effectiveness of this exercise self management intervention on mobility-related disability and falls in older people who have recently sustained a fall-related lower limb or pelvic fracture. The results will have implications for the design and implementation of interventions for older people with fall related lower limb fractures. The findings of this study will be disseminated in peer-reviewed journals and through professional and scientific conferences.Trial RegistrationAustralian New Zealand Clinical Trials Registry: ACTRN12610000805077.Electronic supplementary materialThe online version of this article (doi:10.1186/s12877-016-0206-5) contains supplementary material, which is available to authorized users.
Highlights
Lasting disability and further falls are common and costly problems in older people following fallrelated lower limb and pelvic fractures
Current clinical guidelines do not include clear conclusions about the optimal content of rehabilitation programs [9] and systematic reviews provide no consensus on the best type or intensity of exercise after lower limb and pelvic fractures [1, 5, 6]
Many people who have suffered a lower limb fracture are left with long-term disability and increased risk of future falls, there is no clear evidence for a successful and cost-effective program to reduce mobilityrelated disability and falls in fracture survivors. This randomised trial will determine whether a 12-month home exercise and falls prevention self-management program reduces mobility-related disability and falls among older men and women who live in the community following a lower limb or pelvic fracture
Summary
Many people who have suffered a lower limb fracture are left with long-term disability and increased risk of future falls, there is no clear evidence for a successful and cost-effective program to reduce mobilityrelated disability and falls in fracture survivors. Falls and fractures are costly to individuals, their carers, the health system and society Despite this cost, to our knowledge there has been no research to date examining the cost-effectiveness of intervention designed to enhance mobility and reduce falls after lower limb or pelvic fracture. There is no frequencymatched control group intervention, so we will be unable to determine whether social aspects of the program impact upon any difference between groups If this exercise and fall prevention self-management intervention is shown to reduce falls and disability in this high-risk population, there are major potential benefits to older people, their carers and the community.
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