Community Physiotherapists Research Articles

Contracture prevention: knowledge, understanding, and skills of community occupational therapists and physiotherapists: a survey

Contracture prevention: knowledge, understanding, and skills of community occupational therapists and physiotherapists: a survey

2191 Physiotherapists’ perspectives of barriers and facilitators to effective community provision after hip fracture

Abstract Introduction to investigate physiotherapists’ perspectives of effective community provision following hip fracture. Methods qualitative semi-structured interviews were conducted with 17 community physiotherapists across England. Thematic analysis drawing on the Theoretical Domains Framework identified barriers and facilitators to implementation of effective provision. Interviews were complemented by process mapping community provision in one London borough, to identify points of care where suggested interventions are in place and/or could be implemented. Results four themes were identified: ineffective coordination of care systems, ineffective patient stratification, insufficient staff recruitment and retention approaches and inhibitory fear avoidance behaviours. To enhance care coordination, participants suggested improving access to social services and occupational therapists, maximising multidisciplinary communication through online notation, extended physiotherapy roles, orthopaedic-specific roles and seven-day working. Participants advised the importance of stratifying patients on receipt of referrals, at assessment and into appropriately matched interventions. To mitigate insufficient staff recruitment and retention, participants proposed return-to-practice streams, apprenticeship schemes, university engagement, combined acute-community rotations and improving job description advertisements. To reduce effects of fear avoidance behaviour on rehabilitation, participants proposed the use of patient-specific goals, patient and carer education, staff education in psychological strategies or community psychologist access. Process mapping of one London borough identified points of care where suggested interventions to overcome barriers were in place and/or could be implemented. Conclusion physiotherapists propose that effective provision of community physiotherapy following hip fracture could be improved by refining care coordination, utilising stratification techniques, employing enhanced recruitment and retainment strategies and addressing fear avoidance behaviours.

Implementation of community physiotherapy in primary care: one-year results of an on-call physiotherapy service

BackgroundPrimary health care systems have a key role in meeting health needs of community, including function. The aim of this paper is to describe the population involved in the Community Physiotherapist project and their health outcomes over a one-year period.MethodsThe Community Physiotherapist is an on-call service which requires a request by general practitioners or medical specialists. Reason for prescription, waiting time for service delivery, diagnostic categories, provided intervention, number of interventions and outcomes were recorded for everyone included in the project. Possible differences in characteristics between individuals referred by medical specialists and general practitioners were also investigated.ResultsFrom January to December 2022, 409 individuals were referred to the Community Physiotherapist pathway. Functional goals were achieved in 79.5% of interventions, without reported adverse events. In most cases physiotherapists provided counselling or caregiver training and 3.3% of individuals needed a full rehabilitation program. The groups of individuals referred by the two types of prescribers showed no significant differences, apart, as expected, from their median age.ConclusionsThe introduction of the Community Physiotherapist model within the primary care setting allows to provide appropriate, effective and safe interventions. Sharing the project among all the health professionals helped to support its appropriateness and effectiveness. Results also indicate that a new organizational model, such as the Community Physiotherapist, will take a long time to be implemented.

Physiotherapists' perspectives of barriers and facilitators to effective community provision after hip fracture: a qualitative study in England.

to investigate physiotherapists' perspectives of effective community provision following hip fracture. qualitative semi-structured interviews were conducted with 17 community physiotherapists across England. Thematic analysis drawing on the Theoretical Domains Framework identified barriers and facilitators to implementation of effective provision. Interviews were complemented by process mapping community provision in one London borough, to identify points of care where suggested interventions are in place and/or could be implemented. four themes were identified: ineffective coordination of care systems, ineffective patient stratification, insufficient staff recruitment and retention approaches and inhibitory fear avoidance behaviours. To enhance care coordination, participants suggested improving access to social services and occupational therapists, maximising multidisciplinary communication through online notation, extended physiotherapy roles, orthopaedic-specific roles and seven-day working. Participants advised the importance of stratifying patients on receipt of referrals, at assessment and into appropriately matched interventions. To mitigate insufficient staff recruitment and retention, participants proposed return-to-practice streams, apprenticeship schemes, university engagement, combined acute-community rotations and improving job description advertisements. To reduce effects of fear avoidance behaviour on rehabilitation, participants proposed the use of patient-specific goals, patient and carer education, staff education in psychological strategies or community psychologist access. Process mapping of one London borough identified points of care where suggested interventions to overcome barriers were in place and/or could be implemented. physiotherapists propose that effective provision of community physiotherapy following hip fracture could be improved by refining care coordination, utilising stratification techniques, employing enhanced recruitment and retainment strategies and addressing fear avoidance behaviours.

Cultural And Social Barrier in Community Physiotherapy Practice: Ethics in the Indian context

Background: Ethics becomes inevitable in the physiotherapy profession as it is concerned with professionalism and patient outcomes by avoiding patient-therapist conflicts and helps avoiding medical negligence. Objctive: This study aims to explore the impedance faced by the community physiotherapist in implementing the code of ethics. Methodology: A structured interview-based questionnaire was framed to assess the perception of ethics, role of ethics and the barriers faced in implementing ethical guidelines by community physiotherapist during their practice. Results: Ethics is important as it dignifies the profession and gains the confidences of the patient and helps in developing a good rapport with the patient. The most important barriers faced by the physiotherapist in abiding by the code of ethics were the unawareness among the patient and their cultural belief alongside with lack of inter-sectorial harmony. Conclusion: This study concludes that educating the patients and creating an inter-sectoral harmony will be most effective in breaking the barriers in ethical implementation in practice.

Effectiveness of a rapid access musculoskeletal service in rural primary care.

Facing a crippling scarcity of community physiotherapists, a family doctor clinic in rural Canada collaborated with a highly skilled and experienced physiotherapist to provide rapid access to musculoskeletal (MSK) assessment for patients presenting to the doctor or practice nurses. The physiotherapist saw six patients for 30 minutes each in a weekly session. He did an expert assessment and frequently found a home programme of exercises was the appropriate treatment with onward referral and/or investigation for more complex cases. Rapid access was provided in a convenient location. The alternative was a 12-15 month wait for physiotherapy at least 1 hour's drive away. Outcomes were good. The results of two audits will be presented. Practice use of lab tests and X-rays was reduced. MSK knowledge and skills of doctor and nurses was improved. We hypothesised that rapid access to a physiotherapist would lead to improved outcomes compared with the above-noted long wait times. We limited contact to two or, at most, three sessions - ideally just one - to safeguard our goal of rapid access. What we did not expect, and were very surprised to see, was the number of patients - approximately 75% of the total - who had good to excellent outcomes following one or two visits. We postulate that hard-pressed physiotherapy services need a new practice paradigm, using this community-based model. We recommend establishment of further pilot projects with very careful selection of practitioners and detailed evaluation of outcomes.

Physiotherapy as part of primary health care, Italy.

To describe the Family and Community Physiotherapist model, which aims to incorporate rehabilitation services within primary health care in Tuscany, Italy. The Department of Health Professions of the Central Tuscany local health authority designed the model during 2020-2021. We describe the four phases of the organizational case study implementation of the model, namely: (i)analysis of the political and organizational framework, as well as determination of changing health-care needs; (ii)model co-design and training of multiprofessional health-care workers (local general practitioners, physiatrists and geriatricians); (iii)delivery and surveillance of rehabilitation services; and (iv)evaluation. During the initial roll-out of the project in April-December 2021, general practitioners referred 165 patients with a mean age of 83.7years (standard deviation: 11.1) to the Family and Community Physiotherapist. Interventions were mainly activated for patients with comorbidities (64/165; 38.8%), followed by those with long-term immobilization issues (36/165; 21.8%). The most commonly provided intervention was counselling, contributing to the achievement of objectives for 127 patients (77.0%). A full rehabilitation path was proposed for only 10 patients (6.1%). No additional costs were incurred by the health authority during the implementation of the model. Our model facilitated the provision of rehabilitative care in the community, preventing the exacerbation of chronic conditions and meeting the population health needs in non-hospital environments. The model overcame the typical lack of integration within health-care services with flexibility, promoting care proximity solutions to cope with health challenges such as an ageing population and the coronavirus disease.

FP.07 Experiences with systematic video recordings of individualized physiotherapy for 111 patients with neuromuscular disorders in a 7-year quality project

Physiotherapy is a cornerstone in the management of hereditary neuromuscular disorders (NMDs). The National Neuromuscular Centre Norway (NMK) provides a two-week individualized physiotherapy intervention focusing on optimization of movement strategies in relevant activities. From 2014 to 2021, NMK documented the content of the tailored intervention in a quality project using systematic video recordings. The aims were to investigate the video recordings' contribution in the clinical communication with community physiotherapists (cPTs), and to explore how the PTs at NMK could develop and enhance their clinical practice by analyzing the patients' changes in movement quality and -strategies. 111 patients with NMDs participated. Video recordings of selected sequences of individualized treatment approaches were captured for all patients, and further conveyed to the patients' cPTs after discharge. 83 patients were recorded during standardized pre and post testing, consisting of 10m walk test, maximum step length, single leg stance and walking figure of eight. Patients unable to walk were not tested. Video recordings of pre and post tests clearly display positive changes in movement quality for the majority of patients, and have been vital in improving clinical competence for the PTs at NMK. The videos are valuable in case-presentations on clinical courses and in webinars, and highlight how specific and individualized treatment techniques contribute towards optimization of movement in people with NMDs. Recordings of particularly relevant treatment sequences conveyed to cPTs, in combination with written reports, enhanced their clinical reasoning processes and served as helpful input in the daily follow-up of patients. Video recording of people with NMDs participating in specialized physiotherapy treatment is a valuable tool to improve clinical competence, and may enhance clinical communication with cPTs.

The Palliative Care Knowledge Questionnaire-Basic (PCKQ-B): Development and Validation of a Tool to Measure Knowledge of Health Professionals about Palliative Care in India.

Objectives:A well-educated and aware staff are the needed to overcome barriers to palliative care provision in the face of ever-increasing needs of palliative care in developing countries like India. Lack of a standardised and locally validated need assessment tool is felt as one of the important requirements for any successful educational program. This project is to develop and validate a basic palliative care knowledge needs assessment questionnaire.Materials and Methods:Development of Palliative Care Knowledge Questionnaire-Basic (PCKQ-B) for Indian nurses working in a tertiary care hospital in Delhi-NCR, India was undertaken with four basic processes, that is, item generation, content validity, pilot testing and field testing. Literature search helped us to find appropriate domains and items; content validity obtained with a panel of seven experts, pilot testing and finally field testing was done on 102 nurses working in 6 branches of Max Super Specialty Hospital, Delhi-NCR, India. The field study data were used to do item analyses including item difficulty, item discrimination and calculate reliability indicators including test-retest correlation and KR-20.Results:Content Validity index (CVI) of all the items was >0.78 (except 1 item) and Scale-CVI was 0.98 (excellent content validity). Items were selected on the basis of item difficulty index of 0.1 to 0.9 and an item discrimination index greater than 0.2. A total of 25 questions were selected that elicited KR-20 value of 0.65 and intra class correlation (test-retest reliability) of 0.52.Conclusion:Overall, PCKQ-B is a 25 item questionnaire with a moderate reliability. Although validated for nurses in tertiary care hospitals, this tool might find utility in education of primary health workers, community health workers, social workers, or physiotherapists in palliative care teams.

Community physiotherapists’ experiences of working with patients with persistent pain from diverse cultural backgrounds in London

Purpose: On-going research suggests that patients with persistent pain would benefit from being treated in the community and signposted to activities or exercise they enjoy doing. Clinicians such as physiotherapists in the community, help guide patients to self-manage, improve their coping skills, challenge their negative health beliefs, and adhere to recommended treatment. Language and culture are known to affect pain, pain beliefs and attitudes towards healthcare. Little is known about how physiotherapists manage patients from culturally diverse backgrounds. The aims of this project are to explore (1) Physiotherapists’ experiences of working with patients from culturally diverse backgrounds with persistent pain in the community and (2) their beliefs about the reasons for lack of adherence to exercise in this patient population.

People with physical disabilities in Sri Lanka are in need for the service of community physiotherapists

Background: Physiotherapists have long been recognized as important providers of services for people with disability. In Sri Lanka the concept of community physiotherapy has not emerged yet. The present study aimed to identify the need for ‘community physiotherapy service’ in Kandy district, Sri Lanka. Methods: A community service projection community based rehabilitation, of three years was conducted by the department of physiotherapy, faculty of allied health sciences, University of Peradeniya, Sri Lanka in 2017-2019 in collaboration with department of social service and social welfare of Kandy district secretariat, Sri Lanka.Results: One hundred and seventy participants with physical disabilities were included in the study 94 (55.29%) were males (mean age; 33.57 (SD ±23.17) and 76 (44.71%) were females (mean age; 33.14 (SD ±24.98). The pediatric population was 41.76% (N=71) followed by 38.82% of adults (N=66) and 19.41% of elderly patients (N=33) of the total population. The highest number of PWD had pediatric conditions (39.41%), followed by musculoskeletal (31.76%), neurological (15.88%), geriatric (8.82%) and cardio-respiratory (4.12%) conditions. The majority (55.88%) of all the people with disabilities who visited the clinics were in need for further physiotherapy consultation and follow up.Conclusions: In Kandy district of Sri Lanka alone, number of people with physical disabilities who are in need of continuous physiotherapy follow ups is high compared to services already available. Conducting a successful community-based rehabilitation program in Sri Lanka as a whole, require having a specialized health care practitioner to the primary health care team; ‘a community physiotherapist’.

Management of prepregnancy, pregnancy, and postpartum obesity from the FIGO Pregnancy and Non‐Communicable Diseases Committee: A FIGO (International Federation of Gynecology and Obstetrics) guideline

Management of prepregnancy, pregnancy, and postpartum obesity from the FIGO Pregnancy and Non‐Communicable Diseases Committee: A FIGO (International Federation of Gynecology and Obstetrics) guideline

Mapping Physiotherapy Use in Canada in Relation to Physiotherapist Distribution.

Purpose: In this cross-sectional study, we examined the distribution of physiotherapists at the health region level across Canada in relation to self-reported physiotherapy use across the provinces and territories. Method: We drew on two data sources: the physiotherapy use question from the 2014 Canadian Community Health Survey and physiotherapists' primary employment information, obtained from the Canadian Institute of Health Information's 2015 Physiotherapist Database. We then applied geospatial mapping and Pearson's correlation analysis to the resulting variables. Results: Physiotherapy use is moderately associated with the distribution of physiotherapists (Pearson's r 92 = 0.581, p < 0.001). The use and distribution variables were converted into three categories using SDs of 0.5 from national means as cut-off values. Cross-classification between the variables revealed that 15.2% of health regions have a high use-high distribution ratio; 18.5% have a low use-low distribution ratio; 4.3% have a high use-low distribution ratio; 2.2% have a low use-high distribution ratio; and 60.0% have medium use-medium distribution ratio. Conclusions: The distribution of physiotherapists and self-reported physiotherapy use varies across health regions, indicating a potential inequality in geographical access. Given that most provinces have a regionalized approach to health human resources and health service delivery, these findings may be helpful to managers and policy-makers and may allow them to make a more granular comparison of intra- and inter-provincial differences and potential gaps.

Housebound patients' experiences of a falls service provided by a team of community physiotherapists

Background/Aims: To explore the experiences of patients of a falls service provided by a community physiotherapy team to elderly, housebound people who have fallen. Methods: Six housebound elderly patients who had been referred to the service were interviewed in their own homes. The interviews were transcribed and a thematic analysis framework was used to analyse the data. Codes were identified and developed into key themes that addressed the overall research question. Results: The analysis revealed that the participants presented with multiple risk factors including recurrent falls and comorbidities and were at high risk of falls. Exercise was understood to increase their mobility and the majority expressed a fear of falling. The participants appeared to have a limited understanding of the referral process, the cause of their falls and the interventions that may reduce their risk of falling. Conclusions: A multidisciplinary falls team, established and recognised as a central point of referral for the care of people who have fallen, could enhance the care of elderly, housebound people who have fallen. The team, with their specialist knowledge and understanding of the multifactorial nature of falls and appropriate interventions, could coordinate and monitor the assessments and interventions needed with the relevant professionals and services.

Physiotherapy clinical education at a South African university

Background. Clinical education for physiotherapists forms a vital part of undergraduate programmes and equips students with competencies to practise autonomously as qualified health practitioners. However, disparities are evident in approaches to clinical education. Objective. To explore the perceptions of physiotherapy students, community-service physiotherapists and physiotherapy clinical supervisors regarding the clinical education framework at a tertiary institution in South Africa in order to understand preparedness of students for practice. Methods. A case study approach with two focus group discussions with students and interviews with community physiotherapists and clinical supervisors was employed. Data were analysed and categorised into key themes and sub-themes. Results. Five themes emerged from triangulation of data from the three groups: preparedness for professional practice, institutional barriers, curriculum disputes, personal factors and recommendations for physiotherapy clinical education. Students felt inadequately prepared owing to a perceived lack of exposure to certain aspects of physiotherapy, while community therapists believed that reflection on the undergraduate programme after qualifying contributed to their adequate preparation. Clinical supervisors supposed that students would benefit from actively engaging with teaching and learning opportunities, and clinical personnel collaboration was seen as key to facilitate a continuum in clinical education from classroom to healthcare setting. Conclusion. Participants reported that the existing curriculum structure may need to be revisited to address various issues, while holistic collaboration between students, supervisors and clinical personnel is imperative to create a cohesive learning environment.

Theme 13 Respiratory and nutritional management

Background Regular administration of positive pressure non-invasive ventilation (NIV), typically at night to ameliorate nocturnal hypoventilation, extends survival without halting disease progression (1). Many people with MND need practical support to benefit from NIV treatment beyond that which can be provided by family caregivers. There is a paucity of research describing formal care support in MND in general, and very little knowledge of the work of professionals supporting NIV treatment in any context. Objectives To understand how professional caregivers support NIV treatment in MND. Methods A qualitative approach was used to facilitate exploration and description of formal support of NIV treatment by a variety of health and social care professionals who, as a part of their job, provide support for MND patients using NIV. The semi-structured interview schedule included knowledge of MND symptoms, familiarity with NIV treatment, practical support, expectations, and a critical assessment of NIV treatment and their ability to support NIV treatment. The analysis was essentially explanation building, towards seeing common patterns, and ultimately providing recommendations. Results Seventeen professionals consented, including GPs, community and respiratory physiotherapists, speech and language therapists (SLTs), community nurses and nursing home/care agency staff. GPs, community physiotherapists and SLTs reported very few cases in their practices but had knowledge of NIV treatment, in contrast to community nurses and nursing home/care agency staff, who typically have neither knowledge nor experience until faced with a patient using NIV. Practical support provided by professionals included advice, titrating pressure, assistance for those unable to use the equipment independently, and psychological support. Discussion Attitudes and expectations of NIV differed, with some professionals being concerned about symptom relief, some about functional improvements (such as improved speech), and some with operational issues (such as mask comfort), without considering the worth of NIV as a treatment. Some professionals who are responsible for the daily care of patients using NIV report no education about NIV in advance of meeting such patients, and so typically learn about NIV treatment ‘on-the-job’. Conclusions Professional carers were very disparate in their attitudes and their background training in MND and NIV. There is a need to examine training requirements for nursing home/care agency staff. Furthermore, professionals showed no consensus on the benefits of NIV but were fulfilling their professional duties to administer and sustain it without knowledge or involvement in the decision to commence it. Reference Bourke S, Tomlinson M, Williams T et al Lancet Neurology 2006; 5:140-7.

AIMPaediatric Spasticity and Orthopaedic Management for Children with Physical and Neuro-disability

Aims: Objective measures used to assess spasticity and need for medical or orthopaedic management/intervention is not standardised between paediatricians, orthopaedic surgeons, physiotherapists and community network teams working with children with physical and neuro-disability. Standardised measurement improves decision-making. Since 2012 the HSE South physiotherapy services in Enable Ireland have been rolling out a simple, effective but life-changing care pathway for children with neuromuscular conditions. One of these conditions is Cerebral Palsy which affects 2.5 per 1000 births in Ireland and is a group of permanent movement disorders that appear in early childhood. Methods: In Cork a multidisciplinary team are working together in a community setting to prevent one of the most painful and debilitating outcomes of Cerebral Palsy; hip dislocation. The specific need for hip surveillance and management is associated with each child’ssss abnormal muscle tone and challenges with mobility which causes asymmetry of posture and subsequent hip displacement. The negative impact of hip dislocation on quality of life is felt not only by the child but also by the care giver who is unable to provide adequate care without causing discomfort. This highlights the necessity for the orthopaedic care pathway for hip surveillance. The team in Cork are now striving to meet the HSE guidelines on specialist supports for children with disabilities, published in 2015. They recognised the lack of standardised intervention and management in assessing the need for specialist services and decided to address it. Standardisation is understood to improve decision-making and in turn results in a structured, integrated management pathway. The orthopaedic care pathway practiced by the team has four steps and focuses on early intervention and timely, effective service provision, without which, surveillance serves little purpose. Step one is referral for a physical assessment completed jointly with community physiotherapists which is based on the current international guidelines, then x-rays are taken for analysis, third, an individualised service plan is developed and finally the whole team make decisions based on the outcomes of the assessment. A key element of its success is the multidisciplinary team who are engaged in the process and take part in thorough clinical discussions. This team includes Enable Ireland Physiotherapists radiologists, orthopaedic surgeons and paediatricians with special interest in neurodisability working with community teams. Conclusion: Since its initiation, 600 children have accessed the care pathway which has enabled timely detections and management of possible secondary musculo-skeletal complications. Additionally, the creation of a database in the Cork and Kerry regions has aided in better provision of care as well as ensuring progress can be tracked. Perhaps most interestingly, this initiative is cost-neutral because it doesn’t require extra staffing. Instead, it utilises the current health care professionals in the region and promotes the standardisation of the care pathway through continual engagement, training of community-based team members and educating families.

Establishing A Memory Clinic

Kilkenny Memory Clinic Background: The background into the setting up of the Kilkenny Memory Clinic established in 2013 was to provide access to care pathways for people living with Dementia within the Kilkenny area. The research review for Irelands National Dementia Strategy “Creating Excellence in Dementia Care 2012” highlighted the importance of a timely and accurate diagnosis of dementia. People were presenting to both the acute and long term settings in the area with obvious memory problems but with no diagnosis or pathway of care The aims and objectives were to provide a service to assess memory and cognitive / functional ability, give a diagnosis and create a pathway to linked services within the area. Methodology: A multi-disciplinary team approach: Consultant Gerontologist, OT, Hospital management, CNM2 Dementia care. St Columbas Day Centre was the location for monthly clinics Assessments consist of: Initial Physical and nursing assessment and Bloods taken Cognitive and functional assessments conducted by OT. Followed by : MDT meeting where history and assessment results discussed followed by patient and family having a consultation with the Consultant, a diagnosis maybe given, referral for further assessments, referral to link services as specific to each individual. Outcomes/Results: Growing client numbers indicate continued need. Increase number of younger adults attending the clinics Greater demand from PCCC Teams who refer clients early to the service Increased communication between the services with positive feedback from PHNs, Community Psychiatry, Community Physiotherapists and OTs, Respite, Day Care Services and Support Groups. Very positive links with support groups such as Kilkenny contact and ASI Reduction in crisis calls to the services as clients are known to team Phone follow up service for clients and their families offering support and advice following diagnosis. Early on following establishment of the clinic the lack of support for people following diagnosis and in the early stages of dementia was highlighted ,DREAM ( Dementia, Research, Education, Advocacy in Motion ) a peer support group is now running twice monthly in Loughboy Parish Centre, Kilkenny. This service is facilitated by nurses from the memory clinic so links to services and supports are maintained The support that this group gives to one another is invaluable. The group have taken part in research and were part of the recent launch of the Understand together Dementia awareness campaign and 3 members are now part of the Irish Dementia Working Group. Future Plans: Launch of Kilkenny Memory Clinic Brochure in early 2017 to increase GP and community awareness of service. Assistive technology Library being developed on site sponsored by Genio Ongoing audit and assessment of the service so as to enhance the service to clients and continue to grow links with other services in the area Acknowledgements to Hospital management, The Director’s of Nursing and administration staff of St Columbas Hospital, Thomastown, Co Kilkenny

Development of an evidence-based complex intervention for community rehabilitation of patients with hip fracture using realist review, survey and focus groups

ObjectivesTo develop an evidence and theory-based complex intervention for improving outcomes in elderly patients following hip fracture.DesignComplex-intervention development (Medical Research Council (MRC) framework phase I) using realist literature review, surveys...

Falls prevention activities among community-dwelling elderly in the Netherlands: A Delphi study

IntroductionThis study aimed to provide an overview of the current falls prevention activities in community-dwelling elderly with an increased risk of falling in the Netherlands. Therefore, we determined: a) how health professionals detect community-dwelling elderly with an increased risk of falling; b) which falls prevention activities are used by health professionals and why; c) how elderly can be stimulated to participate in falls prevention programs; and d) how to finance falls prevention. MethodsA two-round online Delphi study among health experts was conducted. The panel of experts (n=125) consisted of community physiotherapists, community nurses, general practitioners, occupational therapists and geriatricians, from all over the Netherlands. The median and Inter Quartile Deviation (IQD) were reported for the questions with 5-point Likert scales, ranging from ‘least’ (1) to ‘most’ (5). ResultsRespectively 68% (n=85/125) and 58% (n=72/125) of the panel completely filled in the first and second round questionnaires. According to the panel, regular detection of fall risk of community-dwelling elderly with an increased risk of falling hardly takes place (median=2 [hardly]; IQD=1). Furthermore, these elderly are reluctant to participate in annual detection of fall risk (median=3 [reluctant]; IQD=1). According to 73% (n=37/51) of the panel, 0–40% of the elderly with an increased risk of falling are referred to exercise programs. In general, the panel indicated that structural follow-up is often lacking. Namely, after one month (n=21/43; 49%), three months (n=24/42; 57%), and six months (n=27/45; 60%) follow-up is never or hardly ever offered. Participation of elderly in falls prevention programs could be stimulated by a combination of measures. Should a combination of national health education, healthcare counseling, and removal of financial barriers be applied, 41–80% of the elderly is assumed to participate in falls prevention programs (n=47/64; 73%). None of the panel members indicated full financing of falls prevention by the elderly. A number of individuals are considered key in falls prevention activities, such as the general practitioner, physiotherapist, and informal caregiver. ConclusionThis Delphi study showed clear directions for improving falls prevention activities and how to increase participation rates.