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Implementation strategies to support fall prevention interventions in long-term care facilities for older persons: a systematic review

BACKGROUND: Falls are common among older people in long-term care facilities (LTCFs). Falls cause considerable morbidity, mortality and reduced quality of life. Of numerous interventional studies of fall prevention interventions in LTCFs, some reduced falls. However, there are challenges to implemen...

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Autores principales: Albasha, Neah, Ahern, Leanne, O’Mahony, Lauren, McCullagh, Ruth, Cornally, Nicola, McHugh, Sheena, Timmons, Suzanne
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9878796/
https://www.ncbi.nlm.nih.gov/pubmed/36698065
http://dx.doi.org/10.1186/s12877-023-03738-z
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author Albasha, Neah
Ahern, Leanne
O’Mahony, Lauren
McCullagh, Ruth
Cornally, Nicola
McHugh, Sheena
Timmons, Suzanne
author_facet Albasha, Neah
Ahern, Leanne
O’Mahony, Lauren
McCullagh, Ruth
Cornally, Nicola
McHugh, Sheena
Timmons, Suzanne
author_sort Albasha, Neah
collection PubMed
description BACKGROUND: Falls are common among older people in long-term care facilities (LTCFs). Falls cause considerable morbidity, mortality and reduced quality of life. Of numerous interventional studies of fall prevention interventions in LTCFs, some reduced falls. However, there are challenges to implementing these interventions in real-world (non-trial) clinical practice, and the implementation techniques may be crucial to successful translation. This systematic review thus aimed to synthesise the evidence on implementation strategies, implementation outcomes and clinical outcomes included in fall prevention intervention studies. METHODS: A systematic search of six electronic databases (PubMed, CINAHL, EMBASE, PsycINFO, SCOPUS, Web of Science) and eight grey literature databases was conducted, involving papers published during 2001–2021, in English or Arabic, targeting original empirical studies of fall prevention interventions (experimental and quasi-experimental). Two seminal implementation frameworks guided the categorisation of implementation strategies and outcomes: the Expert Recommendations for Implementing Change (ERIC) Taxonomy and the Implementation Outcomes Framework. Four ERIC sub-categories and three additional implementation strategies were created to clarify overlapping definitions and reflect the implementation approach. Two independent researchers completed title/abstract and full-text screening, quality appraisal assessment, data abstraction and coding of the implementation strategies and outcomes. A narrative synthesis was performed to analyse results. RESULTS: Four thousand three hundred ninety-seven potential papers were identified; 31 papers were included, describing 27 different fall prevention studies. These studies used 39 implementation strategies (3–17 per study). Educational and training strategies were used in almost all (n = 26), followed by evaluative strategies (n = 20) and developing stakeholders’ interrelationships (n = 20). Within educational and training strategies, education outreach/meetings (n = 17), distributing educational materials (n = 17) and developing educational materials (n = 13) were the most common, with 36 strategies coded to the ERIC taxonomy. Three strategies were added to allow coding of once-off training, dynamic education and ongoing medical consultation. Among the 15 studies reporting implementation outcomes, fidelity was the most common (n = 8). CONCLUSION: This is the first study to comprehensively identify the implementation strategies used in falls prevention interventions in LTCFs. Education is the most common implementation strategy used in this setting. This review highlighted that there was poor reporting of the implementation strategies, limited assessment of implementation outcomes, and there was no discernible pattern of implementation strategies used in effective interventions, which should be improved and clearly defined. TRIAL REGISTRATION: This systematic review was registered on the PROSPERO database; registration number: CRD42021239604. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12877-023-03738-z.
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spelling pubmed-98787962023-01-27 Implementation strategies to support fall prevention interventions in long-term care facilities for older persons: a systematic review Albasha, Neah Ahern, Leanne O’Mahony, Lauren McCullagh, Ruth Cornally, Nicola McHugh, Sheena Timmons, Suzanne BMC Geriatr Research BACKGROUND: Falls are common among older people in long-term care facilities (LTCFs). Falls cause considerable morbidity, mortality and reduced quality of life. Of numerous interventional studies of fall prevention interventions in LTCFs, some reduced falls. However, there are challenges to implementing these interventions in real-world (non-trial) clinical practice, and the implementation techniques may be crucial to successful translation. This systematic review thus aimed to synthesise the evidence on implementation strategies, implementation outcomes and clinical outcomes included in fall prevention intervention studies. METHODS: A systematic search of six electronic databases (PubMed, CINAHL, EMBASE, PsycINFO, SCOPUS, Web of Science) and eight grey literature databases was conducted, involving papers published during 2001–2021, in English or Arabic, targeting original empirical studies of fall prevention interventions (experimental and quasi-experimental). Two seminal implementation frameworks guided the categorisation of implementation strategies and outcomes: the Expert Recommendations for Implementing Change (ERIC) Taxonomy and the Implementation Outcomes Framework. Four ERIC sub-categories and three additional implementation strategies were created to clarify overlapping definitions and reflect the implementation approach. Two independent researchers completed title/abstract and full-text screening, quality appraisal assessment, data abstraction and coding of the implementation strategies and outcomes. A narrative synthesis was performed to analyse results. RESULTS: Four thousand three hundred ninety-seven potential papers were identified; 31 papers were included, describing 27 different fall prevention studies. These studies used 39 implementation strategies (3–17 per study). Educational and training strategies were used in almost all (n = 26), followed by evaluative strategies (n = 20) and developing stakeholders’ interrelationships (n = 20). Within educational and training strategies, education outreach/meetings (n = 17), distributing educational materials (n = 17) and developing educational materials (n = 13) were the most common, with 36 strategies coded to the ERIC taxonomy. Three strategies were added to allow coding of once-off training, dynamic education and ongoing medical consultation. Among the 15 studies reporting implementation outcomes, fidelity was the most common (n = 8). CONCLUSION: This is the first study to comprehensively identify the implementation strategies used in falls prevention interventions in LTCFs. Education is the most common implementation strategy used in this setting. This review highlighted that there was poor reporting of the implementation strategies, limited assessment of implementation outcomes, and there was no discernible pattern of implementation strategies used in effective interventions, which should be improved and clearly defined. TRIAL REGISTRATION: This systematic review was registered on the PROSPERO database; registration number: CRD42021239604. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12877-023-03738-z. BioMed Central 2023-01-25 /pmc/articles/PMC9878796/ /pubmed/36698065 http://dx.doi.org/10.1186/s12877-023-03738-z Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Albasha, Neah
Ahern, Leanne
O’Mahony, Lauren
McCullagh, Ruth
Cornally, Nicola
McHugh, Sheena
Timmons, Suzanne
Implementation strategies to support fall prevention interventions in long-term care facilities for older persons: a systematic review
title Implementation strategies to support fall prevention interventions in long-term care facilities for older persons: a systematic review
title_full Implementation strategies to support fall prevention interventions in long-term care facilities for older persons: a systematic review
title_fullStr Implementation strategies to support fall prevention interventions in long-term care facilities for older persons: a systematic review
title_full_unstemmed Implementation strategies to support fall prevention interventions in long-term care facilities for older persons: a systematic review
title_short Implementation strategies to support fall prevention interventions in long-term care facilities for older persons: a systematic review
title_sort implementation strategies to support fall prevention interventions in long-term care facilities for older persons: a systematic review
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9878796/
https://www.ncbi.nlm.nih.gov/pubmed/36698065
http://dx.doi.org/10.1186/s12877-023-03738-z
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