Prevention of Fall-Related Injuries: A Clinical Research Agenda 2009-2014
Quigley, Pat, Journal of Rehabilitation Research & Development
Decades of research have been conducted on the risk, prevention, and management of falls. Extensive research addresses the identified intrinsic and extrinsic fall risks and the importance of screening for these risks. The emphasis for patient safety interventions surrounding falls and injury prevention must be on patient-centered, multifactorial, individualized care plans that are population-based. Yet the link between risk assessment and the effectiveness of population-based interventions remains weak.
Early efforts focused on risk factors for prevention of falls in the elderly, largely ignoring interventions and also considering all fallers as one single group. Research then moved into fall screening and risk assessment, but these two processes were often intermingled, leading to confusion about linking risk to specific interventions. Still the focus was on fall prevention and the elderly, lumping all fallers into one single group. Next, research focused on interventions, but the focus was on fall prevention and the elderly, again lumping all fallers together.
A new agenda begins to question this focus on fall prevention and addresses fall protection and injury prevention, emphasizing therapeutic risk associated with activity and community participation. This new agenda also recognizes the need to segment high-risk patient populations to identify unique risks and tailor interventions (e.g., peripheral neuropathy, wheelchair fallers) using new three-dimensional techniques to assess gait and balance as well as other key risk factors. The new agenda also goes beyond fall screening and fall risk assessment, emphasizing the need to screen individuals, follow up with in-depth risk assessment protocols, and link interventions to specific modifiable risk factors.
As more evidence is available to clinicians, for translational research efforts are needed to develop clinical tools to make it easier for clinicians to provide evidence-based practice and to explore more effective and efficient strategies for implementing evidence-based programs across clinical settings and facilities. To advocate for evidence-based practice in fall prevention and fall protection, the Veterans Integrated Service Network (VISN) 8 Patient Safety Center of Inquiry held its second international call across professions and experts to articulate the state of the science, elucidate research priorities, and facilitate the translation of research into practice.
In April 2007, fall experts from the United States and Canada participated in a three-day national conference, "Transforming Fall Prevention Practices." After presenting state-of-the-art knowledge and practices in fall prevention, risk assessment, and interventions, they joined with invited research methodologists and expert clinicians over another half day for the research agenda-setting session. Participants reached consensus on the research needed to advance both science and clinical practice.
Priorities were grouped into three research domains:
* Clinical interventions.
The criteria used for selecting research priorities were the--
* Need for consensus among all members.
* Feasibility of the research being conducted within 5 years.
* Presence of an existing program of research on which to build.
* Fit with the mission and vision of the Veterans Health Administration (VHA) in primary health promotion, patient safety, function, and independence.
This editorial focuses solely on clinical intervention. We examined the current state of the science relevant to clinical intervention research and developed a research agenda for studies that can be conducted as 5-year research programs likely to result in new discoveries, improved clinical practice, reduced variations in practice, and improved patient outcomes. Clinical intervention research is needed to test the effects of specific interventions related to special populations, medication prescribing, clinical units and staffing, and interdisciplinary approaches to fall prevention . …