Multimedia Patient Education, Professional Follow-Up May Reduce Falls

Laurie Barclay, MD

November 22, 2010

November 22, 2010 — Among patients with intact cognition admitted to a range of hospital wards, personalized multimedia education with trained health professional follow-up is associated with lower rates of falling, according to the results of a 3-group randomized trial reported online November 22 in the Archives of Internal Medicine.

"Falls are a common adverse event during hospitalization of older adults, and few interventions have been shown to prevent them," write Terry P. Haines, PhD, from Monash University and Southern Health, Kingston Centre in Victoria, Australia, and colleagues. "...A promising intervention is the patient education program used as a part of the first targeted multifactorial program shown to prevent falls in a randomized trial."

The goal of the study was to determine the effectiveness of 2 forms of multimedia patient education — complete program and materials only — vs usual care (control) for in-hospital fall prevention. The complete program consisted of a multimedia patient education program based on the health-belief model combined with trained health professional follow-up interventions. The educational component presented information about frequency and causes of falls, invited patients to consider their own risk and identify problem areas, and then guided them toward developing goals and strategies for prevention.

The materials-only group received multimedia patient education materials alone without individual follow-up, and the control group received usual care, which typically included risk screening, use of wrist bands and other alert items, and generic interventions such as checklists.

Between January 2008 and April 2009 at 2 Australian hospitals, 1206 older hospitalized patients admitted to various acute wards (orthopaedic, respiratory, and medical) and subacute wards (geriatric and neurorehabilitation) were randomly assigned to the complete program (n = 401), the materials-only intervention (n = 424), or to usual care (n = 381). Blinded research assistants collected falls data by reviewing hospital incident reports and medical records and by performing weekly patient interviews.

The groups had no significant differences in rates of falls per 1000 patient-days, which were 9.27 for control, 8.61 for materials only, and 7.63 for the complete program. The intervention significantly interacted with the presence of cognitive impairment.

Cognitively intact patients in the complete program group had fewer falls (4.01 per 1000 patient-days) than cognitively intact patients in the materials-only group (8.18 per 1000 patient-days; adjusted hazard ratio [HR], 0.51; 95% confidence interval [CI], 0.28 - 0.93) and the control group (8.72 per 1000 patient-days; adjusted HR, 0.43; 95% CI, 0.24 - 0.78). Falls occurred in 6% of patients in the complete program group vs 11% in the control group.

"Multimedia patient education with trained health professional follow-up reduced falls among patients with intact cognitive function admitted to a range of hospital wards," the study authors write.

Limitations of this study include lack of blinding of study participants, discrepancy in the proportion of participants recruited from subacute hospital wards, and a high proportion of patients who were admitted to study wards but were not approached for consent to enter this study.

"Many of the strategies pursued by patients as a result of participating in the complete program focused on (1) working more effectively with staff members caring for them; (2) identifying environmental hazards; and (3) using appropriate aids, equipment and clothing," the study authors conclude. "These proposed strategies form a plausible mechanism of action for reducing falls among these patients and highlight the importance of behavioral elements in the causes of falls in this setting. However, the complete program was not an effective strategy and may even be harmful for patients with impaired cognitive function: the rate of injurious falls was higher in this group."

A National Health and Medical Research Council (NHMRC, Australia) project grant, an NHMRC Career Development Award, and a Menzies Research Scholarship supported this study. The study authors have disclosed no relevant financial relationships.

Arch Intern Med. Published online November 22, 2010.

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