title: Educating nursing home staff on fracture prevention: a cluster randomised trial.
abstract: OBJECTIVE
  to assess whether specialist osteoporosis nurses delivering training to care home staff can reduce fractures and improve the prescription of treatments to reduce fractures versus usual care.
  
  
  METHODS
  pragmatic cluster randomised controlled trial (RCT) with randomisation at the Primary Care Organisation (PCO) level.
  
  
  METHODS
  care homes (residential, nursing and EMI) across England and Wales within PCOs.
  
  
  METHODS
  all 300 PCOs in England and Wales were invited to take part. Of these, 58 agreed to participate and gained ethical approval in time to start the study: 29 clusters were randomised to the intervention group and 29 to the control.
  
  
  METHODS
  specialist osteoporosis nurses undertaking short training sessions with care home staff emphase the importance of fracture and fall prevention and train staff on how to identify those residents at high risk of fracture. Residents' risk of fracture and falls was reported to general practitioners (GPs) of patients along with treatment recommendations.
  
  
  METHODS
  primary outcome measures were total fractures over the past 12 months and total hip fractures over past the 12 months. Secondary outcome measures were total home falls, number of residents sustaining a fall, number of residents prescribed bisphosphonates, number of residents prescribed calcium and vitamin D and number of residents wearing hip protectors. All outcomes were measured at the care home level.
  
  
  RESULTS
  of the 230 care homes randomised data were collected from 209 of these containing 5,637 residents. There were no differences between the groups in the incidence rate ratios (IRRs) for total fractures (IRR = 0.94 [0.71, 1.26] P = 0.70) or total hip fractures (IRR = 0.86 [0.63, 1.18] P = 0.36). No differences were found between groups for home falls or hip protector use. A significant increase in bisphosphonate prescription was seen in the intervention group over the control group (IRR = 1.50 [1.00, 2.24] P = 0.05). Calcium and vitamin D prescription was significantly increased in the intervention group over the control group (IRR = 1.64 [1.23, 2.18] P<0.01).
  
  
  CONCLUSIONS
  the intervention significantly increased the prescription of bisphosphonates and calcium/vitamin D, but was not associated with a significant effect on the rate of falls or fractures.
authors: University of York, Department of Health Sciences, SRB Area 4, York YO10 5DD, UK. hc18@york.ac.uk
authors: Helen
authors: H
authors: Cox
authors: Suezann
authors: S
authors: Puffer
authors: Veronica
authors: V
authors: Morton
authors: Cyrus
authors: C
authors: Cooper
authors: Jean
authors: J
authors: Hodson
authors: Tahir
authors: T
authors: Masud
authors: David
authors: D
authors: Oliver
authors: Danielle
authors: D
authors: Preedy
authors: Peter
authors: P
authors: Selby
authors: Mike
authors: M
authors: Stone
authors: Anne
authors: A
authors: Sutcliffe
authors: David
authors: D
authors: Torgerson
mesh_terms: D000056:Accident Prevention / Q000379:methods; D000058:Accidental Falls / Q000517:prevention & control* / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D016000:Cluster Analysis; D004506:Education, Nursing / Q000379:methods*; D005260:Female; D050723:Fractures, Bone / Q000517:prevention & control*; D006707:Homes for the Aged; D006801:Humans; D008297:Male; D009735:Nursing Homes; D009740:Nursing Staff / Q000193:education*; D011361:Professional Competence; D012016:Reference Values; D012112:Residential Facilities; D012307:Risk Factors; D012680:Sensitivity and Specificity