title: Implementing an evidence-based fall prevention program in an outpatient clinical setting.
abstract: OBJECTIVE
  To investigate the dissemination potential of a Tai Ji Quan-based program, previously shown to be efficacious for reducing risk of falls in older adults, through outpatient clinical settings.
  
  
  METHODS
  A single-group pre/post design in which participants attended a twice-weekly Tai Ji Quan training program for 24 weeks.
  
  
  METHODS
  Communities in Lane County, Oregon.
  
  
  METHODS
  Independently living individuals (N=379) aged 65 and older.
  
  
  METHODS
  Using the Reach, Effectiveness, Adoption, Implementation and Maintenance framework, the primary outcome was the proportion of participating healthcare providers who made referrals. Secondary outcomes were the proportion of referred individuals agreeing to participate and enrolling in the program, and measures of program implementation, maintenance, and effectiveness (on measures of falls, balance, gait, physical performance, and balance efficacy).
  
  
  RESULTS
  Of the 252 providers invited to participate, 157 made referrals (62% adoption rate). Of 564 individuals referred, 379 (67% reach) enrolled in the program, which was successfully implemented in senior and community centers with good fidelity, 283 completed the program (75% retention), and 212 of these attended 75% or more of the 48 sessions. Participants reported a reduction in falls, with an incidence rate of 0.13 falls per person-month, and showed significant improvement from baseline in all outcome measures. A 3-month postintervention follow-up indicated encouraging levels of program maintenance among providers, participants, and community centers.
  
  
  CONCLUSIONS
  Healthcare providers successfully implemented a protocol to refer individuals at risk of falling to a Tai Ji Quan-based program. The evidence-based program appears readily scalable and exportable, with potential for substantial clinical and public health effect.
authors.affiliation: Oregon Research Institute, Eugene, Oregon.
authors.forename: Fuzhong
authors.initials: F
authors.lastname: Li
authors.affiliation: Department of Exercise Science, Willamette University, Salem, Oregon.
authors.forename: Peter
authors.initials: P
authors.lastname: Harmer
authors.affiliation: Oregon Health & Science University, Portland, Oregon.
authors.forename: Ronald
authors.initials: R
authors.lastname: Stock
authors.affiliation: Oregon Medical Group, Eugene, Oregon.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Fitzgerald
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Judy
authors.initials: J
authors.lastname: Stevens
authors.affiliation: Outpatient Rehabilitation Services, Sacred Heart Medical Center, Peace Health, Eugene, Oregon.
authors.forename: Michele
authors.initials: M
authors.lastname: Gladieux
authors.affiliation: Department of Human Physiology, University of Oregon, Eugene, Oregon.
authors.forename: Li-Shan
authors.initials: LS
authors.lastname: Chou
authors.affiliation: Cooperative Performance and Rehabilitation, Eugene, Oregon.
authors.forename: Kenji
authors.initials: K
authors.lastname: Carp
authors.affiliation: Harborview Medical Center, Seattle, Washington.
authors.forename: Jan
authors.initials: J
authors.lastname: Voit
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control*; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000379:methods*; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008297:Male; D009922:Oregon; D016730:Program Development; D015397:Program Evaluation; D026302:Tai Ji
keywords: RE-AIM; Tai Ji Quan; dissemination; falls; older adults