title: A stepped-wedge cluster randomised controlled trial for evaluating rates of falls among inpatients in aged care rehabilitation units receiving tailored multimedia education in addition to usual care: a trial protocol.
abstract: BACKGROUND
  Falls are the most frequent adverse event reported in hospitals. Approximately 30% of in-hospital falls lead to an injury and up to 2% result in a fracture. A large randomised trial found that a trained health professional providing individualised falls prevention education to older inpatients reduced falls in a cognitively intact subgroup. This study aims to investigate whether this efficacious intervention can reduce falls and be clinically useful and cost-effective when delivered in the real-life clinical environment.
  
  
  METHODS
  A stepped-wedge cluster randomised trial will be used across eight subacute units (clusters) which will be randomised to one of four dates to start the intervention. Usual care on these units includes patient's screening, assessment and implementation of individualised falls prevention strategies, ongoing staff training and environmental strategies. Patients with better levels of cognition (Mini-Mental State Examination >23/30) will receive the individualised education from a trained health professional in addition to usual care while patient's feedback received during education sessions will be provided to unit staff. Unit staff will receive training to assist in intervention delivery and to enhance uptake of strategies by patients. Falls data will be collected by two methods: case note audit by research assistants and the hospital falls reporting system. Cluster-level data including patient's admissions, length of stay and diagnosis will be collected from hospital systems. Data will be analysed allowing for correlation of outcomes (clustering) within units. An economic analysis will be undertaken which includes an incremental cost-effectiveness analysis.
  
  
  BACKGROUND
  The study was approved by The University of Notre Dame Australia Human Research Ethics Committee and local hospital ethics committees.
  
  
  RESULTS
  The results will be disseminated through local site networks, and future funding and delivery of falls prevention programmes within WA Health will be informed. Results will also be disseminated through peer-reviewed publications and medical conferences.
  
  
  BACKGROUND
  The study is registered with the Australian New Zealand Clinical Trials registry (ACTRN12612000877886).
authors.affiliation: School of Physiotherapy, The University of Notre Dame Australia, Fremantle, Western Australia, Australia.
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Hill
authors.forename: Nicholas
authors.initials: N
authors.lastname: Waldron
authors.forename: Christopher
authors.initials: C
authors.lastname: Etherton-Beer
authors.forename: Steven M
authors.initials: SM
authors.lastname: McPhail
authors.forename: Katharine
authors.initials: K
authors.lastname: Ingram
authors.forename: Leon
authors.initials: L
authors.lastname: Flicker
authors.forename: Terry P
authors.initials: TP
authors.lastname: Haines
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control* / Q000706:statistics & numerical data; D000368:Aged; D003362:Cost-Benefit Analysis; D006757:Hospital Units; D006801:Humans; D007297:Inpatients; D019212:Multimedia; D010353:Patient Education as Topic / Q000191:economics / Q000379:methods; D012046:Rehabilitation; D012107:Research Design
keywords: Geriatric Medicine; Health Economics