title: Fall rates in hospital rehabilitation units after individualised patient and staff education programmes: a pragmatic, stepped-wedge, cluster-randomised controlled trial.
abstract: BACKGROUND
  Falls are the most frequent adverse events that are reported in hospitals. We examined the effectiveness of individualised falls-prevention education for patients, supported by training and feedback for staff, delivered as a ward-level programme.
  
  
  METHODS
  Eight rehabilitation units in general hospitals in Australia participated in this stepped-wedge, cluster-randomised study, undertaken during a 50 week period. Units were randomly assigned to intervention or control groups by use of computer-generated, random allocation sequences. We included patients admitted to the unit during the study with a Mini-Mental State Examination (MMSE) score of more than 23/30 to receive individualised education that was based on principles of changes in health behaviour from a trained health professional, in addition to usual care. We provided information about patients' goals, feedback about the ward environment, and perceived barriers to engagement in falls-prevention strategies to staff who were trained to support the uptake of strategies by patients. The coprimary outcome measures were patient rate of falls per 1000 patient-days and the proportion of patients who were fallers. All analyses were by intention to treat. This trial is registered with the Australian New Zealand Clinical Trials registry, number ACTRN12612000877886).
  
  
  RESULTS
  Between Jan 13, and Dec 27, 2013, 3606 patients were admitted to the eight units (n=1983 control period; n=1623 intervention period). There were fewer falls (n=196, 7·80/1000 patient-days vs n=380, 13·78/1000 patient-days, adjusted rate ratio 0·60 [robust 95% CI 0·42-0·94], p=0·003), injurious falls (n=66, 2·63/1000 patient-days vs 131, 4·75/1000 patient-days, 0·65 [robust 95% CI 0·42-0·88], p=0·006), and fallers (n=136 [8·38%] vs n=248 [12·51%] adjusted odds ratio 0·55 [robust 95% CI 0·38 to 0·81], p=0·003) in the intervention compared with the control group. There was no significant difference in length of stay (intervention median 11 days [IQR 7-19], control 10 days [6-18]).
  
  
  CONCLUSIONS
  Individualised patient education programmes combined with training and feedback to staff added to usual care reduces the rates of falls and injurious falls in older patients in rehabilitation hospital-units.
  
  
  BACKGROUND
  State Health Research Advisory Council, Department of Health, Government of Western Australia.
authors: School of Physiotherapy, The University of Notre Dame Australia, Fremantle, WA, Western Australia; Institute for Health Research, The University of Notre Dame Australia, Fremantle, WA, Western Australia. Electronic address: anne-marie.hill@nd.edu.au.
authors: Anne-Marie
authors: AM
authors: Hill
authors: Institute of Health and Biomedical Innovation and School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia; Centre for Functioning and Health Research, Metro South Health, Brisbane, QLD, Australia.
authors: Steven M
authors: SM
authors: McPhail
authors: Department of Rehabilitation and Aged Care, Armadale Kelmscott Memorial Hospital, Perth, WA, Australia; Health Strategy and Networks, Strategic System, Policy and Planning, Department of Health, Government of Western Australia, Perth, WA, Australia.
authors: Nicholas
authors: N
authors: Waldron
authors: School of Medicine and Pharmacology, WA Centre for Health and Ageing, University of Western Australia, Perth, WA, Australia; Royal Perth Hospital, Department of Health, Government of Western Australia, Perth, WA, Australia.
authors: Christopher
authors: C
authors: Etherton-Beer
authors: Department of Rehabilitation and Aged Care, Sir Charles Gairdner Hospital, Department of Health, Government of Western Australia, East Perth, WA, Australia.
authors: Katharine
authors: K
authors: Ingram
authors: School of Medicine and Pharmacology, WA Centre for Health and Ageing, University of Western Australia, Perth, WA, Australia; Royal Perth Hospital, Department of Health, Government of Western Australia, Perth, WA, Australia.
authors: Leon
authors: L
authors: Flicker
authors: Institute for Health Research, The University of Notre Dame Australia, Fremantle, WA, Western Australia.
authors: Max
authors: M
authors: Bulsara
authors: Physiotherapy Department, Monash University, Frankston, VIC, Australia; Allied Health Research Unit, Monash Health, Clayton, VIC, Australia.
authors: Terry P
authors: TP
authors: Haines
mesh_terms: D000058:Accidental Falls / Q000401:mortality / Q000517:prevention & control* / Q000706:statistics & numerical data*; D000369:Aged, 80 and over; D001315:Australia / Q000453:epidemiology; D016000:Cluster Analysis; D003071:Cognition / Q000145:classification; D015897:Comorbidity; D004496:Education, Continuing / Q000458:organization & administration / Q000706:statistics & numerical data; D005260:Female; D006266:Health Education / Q000458:organization & administration* / Q000706:statistics & numerical data*; D006331:Heart Diseases / Q000453:epidemiology; D006620:Hip Fractures / Q000453:epidemiology; D006757:Hospital Units / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D009140:Musculoskeletal Diseases / Q000453:epidemiology; D009422:Nervous System Diseases / Q000453:epidemiology; D010353:Patient Education as Topic / Q000458:organization & administration / Q000706:statistics & numerical data; D063868:Patient Outcome Assessment; D010359:Patient Readmission / Q000706:statistics & numerical data; D015397:Program Evaluation; D012046:Rehabilitation / Q000193:education; D012047:Rehabilitation Centers / Q000706:statistics & numerical data*; D012140:Respiratory Tract Diseases / Q000453:epidemiology; D020521:Stroke / Q000453:epidemiology; D015996:Survival Rate; D016896:Treatment Outcome