Date Presented 03/27/20
Using a quasiexperimental design, the feasibility of the Stroll Safe outdoor fall-prevention program was examined. Process, scientific, management, and resource assessments were conducted. Results reveal that the program is feasible to implement among active, community-dwelling older adults. Further study using an efficacy trial is warranted. This study helps to build the body of knowledge in outdoor fall prevention, an area of research and practice that is critical to productive aging.
Primary Author and Speaker: Tracy Chippendale
PURPOSE: Fall prevention programs have largely focused on indoor falls. To fill this gap, the Stroll Safe outdoor fall prevention program was developed guided by the Ecological and Health Belief Models and research on common causes and locations of outdoor falls (Chippendale & Raveis, 2017). The manualized 7-week educational intervention includes didactic presentations, group discussion/problem solving, mobility training, action planning, and self-advocacy regarding reporting environmental hazards. The purpose of this study was to assess the program’s feasibility and to use the findings to plan a large scale efficacy trial.
DESIGN: A quasi-experimental control group design was employed (N=24).
PARTICIPANTS: Inclusion criteria were: age 55 and older, English speaking, cognitively competent (Montreal Cognitive Impairment (MOCA) score >24) (Nasreddine et al., 2005), able to ambulate outdoors independently with or without a mobility aid, able to travel independently to the program site, and have sustained a trip, slip, stumble or fall outdoors in the past year. Participants were recruited using a two pronged approach: contacting participants from a prior survey study, and notifying seniors from one senior center and one NORC program using announcements and flyers.
METHODS: Consistent with suggested guidelines for feasibility studies, process, scientific, management and resource assessments were conducted (Tickle-Degnen, 2013). Feasibility was assessed quantitatively using retention rates and attendance records, and qualitatively using a fidelity assessment, reflective log, and an audio recorded focus group with participants after program completion. The scientific assessment included descriptive statistics to explore trends pertaining to changes in fall prevention strategy use and number of slips, trips and falls outdoors from study enrollment through 2 month post-program follow up.
RESULTS: Findings included successful recruitment (100%) and retention of the majority of participants (83%), and predominantly positive participant feedback, with no adverse events. Feedback was obtained to refine the program and research methodology for a larger study, including considerations for hiring and training of research assistants, staffing, program content, and choice of measures. Preliminary results reveal program benefits including a greater increase in use of prevention strategies for the treatment group compared to the control group as per change scores on the Outdoor Falls Questionnaire (OFQ) (Chippendale, 2015) (Cohen’s d=0.9). As per fall calendar reports, a greater decrease in trips, slips and falls from baseline to two months post-program completion was noted for the treatment group as compared to the control group (Cohen’s d=0.4).
CONCLUSIONS: The Stroll Safe program appears to be feasible to implement among active, community-dwelling older adults and preliminary results are promising.
IMPACT STATEMENT: This program/study fills a gap in research and practice with regard to outdoor fall prevention. A larger scale trial is warranted.
RELATIONSHIP TO RESEARCH PRIORITIES: This study focuses on safety and injury prevention for older adults in the community, an AOTA priority.
References
Chippendale, T. (2015). Development and validity of the Outdoor Falls Questionnaire. International Journal of Rehabilitation Research, 38(3), 263-269. doi: 10.1097/MRR.0000000000000115
Chippendale, T., & Raveis, V. (2017). Knowledge, behavioral practices, and experiences of outdoor fallers: implications for prevention programs. Archives of Gerontology and Geriatrics, 72, 19-24. doi: 10.1016/j.archger.2017.04.008
Nasreddine, Z. S., Phillips, N. A., Bédirian, V., Charbonneau, S., Whitehead, V., Collin, I.,…Chertkow, H. (2005). The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. Journal of the American Geriatrics Society, 53, 695–699. doi:10.1111/j.1532-5415.2005.53221
Tickle-Degnen, L. (2013). Nuts and bolts of conducting feasibility studies. American Journal of Occupational Therapy, 67, 171-176. doi: 10.5014/ajot.2013.006270
