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Changes in Physical Therapy Providers' Use of Fall Prevention Strategies Following a Multicomponent Behavioral Change Intervention

CJ Brown, MD, is Investigator, Birmingham/Atlanta VA Geriatric Research, Education, and Clinical Center, and Assistant Professor, Department of Medicine, University of Alabama at Birmingham
M Gottschalk, PT, MS, is Staff Physical Therapist, Department of Rehabilitation Services, Yale-New Haven Hospital, New Haven, Conn
PH Van Ness, PhD, MPH, is Lecturer, Department of Epidemiology and Public Health, and Associate Research Scientist/Senior Biostatistician, Department of Internal Medicine, Yale University School of Medicine, New Haven, Conn
RH Fortinsky, PhD, is Professor of Medicine, Center on Aging, University of Connecticut Health Center, Farmington, Conn
ME Tinetti, MD, is Professor, Department of Epidemiology and Public Health, and Professor, Department of Internal Medicine, Yale University School of Medicine
Dr Brown, Ms Gottschalk, Dr Fortinsky, and Dr Tinetti provided concept/idea/research design. Dr Brown and Dr Tinetti provided writing and project management. Dr Brown provided data collection, and Dr Brown and Dr Tinetti provided data analysis. Ms Gottschalk provided subjects. Dr Tinetti provided fund procurement and institutional liaisons. Dr Brown, Ms Gottschalk, Dr Van Ness, and Dr Fortinsky provided consultation (including review of manuscript before submission). The authors thank the physical therapy providers who participated in the study; Paula Clark, RN, for assistance in data collection; Bridget Mignosa and Virginia Towle for assistance with data management; and Grace Jeng, MD, and Lisa M Walke, MD, for assistance with coding

Address all correspondence to Dr Brown at University of Alabama at Birmingham, VAMC GRECC 11-G Room 8225, 1530 3rd Ave S, Birmingham, AL 35294-0001 (USA) (Cbrown{at}aging.uab.edu)

Background and Purpose. An abundance of evidence suggests that interventions targeting fall risk factors are effective; however, it remains unknown whether, or to what extent, this body of evidence has affected the clinical practice of physical therapy providers. The purposes of this study were: (1) to describe knowledge of, and attitudes toward, fall risk factors and fall reduction strategies; (2) to assess self-reported use of fall reduction strategies with patients; and (3) to identify factors associated with increased use of fall reduction strategies with patients among physical therapy providers exposed to a behavioral change strategy. Subjects and Methods. A cross-sectional survey of physical therapy providers from hospital-based and freestanding outpatient physical therapy facilities throughout north-central Connecticut was conducted between October 2002 and April 2003. The participants were 94 physical therapy providers who had been exposed to the Connecticut Collaboration for Fall Prevention (CCFP) behavioral change effort. The CCFP program uses multicomponent professional behavioral change strategies to embed fall risk factor assessment and management, based on evidence from randomized controlled trials, into the clinical care of older patients. A telephone questionnaire—focusing on fall risk factor knowledge and attitudes and self-reported fall risk factor assessment and management practices before and after exposure to the CCFP efforts—was administered to consenting physical therapy providers. Results. Environmental hazards and gait and balance deficits were named as fall risk factors by 86 (91%) and 73 (78%) participants, respectively. All of the targeted risk factors were mentioned by at least 30% of the participants. Sixty-four participants (68%) reported increased fall reduction practice behaviors. The area of multiple medications was noted most frequently, with 77 participants (82%) noting new practices related to medication use. Only knowledge of fall risk factors and pre-CCFP behaviors were associated with increased fall reduction practices. Discussion and Conclusion. Physical therapy providers reported an increase in practice behaviors in response to the multicomponent behavioral change strategy. Knowledge of fall risk factors was associated with increased fall reduction practice behaviors, most likely due to the focused nature of the education strategy.

Key Words: Behavioral change • Fall prevention • Physical therapy • Rehabilitation

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