Ilana N. Ackerman
Physiotherapists reported only moderate confidence in assessing fall risk and providing fall-prevention care for patients with osteoarthritis, and although asking such patients about their history of falls is common, physiotherapists rarely use screening tools or specific balance tests, according to survey results published in Arthritis Care & Research.
“Falls are a major cause of injury, hospitalization and death among older people,” Ilana N. Ackerman, PhD, BPhysio, of Monash University in Melbourne, Australia, told Healio Rheumatology. “Data from the Osteoarthritis Initiative have shown that people with knee or hip osteoarthritis have a 50% increase in their likelihood of falling, compared to people without these conditions. Although we have strong evidence for preventing falls in older people, little attention has been given to managing falls risk and reducing falls in people with osteoarthritis — this is an ‘evidence to practice gap.’”
To determine physiotherapists’ knowledge and current practice regarding fall prevention among patients with OA, Ackerman and colleagues conducted a national, cross-sectional survey of currently-registered physiotherapists who care for patients with hip and knee OA in Australia. The researchers recruited participants through advertising with the Australian Physiotherapy Association and Monash University, as well as through their own contacts across the country. In addition, participants were encouraged to pass the survey on to colleagues. Those who completed the survey were also given the opportunity to enter a drawing to win a $200 gift card.
Physiotherapists reported only moderate confidence in assessing fall risk and providing fall-prevention care for patients with OA, according to survey results.
The online survey included a mix of multiple-choice and open-ended questions. Three screening questions determined participant eligibility. Additional questions covered practice characteristics, OA management, fall-prevention training and practice, and awareness. In addition, participants ranked their confidence in providing hip or knee OA advice and care on a scale of zero to 10, with zero meaning “not at all confidence” and 10 denoting “extremely confident.”
A total of 370 eligible respondents — including those who worked in public and private hospitals, community health centers, private practices and aged care facilities — completed the survey. Of the respondents, 47% had practiced for 11 years or more.
According to the researchers, despite most respondents reporting specific training or access to educational resources, physiotherapists said they had only moderate confidence in assessing fall risks, with a median confidence ranking of 7, and delivering fall-prevention care, also with a median self-ranking of 7. In addition, although 88% said they asked patients with OA about their history of falls, just 39% used risk screening tools and even fewer used the appropriate tools. The most frequently reported barrier to including fall-prevention activities in OA care was time constraints, including competing clinical priorities.
“Our study shows that falls prevention evidence is not embedded within routine osteoarthritis clinical care,” Ackerman said. “There are clear opportunities for improving clinician awareness, confidence and skills with respect to falls prevention and we are now developing online training modules to upskill physiotherapists so that they can deliver high-quality falls prevention care for people with osteoarthritis.” – by Jason Laday
Disclosure: Ackerman reports receiving grant funding for this study from Arthritis Australia.