Balance & Falls Special Interest Group

http://geriatricspt.org/?v4ujgv

CDC released two new complimentary clinical tools to help healthcare providers reduce older adult falls. The Coordinated Care Plan to Prevent Older Adult Falls offers primary care providers, practices, and healthcare systems a framework for implementing a Stopping Elderly Accidents, Deaths, and Injuries, or STEADI-based clinical fall prevention program in primary care settings to manage older patients’ fall risk. Complementing the Coordinated Care Plan, the STEADI: Evaluation Guide for Older Adult Clinical Fall Prevention Programs describes key steps to measuring and reporting on the success of implementing a STEADI-based clinical fall prevention program. CDC recommends using both the Coordinated Care Plan and the Evaluation Guide simultaneously to ensure the team is able to collect the data needed to report on the clinical fall prevention program’s overall success.

Older adult falls are the leading cause of all fatal and nonfatal injuries among adults age 65 and over in the United States, accounting for over 3 million emergency department visits, 962,000 hospitalizations, and approximately 30,000 deaths in 2016. Additionally, the economic impact of falls and fall deaths is nearly $50 billion in direct medical costs each year.

Although falls are costly, they are preventable. CDC’s STEADI initiative offers a coordinated approach to implementing the American and British Geriatrics Societies’ clinical practice guideline for fall prevention. STEADI consists of three core elements: Screen, Assess, and Intervene to reduce fall risk by offering tailored interventions to reduce fall risk.

For successful implementation of fall prevention activities in primary care settings, the Coordinated Care Plan outlines 12 steps incorporating practical suggestions. These recommendations include how to assess the clinic’s readiness to address older adult falls, identify a fall prevention champion, train staff, and work within the existing clinic workflow to incorporate the fall prevention program, thereby reducing falls among community-dwelling older adults.

As May begins Older Americans Month, see what you can do to help prevent falls. More than 90% of older adults see a medical provider at least once a year, giving clinicians the opportunity to inform and empower older adults to address one or more specific fall risk factors. Reducing falls improves health, fosters independence, and reduces healthcare spending. Help keep your older adult patients safe, independent, and STEADI.

To learn more visit www.cdc.gov/steadi

Projects

National Fall Prevention Awareness Day (NFPAD) Toolkit: We are in the finalization stages for the NFPAD toolkit, which includes applicable materials for multiple settings and types of events. Haim Nesser (Clinical Liaison and Task Force lead) spearheaded revamping and revising materials for the toolkit. The toolkit will include improved marketing materials (State Advocates, other disciplines, advertisements, consent form, photo releases), ideas for events, and powerpoint presentations for community based education. We would like to thank the other members who have been hard at work on the FPAD Toolkit: 1) Deborah Constantine PT, DPT, GCS, CEEAA, 2) Paula Graul, PT MS GCS CEEAA, and 3) Jennifer Vincenzo (BFSIG Chair). Haim and Jennifer will be finalizing materials and submitting for board approval in April/May to have materials prepared for NFPAD 2019 in September!

Outcome Measure Resource Toolkit: The Outcome Measures task force project, championed by Elizabeth Wang-Hsu (Clinical Liaison) and Heidi Moyer (Secretary), is moving towards its final stages and dissemination is anticipated in mid to late 2019. Stay tuned for details! We would like to recognize members of this task force for all of their hard work and efforts in this 2 year journey: Carmen Abbott PT, PhD; Susan Sullivan Glenney, PT, DPT, GCS, CEEAA; Paula Graul PT MS GCS CEEAA; Haim D. Nesser, PT, DPT, CEEAA; and Mariana Wingood, DPT, PT, GCS, CEEAA.

Monthly Challenge: The Monthly Challenge is now on it’s 3rd year and has over 100 subscribers! Topics in 2018 highlighted evidence and interventions on fear of falling, medication management, and educating our medical contemporaries on fall-related issues. In 2019, Haim will be building on those covered in 2019 as well as including more in depth education on revamping physical therapy evaluations for the older adult, systems review for balance and falls, disease specific factors in fall risk (such as Parkinson’s Disease) and so much more! 

Inter-SIG Journal Club: Journal club continues to be a wonderful success! This program was started by the BFSIG a few years ago (thanks to past-chair, Mariana Wingood) and is now an inter-SIG effort within the Academy of Geriatric Physical Therapy (AGPT). Journal Club will be continuing in 2019 with new topics and speakers. This bimonthly effort occurs on the third Tuesday of each month and is chance for a digital meeting with authors of the article resulting in clinical and meaningful discussions to enhance your clinical practice. Look for emails for alerts to upcoming Inter-SIG Journal Clubs!

CDC Webinars: The executive committee is hard at work on projects to continue to serve the needs of the BFSIG members. One such project has been pioneered by our community outreach liaison, David Taylor.  David is facilitating the Centers for Disease Control and Prevention (CDC) to provide two webinars to our membership and AGPT.  These are anticipated to occur late summer of 2019 and will be hosted by AGPT. They will cover the topics of the new My Mobility Plan tool that the CDC recently produced as well as defining and expanding the role of the Physical Therapist in the use of STEADI for fall risk screening. My Mobility Plan is a method to promote a healthy aging perspective through positive changes by changing the way we approach balance and falls management through our language. By encouraging initiation of an action plan to stay independent longer versus the negative phrasing of “don’t fall,” we are encouraging older adults to think of solutions to their mobility problems to maintain mobility instead of focusing on what they can or should no longer do to avoid falls. You can find more information on this topic at https://www.cdc.gov/motorvehiclesafety/older_adult_drivers/mymobility/index.html.

In the News

1. Our community research liaison - Dr. David Taylor  - is representing the physical therapy profession proudly on the CDC website! https://www.cdc.gov/steadi/stories/routine.html
2. BFSIG member, Dr. Bob Nithman and BFSIG Chair Dr. Jennifer Vincenzo, recently published their research on the STEADI in predicting falls in older community-dwelling and retirement-dwelling adults. (available online) https://www.sciencedirect.com/science/article/abs/pii/S0167494319300561?via%3Dihub

Meetings

From our neighbors in Canada - join the Fall Prevention Community of Practice.

You can attend free webinars regularly. All you have to do is sign up as a member for free. You also get great email updates that are a bit different from ours.
https://www.fallsloop.com/

An upcoming webinar is on March 29 on Evidence-based synthesis of balance and mobility testing for fall risk assessment in older adults.

Meeting Description:
The purpose of this webinar is to provide an evidence-based synthesis of balance and mobility testing for fall risk assessment in older adults. An overview of clinical practice guidelines for assessing fall risk in older adults will be provided along with a practical synthesis of evidence to date on the most commonly used tests for first-level screening. We will also highlight new results from the Canadian Longitudinal Study on Aging (CLSA), a population-based study of over 50,000 older Canadians, that address important gaps in the current available evidence. Finally, we will discuss ongoing efforts in research on fall risk assessment and, for interested users, the process for accessing the CLSA data set will be reviewed.
There are many webinars on their free youtube channel as well: https://www.youtube.com/channel/UC-RJP2xe11TnZPYG_FfeGTw

Including, but not limited to: vision, strength, reducing risk of falls on ice, and what to do post fall.

New Positions/Opportunities for Volunteering

The BFSIG is currently looking for volunteers for the following opportunities.

Technology Liaison: We are looking for a member of the BFSIG who is interested in technology related to balance and falls management including but not limited to wearable technology, computer/technology based interventions, and apps.

If you are interested in any of these opportunities, please email us at [email protected] for more information.

We also want to expand a big welcome to Holly Bennett, our new Student Liaison for the BFSIG and Ashley Bell, our new PTA Liaison for the SIG. Thank you to Brenda Holman for her past service as the PTA Liaison for the SIG.

Research

Article 1:

Nithman, R.L. & Vincenzo, J.L. (2019). How steady is the STEADI? Inferential analysis of the CDC fall risk toolkit. Archives of Gerontology and Geriatrics; Published online https://www.sciencedirect.com/science/article/abs/pii/S0167494319300561

Intervention/outcome measure: 77 older adults were evaluated using the STEADI fall risk tool kit. Discriminant (history of a fall) and predictive validity (falling within 6 months) were the outcomes. 

Results: Sensitivity of the STEADI with discriminating fallers and predicting future falls was better among community-dwellers (73-80%) versus the retirement facility-dwellers (56-62%). The STEADI demonstrated high false negative rates among those categorized as low risk: 57% community-dwellers and 24% facility-dwellers fell in the prior 12-months and several fell within 6-months following participation. Many participants were low risk of falls on one mobility screening tool and at a higher risk of falls on another (TUG, 30STS, 4-Stage Balance). Results suggest that it is important to conduct more than one mobility or balance screening test, and indicate that elevated STEADI risk classification was not associated with advancing age. Additionally, outcomes from this study suggest that cut-off scores and the selection of functional fall screening tests, as well as the relative weights and scoring of items on the SIB/3KQ be reevaluated to maximize discriminant and predictive validity of the algorithm. The authors caution interpretation of results considering that the STEADI toolkit may also not predict falls as a result of the recommendations provided within the algorithm/toolkit in order to decrease fall risks. However, only approximately 50% of participants reported adherence to recommendations and non-adherent participants had higher fall rates than those who were adherent.

Article 2: Beauchamp, M. (2019). Balance assessment in people with COPD: An evidence-based guide. Chronic Respiratory Disease; Jan-Dec, 16. Published online. https://www.ncbi.nlm.nih.gov/pubmed/30789019

This review highlights the few balance-specific measures that have been studied in people with COPD. Unfortunately, there are no fall risk cut-offs for measures for people with COPD, however some balance measures are responsive to pulmonary rehab and have an MCID in this article. These measures include: Berg Balance Scale (5 pts), TUG (0.9-1.4 secs), BESTest (13 pts) test. Although no MCID or cut-off is available for this patient population, the author also recommends the MiniBEST and Single limb stance to assess balance.

https://www.ncbi.nlm.nih.gov/pubmed/30789019

If you would like to become involved with the SIG or have any questions/comments please reach us via email at [email protected].

Thank you,

Jennifer Vincenzo, PT, MPH, PhD

Board Certified Geriatric Physical Therapist

Balance and Falls SIG Chair

Dear Balance and Fall SIG Members;

I hope that those who were at CSM last week had a safe journey home. For those who were unable to join us, I hope that the minutes below will provide you with insights about our great projects as well as plans.

This was my last Balance and Falls SIG meeting and I wanted to thank each and everyone of you for all that you have done and do. When I started as Balance and Falls SIG chair I had many visions and as most things go, each component of the vision took much longer than expected. However, I have provided the incoming chair with a large amount of information about where the SIG has started, how it has grown, and what possible opportunities there are. Jennifer Vincenzo is a great leader who is very knowledgeable in public health as well as fall prevention and will be an amazing Chair of this SIG.

Here are the minutes from our SIG meeting at CSM.

1. Introduction of incoming officers/liaisons:
   1. Chair: Jennifer Vincenzo, PT, MPH, PhD
   2. Vice Chair: Shweta Subramani, PT, MHS
   3. Secretary/Treasurer: Heidi Moyer, PT, DPT
   4. Nominating Committee Chair: Anne Reilley, PT, DPT
   5. Research Liaison: Elizabeth Wang-Hsu, PT, PhD
   6. Clinical Liaisons: Haim Nesser, PT, DPT, CEEAA
   7. Public Liaison: Angela Onyekanne, PT, DPT
   8. PTA Liaison: Brenda Holman, PTA
2. Guest Presenter: David Taylor, an active member of the AGPT and Balance and Falls SIG, has been working with the CDC on multiple projects. This includes:
   1. Improving and implementing the STEADI
   2. Increasing clinical community partnerships: PT’s need to get out of our clinics and into the communities
   3. The addition of a 4^th component on the STEADI: outcomes- PTs will have a role in this, however, the details have not been specified.
   4. My Mobility Plan:
      1. If you have not seen it, please check it out: https://www.cdc.gov/motorvehiclesafety/older_adult_drivers/mymobility/index.html
      2. Rational: trying to promote a healthy aging perspective through positive changes
3. AGPT Strategic Plan – where does the Balance and Falls SIG fit in
   1. Assisting with the NCOA partnership: the AGPT created a NCOA task force which just met for the first time at CSM. Our chair and a couple of members are actively involved in the process and will share any updates that arise.
   2. CEU’s
      1. Just like the Health Promotion and Wellness SIG, our SIG will be putting together at least 2 webinars
      2. Current topic ideas are:
         1. Aging in place
         2. Falls prevention in long term care
         3. If you have any other ideas please e-mail [email protected]
         4. There is also a discussion about putting together a webinar that would have representatives from the AGPT and CDC.
4. Update on current projects
   1. Journal Club has grown significantly over the last three years and continues to grow. There is current discussion about possible changes to the journal club, including the possibility of adding CEU’s and recording it. However, the details about these changes have not been discussed and for now Mariana Wingood (the outgoing chair) will continue facilitating/organizing the Journal Club.
   2. National Falls Prevention Awareness Day (NFPAD) Toolbox taskforce is currently working on putting together a toolbox that will improve the ease of your NFPAD events. It will include ideas for events, material for marketing (State Advocates, promotional of involving other disciplines, advertisements, consent for, photo releases), materials for community presentations, materials for healthcare professional presentations, etc. It is in its final stages and we hope to roll this out in the next few months. When we roll it out we hope to have conference call to inform you off the material included, where to find it, and how to use it.
   3. Inter-SIG Efforts
      1. Working with Neurology and Oncology’s Balance and Falls SIG Chairs- calling it the Tri-Alliance. Hoping to present at CSM2020.
      2. Working with the Foot and Ankle SIG of the Orthopaedic Academy to discuss the relationship between Falls and Foot/Ankle impairments. Hoping to present on this at CSM 2020.
   4. Monthly Challenge
      1. Was started in 2017 and it is only sent out to the members who agreed to get the e-mail. One reason for this is that we don’t want to overwhelm everyone’s inbox. If you want to receive e-mails please send an e-mail to the [email protected].
      2. The monthly challenge is sent out at the beginning of the month and at times there are some great discussions. These occur when people hit reply all and it is highly promoted to hit reply all and promote discussion.
      3. To learn more go to our website or use the direct link for the Monthly Challenge: https://drive.google.com/open?id=1NGIqAMNvgXKcrM33qYVoT_oCgMzKwWv4
   5. Outcome Projects
      1. The project started in 2017 and it is currently in its final stages.
      2. This project sounds similar to the EDGE taskforce; however, it is not as thorough as the EDGE. Its main purpose is to disseminate information at a faster rate with the inclusion of other patient populations/settings.
      3. The goal is to provide quick and easy resources for clinicians that are updated on a regular basis.
      4. The project had 4 phases:
         1. Phase 1: Performed a thorough literature search and completed a list of published outcome measures related to balance and falls.
         2. Phase 2: Review process, broken down into 5 rounds to review all outcome measures
         3. Phase 3: cross-validate and make recommendations
         4. Phase 4: create web medium that is accessible to members to utilize, will be updated by clinical liaison, research liaison, and a team of dedicated volunteers
5. Resources: Provided updates about some great resources available including- State Advocates (every state, with the exception of Alaska, Missouri, and South Dakota has one or two), NCOA, CDC, State Coalitions, and don’t forget about your Community Partners.
6. Projects/ideas that were not discussed but are in the works- if interested in assisting with any of these components please e-mail: [email protected]
   1. Putting together a working document where individuals will be able to find as well as add any piece of technology or assistive device that is helping their patient with fall prevention and/or that are used in clinic.
   2. Putting together a document that summarizes the current level of evidence for Interventions.
   3. Facebook Live or Twitter Event where the SIG introduces individuals to what is available on our website. Plan on working with the AGPT to also provide videos on how to join a SIG.
   4. Networking opportunities
      1. Putting together a directory. This would be a working document where individuals who want to network could put their contact information. It will include a section for researchers, educators, and clinicians who are interested in various fall-prevention related work.
      2. Putting together a networking/social event at CSM next year. The Academy of Orthopaedic SIGs have a member meeting and a social event and since many individuals want to socialize/network at the Balance and Falls SIG meeting, but we never have time we may try to put together an additional social event for this purpose.

Thank you all.

Mariana Wingood

Out-going Balance and Falls SIG Chair