Physio findings: programme cuts number of falls, movement assessment reveals risk of cerebral palsy

Falling is the commonest cause of injuries to older people in hospital. But an education programme can significantly reduce the risk, an Australian study reveals.

 

The individualised programmes, for both patients and healthcare professionals, significantly reduced both the number of falls and the extent of injuries.

 

The study covered 3,606 patients in eight Western Australian rehabilitation units. The intervention group received usual care plus the individualised programme, while a control group received usual care only. None of the patients in the study had dementia, which increases the risk of falling.

 

Physiotherapists were given special training to help patients carry out the programme, including information about each patient’s goals and any difficulties they were encountering.

 

The 1,623 patients in the intervention group watched a 10-minute video about preventing falls in hospital. They also had two or three one-hour sessions with a physio, focusing on each patient’s personal risks and relevant fall-prevention strategies.

 

At the end of the 50-week study, the team found that patients in the intervention group had had nearly 40 per cent fewer falls than those in the control group. Only eight per cent had fallen, compared with 13 per cent in the control group. 

 

The number of falls that caused an injury was more than 35 per cent lower than in the control group.

 

‘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,’ the authors conclude.  Hill AM et al. Fall rates in hospital rehabilitation units after individualised patient and staff education programmes: a pragmatic, stepped-wedge, cluster-randomised controlled trial. Lancet 2015. 

Children at risk of neurodevelopmental impairments such as cerebral palsy – for example, premature babies – need to be diagnosed as early as possible for the best chance of successful treatment. 

 

Research suggests that assessing a baby’s fidgety movements can give a clue to future development. So a team from the Arctic University of Norway investigated this in a routine hospital setting.

 

The team gave a general movement assessment to 87 high-risk babies at three months after the date their birth had been expected, and followed them up two years later.  

 

The fidgety movements made by 54 of the babies were normal. The researchers found that 93 per cent of these had normal development at the age of two, and none had cerebral palsy. 

 

Abnormal or sporadic movements were observed in 16 babies, but 75 per cent of them had normal development at two years old. 

 

Seventeen of the babies made no fidgety movements at all.   At the age of two, 53 per cent of these had cerebral palsy.

 

‘When applied in a routine clinical setting, the general movement assessment strongly predicted neurodevelopmental impairments at two years in high-risk infants,’ the team concluded.  Øberg GK et al. Predictive Value of General Movement Assessment for Cerebral Palsy in Routine Clinical Practice, Physical Therapy 2015.