Preventing falls – Data Collection

• Introduction
• Background
• Study Design
• Data Collection
• Analysis
• Data

• Promoting the study

  Advertisements	Local papers, community radio, channel 31
  Posters & brochures (multilingual)	Service and Probus clubs, Neighborhood houses, Community centres, Home care, Meals on wheels
  Presentations	Senior citizens organisations, Social clubs
  Displays	Shopping centres
  Personal contact	General practitioners, Physiotherapists, Hospital staff
  Participant recruitment
  Sampling frame	Identify all people over 70 years old listed on the Australian Electoral Roll in the City of Whitehorse.
  Recruitment	Send recruitment letter to all those identified as eligible from the Electoral Roll. Non-respondents are followed up with a telephone call to explain the study and invite them to participate.

• Data collection protocols

  Initial screening	Ask potential participants initial screening questions on first telephone contact.
  Inclusion criterion	Potential participants should be living in own home or in rented accommodation where home hazards could be modified. Participation in the study is approved by the potential participant’s general practitioner.
  Exclusion criteria	Exclude any potential participant who: has a partner living in same home already in the study anticipates moving from the area within two years has participated in an exercise program similar to the exercise intervention in the last 2 months cannot walk 10-20 metres without rest cannot walk 10-20 metres without assistance cannot walk 10-20 metres without experiencing angina has respiratory disease has cardiac disease had psychiatric illness that prevents participation in interventions has dysphasia (a speech impairment) has recent modifications to home fails the Short Portable Mental Status Questionnaire (a measure of organic brain problems)

• Baseline assessment

  Assessors	A trained assessor makes a home visit to collect background information and assess risk factors. The assessor does not know which intervention(s) the participant will receive, because the random allocation to treatment group has not yet occurred.
  Questionnaire	Home assessor interviews participant to complete background and risk factor questionnaires. Measures include a Falls Efficacy Scale which gives a quantitative measure of the fear of falling during activities of daily living.

• Physical risk factors

  Quadriceps strength	Participant should be seated. Attach spring gauge to one ankle. Record quadriceps strength in kilograms while leg is extended. Repeat three times, and record the best result. Repeat the procedure for the other leg.
  Postural sway	Measure postural sway using the Lord swaymeter under two conditions: (i) in bare feet, and (ii) standing on 8.5cm thick foam pad. Attach the swaymeter belt to the participant’s waist. The rod connected to the belt should be behind the participant. The belt is connected by the rod to a pen. Ensure that the pen and graph paper are placed on a stable surface. The participant’s body movement should be traced on the graph paper by the pen.
  Maximal balance range	Again use the Lord swaymeter with the rod behind the participant. Ask the participant to lean backwards and forwards. The participant should attempt to go as far as possible without losing balance. The test should be attempted three times and the best result recorded. Record the distance travelled by the swaymeter pen for the best attempt.
  Dynamic balance	Use the Lord swaymeter with the rod in front of the participant. Show the participant the pattern to be traced on the swaymeter graph paper. The participant should keep both feet on the ground while moving his or her body to follow the pattern. Record the number of times the pen moves outside the track to be traced, and add 5 every time a corner is cut.
  Timed-up-and-go test	Seat the participant in a chair without arm rests. Ask the participant to get up from the chair, walk three metres, turn around, walk back to the chair and sit down. Record the time taken in seconds.
  Single leg balance	The participant should remove his or her shoes. Ask the participant to balance on one leg without any supports for one minute. Record the time in seconds that the participant is able to balance on one leg. Repeat for the other leg.
  Height	Measure participant’s height (shoes removed) in cm.
  Weight	Measure participant’s weight in kg.
  Visual acuity:	Conduct visual acuity tests in the best lit room in the participant’s home. Open all curtains and turn on all lights.
  Low & high contrast charts	Seat participant two metres from test charts. First use low contrast version of standard letter chart. Cover one eye and ask participant to read chart starting from the line with the largest letters. Record the smallest line the participant could read correctly (entirely or in part). Repeat for other eye. Second use high contrast version of standard letter chart and repeat the test.
  Random dot stereo butterfly chart	1. Ask participant to identify (butterfly) pattern in random dots. 2. Present participant with depth discrimination cards, one at a time, from easiest to most difficult. Each depth discrimination card shows four circles. Ask the participant if any circle on the card appears to be forward from the other circles. (Every card includes one circle that appears forward from the others.) Continue until the participant gets one card wrong. Record the number of correct cards.
  OKP glaucoma screening test	Present participants with the test chart; it shows a series of numbers in a spiral pattern with a black spot in the centre. Cover one eye and ask the participant to read each number and indicate if the black spot disappears. Record the number of times the black spot disappears. Repeat for the other eye. (This is a test of field of view.)
  Home hazards	Examine the rooms used in a normal week by the participant and record the hazards identified.

• Random assignment

  Once the questionnaire and risk assessment are completed, participants should be randomly assigned to one of the eight groups. The random assignment is undertaken using a software program administered by a person not otherwise involved in the conduct of the study.

• Interventions

  Exercise intervention	Fifteen weekly 35-55 minute strength and balance exercise class led by VicFit instructors. Daily 25-30 minute home-based strength and balance exercises.
  Vision intervention	Untreated visual problems identified in baseline assessment are referred to a general practitioner, optometrist or other eye specialist as appropriate.
  Home hazard intervention	Removal of home hazards identified in baseline assessment. Participant agreement is required to remove any hazard. Hazard may be removed by participants or by the Council Home Maintenance program (up to a cost of $100).
  Combined interventions	Participants assigned to combined intervention groups should receive all relevant interventions.
  No intervention	Participants assigned to the “control” group did not receive any of the interventions during the study period. They were offerred an intervention after the study was finished.

• Outcome measurements

  Click the play button to hear more about the calendars.

  Follow up period	18 months
  Falls calendar	Each day participants record, on a “Falls calendar”, whether or not they have fallen. At the end of each month, participants return calendar by reply paid post.
  Calendar follow up	Research assistant telephones participants who have not returned monthly calendars 10 working days after the end of the month.
  Falls interview	Research assistant conducts structure telephone interview with participants who report having fallen to obtain details about the fall.
  Follow up assessment
  Timing	Follow up assessments at 18 months undertaken for half the participants.
  Random selection	Randomly select 1 in 2 participants for follow up assessments.
  Assessment	Repeat the risk factor assessments made at the baseline assessment. The assessor should not know which intervention(s) any participant has received.