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Potential analysis for research on occupational therapy-led physical exercise programmes and home environment adaptation programmes to prevent falls for elderly people living at home / Potenzialanalyse zu ergotherapeutischen körperlichen Trainingsprogrammen und Wohnraumanpassungen zur Vermeidung von Stürzen bei zu Hause lebenden älteren Menschen 원문보기

International journal of health professions : journal of Verein zur Förderung der Wissenschaft in den Gesundheitsberufen, v.3 no.2, 2016년, pp.85 - 106  

Müller, Christian (Hochschule fü) ,  Lautenschläger, Sindy (r Technik und Wirtschaft des Saarlandes, Department Gesundheit und Pflege, Goebenstraße 40, 66117Saarbrü) ,  Voigt-Radloff, Sebastian (cken, Germany)

Abstract

AbstractHintergrundIn Deutschland ereignen sich jährlich vier bis fünf Millionen Stürze bei zu Hause lebenden Menschen im höheren Lebensalter. Die vorliegende Potenzialanalyse prüft, inwieweit ergotherapeutische körperliche Trainingsprogramme und Wohnraumanpassungen das Potenzial haben, extrinsische und intrinsische Sturzrisikofaktoren wirksam zu beeinflussen und die Haufigkeit von Stürzen bei zu Hause lebenden älteren Menschen zu reduzieren.MethodikDie Potenzialanalyse wurde nach einem Methodenleitfaden (S. 11-22) erstellt. Der Leitfaden ist wie folgt abrufbar: http://www.cochrane.de/news/leitfaden-f%C3%BCr-gesundheitsfachberufe-mai-2013. Die Fragestellung zu den versorgungsrelevanten Gesundheitsproblemen der Sturzprophylaxe wurde mit dem PICOS-Schema präzisiert, dazu ein Cochrane-Review systematisch recherchiert und die Evidenzqualität nach der GRADE-Methode bewertet. Des Weiteren wurden Studien im Zeitraum nach der Suchperiode des Reviews mit der Suchstrategie des Reviews identifiziert und gemeinsam mit den Studien des Review auf Übertragbarkeit in den deutschen Versorgungskontext geprüft.EvidenzlageDas aktuellste Cochrane Review aus dem Jahr 2012 belegt, dass körperliches Training die Anzahl an Stürzen (7 Studien, 951 Teilnehmer/-innen, 0.68 RaR; 95 %-KI [0.58-0.80]), die Anzahl gestürzter Personen (6 Studien, 714 Teilnehmer/-innen, 0.78 RaR, 95 %-KI [0.64-0.94]) und Frakturen (6 Studien, 810 Teilnehmer/-innen, 0.34 RaR, 95 %-KI [0.18-0.63]) wirksam reduzieren kann. Darüber hinaus zeigten randomisiert kontrollierte Studien, dass durch Wohnraumanpassungen die Anzahl von Stürzen (4 Studien, 1443 Teilnehmer/-innen, 0.69 RaR, 95 %-KI [0.55-0.86]) und die Anzahl gestürzter Personen (5 Studien, 1153 Teilnehmer/-innen, 0.79 RaR, 95 %-KI [0.70-0.91]) wirksam reduziert werden kann. Eine direkte Implementation der komplexen Interventionen in den deutschen Versorgungskontext ist kritisch zu beurteilen.ForschungsempfehlungEmpfohlen werden: 1) Wohnraumanpassungen standardisiert zu manualisieren und 2) das Manual für körperliche Trainingsprogramme (LiFE) hinsichtlich theoretischer Fundierung, Akzeptanz, Anwendbarkeit und Durchführbarkeit zu prüfen und beide Interventionen im Rahmen von Machbarkeitsstudien zu untersuchen. Zudem sollten 3) klientenzentrierte Veränderungsmaße, Kosten und unerwünschte Effekte mit erfasst werden. Im Anschluss daran kann bei positiven Ergebnissen eine Wirksamkeitsstudie im deutschen Versorgungskontext angeschlossen werden.

Abstract

AbstractBackgroundIn Germany, four to five million community-dwelling people aged 65 years or older fall every year. The presented potential analysis evaluates the potential of occupational therapy-led physical exercise programs and home environment adaptations to reduce the frequency of falling and as well as intrinsic and extrinsic risk factors for falling of older people living at home.MethodsThe potential analysis was compiled according to a method guideline (p.11-22) available as follows: http://www.cochrane. de/news/leitfaden-f%C3%BCr-gesundheitsfachberufe-mai-2013. The research question of fall prevention was considered as very relevant for health care and specified according to the PICOS-system. A Cochrane review was systematically searched and the body of evidence was assessed using the GRADE-system. In addition, studies after the search period of the Cochrane review were identified using the search strategy of this review. Both the studies within and after the review were assessed regarding their transferability to the German health care context.Corpus of evidenceA Cochrane review from 2012 revealed that occupational therapy-led physical exercise programs reduced the frequency of falling of older people living at home (7 studies, 951 participants, 0.68 RaR; 95%-KI [0.58-0.80]), the number of fallers (6 studies, 714 participants, 0.78 RaR, 95%-KI [0.64-0.94]) and the fractures (6 studies, 810 participants, 0.34 RaR, 95%-KI [0.18-0.63]). Further studies showed that home environment adaptation programs significantly reduced the number of falls (4 studies, 1443 participants, 0.69 RaR, 95%-KI [0.55-0.86]) and the number of fallers (5 studies, 1153 participants, 0.79 RaR, 95%-KI [0.70-0.91]). However, direct implementation into the German healthcare context is not recommendable.Implication for researchIt is recommended (1) to manualise identified home environment adaptation programmes for the German healthcare context and (2) to pilot-test the physical exercise programmes ‘LiFE’ with regard to theoretical framework, acceptance, applicability and feasibility and to examine both interventions as part of a feasibility study. If this trial results in a feasible treatment programme well accepted by patients and their treating occupational therapists, a large-scaled randomized clinical trial in terms of comparative effectiveness research may follow.

주제어

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