What can older people tell us about their experiences of therapeutic exercise as part of a falls prevention service?
Janet Husk is a Patient Safety and Quality Improvement Manager at the Clinical Effectiveness and Evaluation Unit of the Royal College of Physicians
The answer is a great deal as you can see in this article on ‘older people’s experiences of therapeutic exercise’ - available online in Age and Ageing. Don’t think it was just younger people (55 to 74 years) that responded; some people that completed a questionnaire were over 95 years of age which just goes to show that people of all ages were exercising and were able to give important feedback about their experiences of NHS run therapeutic exercise programmes to reduce falls.
This work involving patients and NHS staff was a key part of the National Audit of Falls and Bone Health Audit programme which was funded by the Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Audit and Patients Outcome Programme (NCAPOP). This approach complemented the standard national clinical audit cycle.
Evidence tells us that multiple-component group exercise reduced the rate of falls and risk of falling, as does individually prescribed multiple-component home-based exercise.
BUT specifically, the exercise provided must be of the correct:
- type (i.e. targeted resistance training and dynamic balance)
- frequency (i.e. minimum dose 50 hours, preferably at least three times each week)
- intensity (i.e. sufficiently challenging to the individual and progressive)
- duration (i.e.15–52 weeks).
We wanted to see if we in the NHS were getting it right because there were definite clues from the older people’s experiences of falls prevention services report and in the 2010 national audit of falls and bone health report that this may not be the case. So using a multi-disciplinary project group which included patient and staff representatives, we developed two questionnaires. One was a specific questionnaire based on these concerns for patients. The second was a questionnaire about exercise provision and was sent to staff members involved in the delivery of NHS run exercise interventions for reducing falls risk in NHS trusts.
People were keen to participate in the project and over 1700 patients gave us their views. Results showed that although two-thirds attended group-based therapeutic exercise classes generally of short duration (80% <12 weeks) and low intensity (85% one class per week) at hospitals and community venues. Only 52% reported that exercises were made more difficult as they improved. Despite this there were many positive comments, e.g.
‘The attitude of the staff helped win me over as I had no intention of going beyond the first session. However they convinced me that even at 82 it would be beneficial.’
What we found was that people were exercising; they were satisfied with the exercise provision and enjoyed the exercises, but not enough evidence based classes or additional training for staff to deliver them are provided. People want longer term exercise services for falls prevention so we made recommendations that these services need commissioning in the community including the sorts of skills and training people leading these programmes should have to enable better healthcare for older people. Read all about it in our report.