Dear Alison
The CSP has just completed a National Sentinel audit based on these
guidelines.
A report is soon to be available from the Professional Affairs Department at
the CSP on this audit. You can obtain an executive summary of this from PA
on ph: 020 7306 6633. The working group have made several suggestions and
will continue to meet to try to agree upon a minimum data set and
recommendations of outcome measures for use in your patient group. The audit
form might help you come up with something - I can send this to you.
My immediate thought was that perhaps you could come up with agreed
criteria, a flow chart or algorithm, that would highlight to any of the
other professionals you're working with, that the patient needs to go
imediately to a particular professional e.g. with your example of the dizzy
faller needing to see the medical doctor rather than seing you, to save
duplication of questionning and inappropriate use of time.
You could then add a range of outcome measures according to a pre-agreed
rationale, ie specific assessment measures: e.g. standing balance, step
test, for people with muscular weakness; 180 degree turn, TUAG, Berg Test
for functional info etc.
Regarding measures, assessment; I think there is a whole host of papers
written quite recently that might be worth checking out, in an attempt to
find a range suitable for your screening assessment. If not on Medline, then
certainly CINAHL.
Off the top of my head: Tinetti, Simpson, Nashner, Berg, Shumway-Cook,
Horak, are names worth searching on. But there'll be loads of others.
Ragnarsdottir had an article in Physiotherapy 'The concept of balance' in
1996 82, 6, p368 - 374 which has some good references to use as a start.
The CSP has developed a listing of outcome measures at
http://www.nice.org.uk. (See Frontline, Jan 5 2000, p18).
Good luck with it
Ralph Hammond MCSP
Professional Adviser
Research and Clinical Effectiveness Unit
Chartered Society of Physiotherapy
UK
-----Original Message-----
From: alison hall [mailto:[log in to unmask]]
Sent: 08 January 2000 17:29
To: [log in to unmask]
Subject: Falls Clinics for the Elderly
I am a physio working in a Day Hospital in Durham (UK). We are
trying to set up a falls screening clinic (multidisciplinary). I am trying
to formulate a screening standardised assessment for the physio/OT part of
the screening process, based on the CSP Guidelands for the Collaborative
Management of Elderly patients Who have Fallen.
I'm trying to use validated outcome measures, but I want to be
sensible,since we're a screening clinic,
i.e. use the formulated assessment as a guideline to direct the
progression of the assessment based upon the history of the fall and the
clinical presentation. So if someone comes in who has had a dizzy spell
prior to each fall, I don't want to go assessing them unnecessarily with a
myriad of balance tests (since they will be seeing at least 4 different
professionals at each clinic) and there would more likely be a medical cause
for the fall.
Of course, general observation of gait and transferring would
obviously flag up any indicators of physical risk factors and this would
direct the assessment thereafter along the standardised assessment of
ROM/strength/balance etc as necessary.
If a person was suspected of having a balance/mobility problem, we
might then decide to pull out of "our bag of tricks", for example, a
standardised, validated outcome measure like the Get up and Go Test, or the
Lateral Reach Test, or the Berg Balance Scale - depending upon the history
of the fall and/or our observation of them during general transferring/gait.
The rationale for my not wanting to do a routine standardised
assessment of EVERYTHING on EVERYONE is based on the fact that in a normal
assessment situation, we would use our problem solving skills about what
TYPE of test is required on each INDIVIDUAL patient, depending upon the
history of the current problem and obvious clinical signs as the assessment
progresses. Not to mention
the fact that the CSP Guidelines are, in fact, guidelines indicating
what should be considered in each case. We felt it would not be clinically
useful or efficient to do a FULL STANDARDISED assessment on everyone.
I don't think this will affect any audit procedure, as a screening
clinic cannot claim in itself to reduce the number of falls. We are merely
there to assess the patients, so audit-wise we can show what TYPE of patient
is being referred in and exactly WHAT problems they were found to have and
where they were thereafter referred to sort each problem out!
I would be grateful if anyone could offer me their opinion, advice
etc with regard to screening assessments for Falls Clinics in the Elderly
and indeed let me know of any Falls Clinics they are involved in/any
research that might be interesting (even treatment for fallers!).
In terms of follow up of these patients, any patients found to have
a physical problem for which physiotherapy/OT can be used as an
intervention to reduce the fall risk, can be thereafter seen in our Day
Hospital,or at a domiciliary visit etc (or indeed given exercises at the
screening clinic).
We also intend to have a Falls Group for selected patients which
will be Therapy (OT/Physio)run, with the aims to educate and empower
patients/increase confidence in the areas of:-
getting up from floor, summoning help, removing risks from the
environment etc.
These will be interactive sessions with the patient group to make
THEM come up with the answers, as well as ourselves (based on knowledge of
retention of information!).
Thanks for your help!
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