Self-Management and Adherence with Exercise-Based Falls Prevention Programmes for Older People with Long-Term Conditions: A Framework for Physiotherapy Practice

Robinson, Lisa (2012) Self-Management and Adherence with Exercise-Based Falls Prevention Programmes for Older People with Long-Term Conditions: A Framework for Physiotherapy Practice. Doctoral thesis, Northumbria University.

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Abstract

Introduction
This study aimed to work with older people attending a regional falls and syncope service, older people with the falls-associated chronic liver disease primary biliary
cirrhosis, relatives and local physiotherapy practitioners to develop a framework for physiotherapy practice to promote self-management and adherence with an exercise based
falls prevention programme for older people with a long-term condition.

Methods
Focus groups were conducted with older people attending a regional falls and syncope service (3 groups, total 12 participants), relatives (1 group, total 4 participants) and local physiotherapists (4 groups, total 18 participants). Participants were asked to propose strategies to promote self-management and adherence with an exercise-based falls prevention programme. These strategies were tested and refined in an experimental case-series for 10 older people with primary biliary cirrhosis.

Findings
The older people participating in the focus group research expressed a long-term commitment to exercise-based falls prevention programmes. They valued approaches that promoted self-efficacy and self-management. The physiotherapists
indicated that the older people they came into contact with were poorly motivated to participate in an exercise-based falls prevention programme. They demonstrated a limited awareness of strategies to promote self-efficacy and self-management. Visual analysis of the experimental case-series data revealed unstable baselines and fluctuations throughout the treatment and follow up phases in keeping with
variations in disease-specific quality of life measures, suggesting that long-term conditions interact with measures that predict and monitor falls-risk and selfefficacy.
The exercise-based falls prevention programmes had perceived benefit for older people with primary biliary cirrhosis. However, this was not evident in the measures selected, many of which demonstrated a ceiling effect in the population
group under investigation. The self-management strategies had low levels of perceived acceptability. Participants indicated that they lacked the necessarily skills to monitor their progress with an exercise-based falls prevention programme on completion of the experimental case-series.

Conclusion
This study demonstrated that self-management does not sit comfortably within the philosophy of routine clinical practice. The framework for physiotherapy practice
developed during the course of the current study has the potential to empower physiotherapists and older people with long-term conditions identified as being at increased risk of falling to work in partnership to challenge existing approaches to clinical service delivery.

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