Self-management and adherence with exercise-based falls prevention programmes

A qualitative study to explore the views and experiences of older people and physiotherapists.

Purpose: The aim of this study was to involve older people and physiotherapists in the development of acceptable strategies to promote uptake and adherence with an exercise-based falls prevention programme.

Method: Focus groups were conducted with older people attending a regional falls and syncope service (3 groups, total 12 participants) and local physiotherapists (4 groups, total 18 participants). Framework analysis was undertaken to identify why uptake and adherence with an exercise-based falls prevention programme is currently poor and to provide suggestions for how it might be improved.

Results: The older people participated in an exercise-based falls prevention programme to remain independent in activities of daily living. They valued approaches that promoted self-efficacy and self-management. In contrast, the physiotherapists perceived that many older people were reluctant to participate in an exercise-based falls prevention programme. While it was acknowledged that older people should be encouraged to take greater responsibility for the maintenance of their own health, the physiotherapists demonstrated a conflicting desire to remain in control of the treatment programme.

Conclusions: A focus on self-management support may provide the key to promoting uptake and adherence with an exercise-based falls prevention programme. Physiotherapists should move from being “experts” to “enablers” who use their professional knowledge and expertise to support older people at risk of falling to maintain optimum levels of health and independence.

Implications for Rehabilitation:

• Despite the established efficacy of exercise-based falls prevention programmes, their impact remains limited by low levels of uptake and adherence.
• Clinical encounters between physiotherapists and older people at risk of falling offer the opportunity for the exchange of new information to promote patient empowerment and shared decision-making.
• Physiotherapists need to move away from being experts who care for and do to their patients to enable us to use their professional knowledge and expertise to maintain optimum levels of health and independence for older people at risk of falling.

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