Year: 2010

Staff: Briony Dow, Sue Williams, David Berlowitz (Institute for Breathing and Sleep), Xiaping Lin, Vanessa Wilkinson (Institute for Breathing and Sleep), Karen Borschmann, Melissa Russell, Kate Crowley (Institute for Breathing and Sleep), Frances Batchelor, Keith Hill

Summary: This project investigated the frequency of specific sleep difficulties (e.g. sleep apnoea, periodic leg movements) in people aged 70 and over who had previously fallen. In addition, the association between specific sleep difficulties and falls risk were evaluated, and the feasibility of undertaking in-laboratory polysomnography was examined. The study found sleep difficulties are common in older fallers. Home assessments and in-laboratory sleep studies are feasible in older people.

Funding source: Department of Veteran’s Affairs

Year: 2005-07

Staff: Keith Hill, Sue Williams, Sue Hunt, Caroline Brand (RMH), Helen Moran (RMH)

Summary: Both arthritis and falls are common problems for older Australians. There are many risk factors that increase the tendency of a person to fall. Arthritis is reported to be one of those risk factors although only limited research has been done specifically looking at the effect of arthritis on the risk or tendency for a person to fall.

We recently completed a study investigating two of the most common forms of arthritis in the Australian community, Osteoarthritis (OA) and Rheumatoid arthritis (RA). A comprehensive laboratory and clinical test battery of balance and falls risk measures was undertaken by women with OA or RA. Participants were provided with a home exercise program based on the successful Otago falls prevention program, and were re-assessed after 4 months.

Falls were common in participants with osteoarthritis (61% fell in preceding 12 months) and rheumatoid arthritis (67% fell in preceding 12 months) compared to approximately 30% of people aged over 65 in the general community falling each year. Participants with either osteoarthritis or rheumatoid arthritis had substantial impairment across a range of balance performance and falls related measures. Participants achieved improved performance on the majority of balance and related measures following the exercise program.

Publication(s): Williams SB, Brand CA, Hill KD, Hunt SB, Moran H. (2010). Feasibility and Outcomes of a Home-Based Exercise Program on Improving Balance and Gait Stability in Women With Lower-Limb Osteoarthritis or Rheumatoid Arthritis: A Pilot Study. Archives of Physical Medicine and Rehabilitation, 91 (January), 106-114.

Funding source: J.O. and J.R. Wicking Trust

Year: 2009-Current

Staff: Sue Williams, Claudia Meyer, Keith Hill, Xiao Jing Yang, Nicolas Cortes

Summary: This project is investigating whether an approach for the assessment and provision of a home exercise program for people with mild balance dysfunction implemented in a recently completed DVA funded project (Effectiveness of a screening program for early balance problems and targeted exercise interventions among older community ambulant Veterans; Hill et al, 2008) can be implemented with similar level of success through existing community health settings. It is also looking at the key factors influencing successful implementation of the program for physiotherapists working in relevant community settings and for maximising participant adherence to the program for older people with mild balance impairment.

Funding source: Department of Veterans’ Affairs

Year: 2006-08

Staff: Xiao Jing Yang (PhD candidate), Keith Hill, Kirsten Moore, Shyamali Dharmage (University of Melbourne), Sue Williams, Leslie Dowson, Sarah Tarquinio

Summary: Many older people who feel a little unsteady, or experience occasional falls tend to put this down to the effects of ageing, and do not seek medical or allied health advice about the fall, or ways to minimise risk of future falls.  This study will recruit Veterans and war widow/ers aged over 65 who remain independent walking away from home, but who feel a little unsteady or have occasional minor falls or near falls.  Participants will go through a balance and mobility assessment, which will include balance measures on a force platform.   At the end of the assessment, the person will be classified as “balance within normal limits for age and gender”, in which case they will be informed of test results, and have no other involvement in the study.   For those whose balance is identified as “outside of normal limits”, participants will be randomised to an intervention group, who will receive a physiotherapist delivered home exercise program with reviews, or to a “usual care” group, who will be given a general falls prevention information brochure, but otherwise do what they would normally do from a health perspective.  Participants will be re-assessed 6 months later to determine the effectiveness of the exercise program.

If you meet the criteria above and are interested in participating please contact Leslie Dowson on 8387 2200.

Funding source: Department of Veterans’ Affairs

Year: 2007-08

Staff: Kirsten Moore, Kay Ledgerwood, Karen Borschmann, Emma Renehan, Melissa Russell, Xiaoping Lin, Will Fernley-Sander, Sue Hunt (NARI), Rachel Whiffen, Colin Brown, Jasmine Sison (HealthWest Partnership)

Summary: NARI, in conjunction with the HealthWest Partnership, recently completed a randomised controlled trial to evaluate the effectiveness of health professional facilitated education sessions on physical activity levels and readiness to change amongst Macedonian and Polish older people (55+) in the Western Region of Melbourne. Of the 121 participants who completed the baseline assessment, 93 completed the follow-up assessment including 48 intervention and 45 control participants. Significant improvements were found for distance walked in six meters for both groups, the sit to stand for the intervention group and the stages of change questionnaire for the control group. Although the results indicated a trend for improvement on all outcome measures for all participants, there was no significant effect from the physical activity intervention. Limitations to the study were discussed and recommendations made for future research and physical activity interventions.

Funding source: HealthWest Partnership

Reports: The final report can be downloaded here ....

Year: 2006-09 (current)

Staff: Keith Hill, Cathy Said (University of Melbourne), Shylie Mackintosh (University of South Australia), Craig Whitehead (Flinders University), Frances Batchelor, Sue Hunt

Summary: This multi-centre study aims to evaluate the effectiveness of a targeted falls intervention program in reducing falls following stroke.  It has been shown that individuals who have suffered stroke have a higher rate of falls than in the general population.  To date there has been little research into this area and no randomised controlled trials evaluating the effectiveness of a falls prevention program in this “at risk” group.  The study, which has NH & MRC funding, will recruit participants who have been discharged from hospital (rehabilitation) following stroke.  Participants will be recruited from 4 sites in Melbourne and 3 sites in Adelaide, and followed up for 12 months.  In addition to the main study, two sub-studies will be undertaken: the first a longitudinal study of falls, fear of falling and activity restriction; and secondly a study which will examine residual impairments in stability, and the effects of the falls prevention program on gait stability and obstacle negotiation.

Funding source: NH & MRC Grant

Year: 2006-07

Staff: Kirsten Moore, Robert Webb, Keith Hill, Freda Vrantsidis, Sue Hunt, Leslie Dowson

Summary: The Moreland Community Health Centre and the National Ageing Research Institute (NARI) recently completed a randomised control trial to explore the effectiveness of a unique and gentle exercise approach, based on the Feldenkrais Method, called “Getting Grounded Gracefully. After completing this 8 week program, the intervention group showed significant improvement in gait speed and falls efficacy and a trend was evident in the Timed Up and Go, a measure of dynamic balance. Survey responses indicate that the program was well received by the intervention participants, and class attendance was high. This program warrants further investigation given that the study was underpowered.

Funding source: J.O. and J.R. Wicking Trust

Year: 2005-07

Staff: Keith Hill, Marcia Fearn, Alison Street (Ronald Sawers Haemophilia Centre at the Alfred Hospital), Cath Walsh (Alfred Hospital), Leonie Mudge (Alfred Hospital), Megan Walsh (Alfred Hospital)

Summary: Clinical staff at the Ronald Sawers Haemophilia Centre at the Alfred Hospital identified that falls appear to be a common problem for their clients with haemophilia and other bleeding disorders. However, there has been virtually no research to date evaluating falls and balance dysfunction in people with haemophilia and other bleeding disorders (PWH). This project aimed to evaluate the magnitude of the problems of falls and balance dysfunction in PWH, and to determine the feasibility of a home exercise program targeting balance training for this group. Balance performance of 20 PWH and aged matched controls were compared, using a range of clinical measures of balance and falls risk, as well as functional balance and mobility measures on a force platform. Following completion of the initial assessment, all PWH participants were prescribed an individualised tailored home exercise program by the assessing physiotherapist. Results demonstrated moderate impairment in balance performance in PWH, relative to an age matched sample. They also provided indication that an individualised balance home exercise program may improve measures of balance, mobility and falls risk in PWH. In conclusion, it is recommended that balance, mobility and falls risk be routinely measured in PWH by a physiotherapist, and if there is an indication of reduced balance performance, an exercise program incorporating balance exercises, in addition to the more routinely prescribed strengthening and flexibility exercises, should be provided to clients.

Funding source: Haemophilia Foundation Australia

Note: This report is also included under "Falls Prevention Research - Service Evaluation"

Year: 2002-06

Staff: Keith Hill, Irene Blackberry, Melissa Russell, Melita Giumarra, Fiona Bremner, Sue Williams, Terry Sullivan, Sarah Tarquinio

Summary: The primary aim of this project is to evaluate the effectiveness of a targeted multi-factor intervention in improving health and well being of older people who present to an Emergency Department (ED) following a fall. It also aims to identify those within this high-risk population most likely to benefit from the intervention program.

The project will also involve validation of the Falls Risk for Older People - Community Setting (FROP-Com).

The project is currently underway at the Royal Melbourne, Western, Sunshine, Northern, Williamstown, Sandringham and Austin Hospitals.

Funding source: Victorian Department of Human Services and the Australian Government Department of Veteran Affairs

Reports: For more details, link to the Information Sheet here ....  For preliminary analysis details, link to the Preliminary Analysis data sheet here...

View the FROP-Com and Guidelines

Update: In 2010 the NARI Fall Research Team reviewed the FROP-Com and Guidelines to reflect work by Russell 2008 and Murray 2005 identifying mild, moderate and high falls risk (previously two graded categories of risk). The falls risk gradings have been modified accordingly and other basic formatting changes made.

Click here for the amended FROP-Com

Click here for the amended Guidelines

Year: 2001-06 (current)

Staff: Natalie ElHaber (PhD candidate), Keith Hill, John Wark (University of Melbourne)

Summary: A comprehensive series of balance and mobility related measures (including force platform measures on the Chattecx Balance System) are being compared between monozygous (identical) and dizygous (non-identical) twins to identify whether there is a heritable component to performance on these measures which are important falls risk factors.

Year: 2001-05

Staff: Kate Murray (PhD candidate), Keith Hill, Bev Phillips (University of Melbourne), John Waterston (Alfred Hospital)

Summary: This project had three components, all related to the common, and often poorly managed problems associated with vestibular (inner ear) dysfunction). Phase 1 involved a comprehensive review of older people presenting to Emergency Depts after a fall, including formal vestibular function tests. Phase 2 involved investigation of two new assessments of specific structures in the inner ear (the otoliths). Phase 3 was a study investigating the effectiveness of vestibular rehabilitation for people with different inner ear pathology. Results that a vestibular rehabilitation program was effective in reducing symptoms and handicap and improving balance in a sample with chronic vestibular pathology. Outcomes were similar for those with semicircular canal involvement only, and for those with combined semicircular canal and otolith pathology.

Funding source: Phase 1 funded by MacPherson Smith Trust. Phase 3 funded by the Garnett Passe and Rodney Williams Memorial Foundation.

Year: 2001-05

Staff: Shylie MacKintosh (PhD candidate), Keith Hill, Pat Goldie (LaTrobe), Karen Dodd (LaTrobe)

Summary: Falls are a common problem after stroke. This study involved a comprehensive assessment of stroke patients following discharge from hospital, and following patients up for the next six months, to identify subsequent falls and changes in balance and mobility measures. Forty six percent of stroke patients fell at least once during the 6 months following discharge home. Significant predictors of multiple falls after return home were having had a fall while in hospital, and one of the Step Test or Berg Balance Scale. Results highlight the need for targeted falls prevention programs for people returning home after stroke rehabilitation.

Year: 2001-04

Staff: Terry Haines (PhD candidate), Keith Hill, Kim Bennell (University of Melbourne), Richard Osborne (University of Melbourne)

Summary: This randomised controlled trial with over 600 patients in a sub-acute hospital setting in Melbourne (Peter James Centre) was the first RCT to demonstrate a significant reduction in falls among in-patients. The intervention group received one of four intervention based on a multi-disciplinary falls risk assessment tool (falls risk alert card, education program, additional exercise program, and/or hip protectors).

Reports: The "Exercise program" used with this study is available here ....   and the "Patient education booklet" is available here ....