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Educating nursing home staff on fracture prevention: a cluster randomised trial

Educating nursing home staff on fracture prevention: a cluster randomised trial
Educating nursing home staff on fracture prevention: a cluster randomised trial
OBJECTIVE: to assess whether specialist osteoporosis nurses delivering training to care home staff can reduce fractures and improve the prescription of treatments to reduce fractures versus usual care. DESIGN: pragmatic cluster randomised controlled trial (RCT) with randomisation at the Primary Care Organisation (PCO) level. SETTING: care homes (residential, nursing and EMI) across England and Wales within PCOs. PARTICIPANTS: all 300 PCOs in England and Wales were invited to take part. Of these, 58 agreed to participate and gained ethical approval in time to start the study: 29 clusters were randomised to the intervention group and 29 to the control. INTERVENTION: specialist osteoporosis nurses undertaking short training sessions with care home staff emphase the importance of fracture and fall prevention and train staff on how to identify those residents at high risk of fracture. Residents' risk of fracture and falls was reported to general practitioners (GPs) of patients along with treatment recommendations. OUTCOME MEASURES: primary outcome measures were total fractures over the past 12 months and total hip fractures over past the 12 months. Secondary outcome measures were total home falls, number of residents sustaining a fall, number of residents prescribed bisphosphonates, number of residents prescribed calcium and vitamin D and number of residents wearing hip protectors. All outcomes were measured at the care home level. RESULTS: of the 230 care homes randomised data were collected from 209 of these containing 5,637 residents. There were no differences between the groups in the incidence rate ratios (IRRs) for total fractures (IRR = 0.94 [0.71, 1.26] P = 0.70) or total hip fractures (IRR = 0.86 [0.63, 1.18] P = 0.36). No differences were found between groups for home falls or hip protector use. A significant increase in bisphosphonate prescription was seen in the intervention group over the control group (IRR = 1.50 [1.00, 2.24] P = 0.05). Calcium and vitamin D prescription was significantly increased in the intervention group over the control group (IRR = 1.64 [1.23, 2.18] P<0.01). CONCLUSION: the intervention significantly increased the prescription of bisphosphonates and calcium/vitamin D, but was not associated with a significant effect on the rate of falls or fractures
reference values, methods, vitamin d, risk, accident prevention, incidence, professional competence, 80 and over, time, intervention studies, female, nursing staff, england, fractures, aged, prevention & control, wales, hip, education, risk factors, bone, nursing, sensitivity and specificity, male, osteoporosis, homes for the aged, england and wales, accidental falls, hip fractures, residential facilities, nursing homes, humans, calcium, cluster analysis, statistics & numerical data
0002-0729
167-172
Cox, H.
e589d438-83bb-4533-accb-69308d15b786
Puffer, S.
2a02e6ef-87ff-4b6d-8b2f-38bce151bc6b
Morton, V.
dbf3225c-31e7-4127-a405-375e21bdfffb
Cooper, C.
e05f5612-b493-4273-9b71-9e0ce32bdad6
Hodson, J.
0b74eb61-d03d-4eab-9082-1ffef5f4a440
Masud, T.
c2a91f3a-4dc9-4dc2-9102-0ff8cacdfe53
Oliver, D.
9474e136-f46a-4879-ae13-ac5825fe7717
Preedy, D.
d543664c-67ad-4692-b863-652ae272fb44
Selby, P.
3c685c56-72fd-4a25-b4b8-120074cc087b
Stone, M.
9dc42e09-cff8-44b8-8499-49a281922967
Sutcliffe, A.
c9fa564c-409e-49e5-bc66-bc13bf7ea5ce
Torgerson, D.
9eb7003f-725d-47b5-9ff9-6afc20be983c
Cox, H.
e589d438-83bb-4533-accb-69308d15b786
Puffer, S.
2a02e6ef-87ff-4b6d-8b2f-38bce151bc6b
Morton, V.
dbf3225c-31e7-4127-a405-375e21bdfffb
Cooper, C.
e05f5612-b493-4273-9b71-9e0ce32bdad6
Hodson, J.
0b74eb61-d03d-4eab-9082-1ffef5f4a440
Masud, T.
c2a91f3a-4dc9-4dc2-9102-0ff8cacdfe53
Oliver, D.
9474e136-f46a-4879-ae13-ac5825fe7717
Preedy, D.
d543664c-67ad-4692-b863-652ae272fb44
Selby, P.
3c685c56-72fd-4a25-b4b8-120074cc087b
Stone, M.
9dc42e09-cff8-44b8-8499-49a281922967
Sutcliffe, A.
c9fa564c-409e-49e5-bc66-bc13bf7ea5ce
Torgerson, D.
9eb7003f-725d-47b5-9ff9-6afc20be983c

Cox, H., Puffer, S., Morton, V., Cooper, C., Hodson, J., Masud, T., Oliver, D., Preedy, D., Selby, P., Stone, M., Sutcliffe, A. and Torgerson, D. (2008) Educating nursing home staff on fracture prevention: a cluster randomised trial. Age and Ageing, 37, 167-172. (doi:10.1093/ageing/afm168).

Record type: Article

Abstract

OBJECTIVE: to assess whether specialist osteoporosis nurses delivering training to care home staff can reduce fractures and improve the prescription of treatments to reduce fractures versus usual care. DESIGN: pragmatic cluster randomised controlled trial (RCT) with randomisation at the Primary Care Organisation (PCO) level. SETTING: care homes (residential, nursing and EMI) across England and Wales within PCOs. PARTICIPANTS: all 300 PCOs in England and Wales were invited to take part. Of these, 58 agreed to participate and gained ethical approval in time to start the study: 29 clusters were randomised to the intervention group and 29 to the control. INTERVENTION: specialist osteoporosis nurses undertaking short training sessions with care home staff emphase the importance of fracture and fall prevention and train staff on how to identify those residents at high risk of fracture. Residents' risk of fracture and falls was reported to general practitioners (GPs) of patients along with treatment recommendations. OUTCOME MEASURES: primary outcome measures were total fractures over the past 12 months and total hip fractures over past the 12 months. Secondary outcome measures were total home falls, number of residents sustaining a fall, number of residents prescribed bisphosphonates, number of residents prescribed calcium and vitamin D and number of residents wearing hip protectors. All outcomes were measured at the care home level. RESULTS: of the 230 care homes randomised data were collected from 209 of these containing 5,637 residents. There were no differences between the groups in the incidence rate ratios (IRRs) for total fractures (IRR = 0.94 [0.71, 1.26] P = 0.70) or total hip fractures (IRR = 0.86 [0.63, 1.18] P = 0.36). No differences were found between groups for home falls or hip protector use. A significant increase in bisphosphonate prescription was seen in the intervention group over the control group (IRR = 1.50 [1.00, 2.24] P = 0.05). Calcium and vitamin D prescription was significantly increased in the intervention group over the control group (IRR = 1.64 [1.23, 2.18] P<0.01). CONCLUSION: the intervention significantly increased the prescription of bisphosphonates and calcium/vitamin D, but was not associated with a significant effect on the rate of falls or fractures

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More information

Published date: 2008
Keywords: reference values, methods, vitamin d, risk, accident prevention, incidence, professional competence, 80 and over, time, intervention studies, female, nursing staff, england, fractures, aged, prevention & control, wales, hip, education, risk factors, bone, nursing, sensitivity and specificity, male, osteoporosis, homes for the aged, england and wales, accidental falls, hip fractures, residential facilities, nursing homes, humans, calcium, cluster analysis, statistics & numerical data

Identifiers

Local EPrints ID: 61026
URI: http://eprints.soton.ac.uk/id/eprint/61026
ISSN: 0002-0729
PURE UUID: a0be0484-d2b8-416a-9979-b28ecd412fc3
ORCID for C. Cooper: ORCID iD orcid.org/0000-0003-3510-0709

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Date deposited: 02 Sep 2008
Last modified: 18 Mar 2024 02:44

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Contributors

Author: H. Cox
Author: S. Puffer
Author: V. Morton
Author: C. Cooper ORCID iD
Author: J. Hodson
Author: T. Masud
Author: D. Oliver
Author: D. Preedy
Author: P. Selby
Author: M. Stone
Author: A. Sutcliffe
Author: D. Torgerson

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