252 - Barriers and facilitators to exercise engagement in people over 60 at risk of falls: an exploratory study

Abstract

Purpose: A study protocol abstract.

The main aim is to explore the barriers and facilitators to exercise engagement in participants over the age of 60 at risk of falls.

30% of over 65's and 50% of over 80's will fall each year, costing the NHS 2.3 billion. Locally, A and E attendances due to falls and hip fractures are above national average. Falling reduces patient confidence and further mobility, which can impact on developing long term conditions.

Musculoskeletal (MSK) Physiotherapists receive referrals of injuries or fractures post falls into the service. 30% of our caseload are over the age of 60, and health professionals should be screening for falls risk. Research has shown that functional exercises help improve the strength and balance in over 60's.

Patients may return back into the service following another injury, or fail to attend. Exploring patient views will help us to understand engagement, improve our services and create proactive falls signposting pathways.

Research has shown 78% of over 70's had not completed home exercises. There is also a lack of research studying engagement in patients over 60 in the north west and those with health inequalities.

Methods: This study is a qualitative study, using semi structured interviews to explore 10 patients experiences.

The inclusion criteria includes patients over the age of 60, identified at risk of falls and referred for MSK Physiotherapy in Rossendale.

Physiotherapy staff have filled in an electronic template. ‘Risk of falls’ is defined as: Self-reported unsteadiness/concern, one or more falls in the last 6 months, or clinician identified a slow/unsteady gait pattern.

Falls risk will already have been discussed with the physiotherapist and an exercise programme provided.

PPI engagement groups identified falls and exercise as important topics, and reviewed the patient facing documents prior to ethics submission and study commencement.
Interviews will be recorded using dictaphone, following confidential and governance principles as detailed in protocol.

Results: At the time of writing, three patients have been interviewed. It is estimated 10 patients will have been interviewed by Summer 2024. Patient's have been randomly stratified. Anonymised qualitative data will be transcribed by an NIHR transcriber. Data will be studied using NVivo to identify common patient themes, including peer review of analysed data and feedback from public patient group. It is estimated around 12 months from participant recruitment, to analysis of findings.
The template has been rolled out across Pendle, and ongoing meetings re: implementation of the fragility pathway.

Conclusion(s): Current findings are themes around participant beliefs such as habits, motivations and influences regarding behaviour change and physiotherapy engagement.
Also identifying participant preferences regarding reminders of exercises, leaflet/literacy and staff communication.

Developing next stage of research: questioning staff and patients around health inequalities such as age, fraility and socioeconomic underserved populations.

Impact: Short term: Apply themes to improve local and community service delivery, including exercise engagement, format and staff communication

Medium term: Contributing to MSK fragility pathway roll out, including support for wider trust workforce

Long term: Reduce re-referrals, reduce cost on NHS services and improve quality of life

Funding acknowledgements: Research was part of an internship programme funded by NIHR ARC 2022-23 and a scholarship programme funded by NIHR CRN 2023-2025. This provides one day a week towards the research project, training, scholarship programme work and any additional research activities such as ARCFEST and research festivals, poster conferences. NIHR ARC will also fund towards participant vouchers and the use of their professional transcriber and dictaphone. NIHR public advisors will be reimbursed for their time at the research meetings through the NIHR public advisors group.