Evidence-Based Project, Part 5: Recommending an Evidence-Based Practice Change
whinnyEvaluation Table
Use this document to complete the evaluation table requirement of the Module 4 Assessment, Evidence-Based Project, Part 4A: Critical Appraisal of Research
Full citation of selected article |
Article #1 |
Article #2 |
Article #3 |
Article #4 |
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Hempel, S., Newberry, S., Wang, Z., Booth, M., Shanman, R., Johnsen, B., & Ganz, D. A. (2017). Hospital fall prevention: a systematic review of implementation, components, adherence, and effectiveness. Journal of the American Geriatrics Society, 61(4), 483-494.
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DiBardino, D., Cohen, E. R., & Didwania, A. (2014). Meta‐analysis: multidisciplinary fall prevention strategies in the acute care inpatient population. Journal of hospital medicine, 7(6), 497-503. |
Haines, T. P., Hill, K. D., Bennell, K. L., & Osborne, R. H. (2017). Additional exercise for older subacute hospital inpatients to prevent falls: benefits and barriers to implementation and evaluation. Clinical Rehabilitation, 21(8), 742-753. |
Spiva, L., & Hart, P. (2014). Evidence-Based Interventions for Preventing Falls in Acute Care Hospitals. |
Conceptual Framework Describe the theoretical basis for the study
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None
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multidisciplinary fall prevention interventions in acute care hospital |
None |
Inclusion of prospective controlled-design studies reporting the effectiveness of fall prevention programs in hospitals. |
Design/Method Describe the design and how the study was carried out
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Systematic review using a qualitative method |
Used qualitative method where the bibliographies of all systematic reviews and meta-analyses were hand searched a meta-analysis reviews |
Randomized controlled trial, subgroup analysis. |
Cluster randomized study |
Sample/Setting The number and characteristics of patients, attrition rate, etc. |
U.S. acute care hospitals
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Acute care settings |
5038 total participants. 1958 Male and 3080 Female. Patients of a metropolitan sub-acute/aged rehabilitation hospital |
Acute Care Settings |
Major Variables Studied List and define dependent and independent variables |
Participants Studies reporting in-hospital falls for intervention groups and concurrent (e.g., controlled trials) or historic comparators (e.g., before-after studies). |
The belt, older people, |
Dependent - Falls, independent - exercise, |
Dependent- the relative risk of a fall per occupied bed day (RR(fall)) and independent - the relative risk of being a faller (RR(faller)) |
Measurement Identify primary statistics used to answer clinical questions |
Incidence rate ratios (IRR, ratio of fall rate post intervention or treatment group to the fall rate pre-intervention or control group) and ratings of study details. |
Electronic fall prevention tool kit which triggered automatic ordered interventions. |
multifactorial interventions including exercise to prevent inpatient falls in older adults |
The primary outcome was patient falls per 1000 patient-days adjusted for site and patient care unit. A secondary outcome was fall-related injuries. |
Data Analysis Statistical or qualitative findings |
Meta-regressions analysis |
Effect sizes (odds ratios) and 95% confidence intervals were derived for individual studies and then combined across research reports using a random-effects meta-analysis. |
Intervention group participants in this subgroup analysis had a significantly lower incidence of falls than their control group counterparts (control: 16.0 falls/1000 participant-days, intervention: 8.2 falls/1000 participant-days, log-rank test: P = 0.007). However few differences in secondary balance, strength and mobility outcomes were evident. |
Hospitalization further increases risk of falls |
Findings and Recommendations General findings and recommendations of the research |
Study shows better reporting of outcomes, implementation, adherence, intervention components, and comparison group information is necessary to establish evidence on how hospitals can successfully prevent falls. |
Fall prevention strategies have a significant but small effect on fall rates despite the use of complex, multidisciplinary interventions. Additional randomized trials are needed to examine the possible benefits of multidisciplinary fall prevention strategies in the acute inpatient setting. |
This exercise programme provided in addition to usual care may assist in the prevention of falls in the sub-acute hospital setting. |
The authors found that precautionary care including a falls safety champion reduced the occurrence of injurious falls by 58.3% (n=36). |
Appraisal Describe the general worth of this research to practice. What are the strengths and limitations of study? What are the risks associated with implementation of the suggested practices or processes detailed in the research? What is the feasibility of use in your practice? |
Adherence methodologies are of specific significance for long haul changes |
A broad eligibility criterion was incorporated in the study and questions were clearly reviewed and addressed. |
Participants had their balance, strength and mobility assessed upon referral for the exercise programme and then again prior to discharge. |
The use of a fall prevention tool kit in hospital units compared with usual care significantly reduced rate of falls. |
General Notes/Comments |
N/A
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N/A |
N/A |
N/A |
Levels of Evidence Table
Use this document to complete the levels of evidence table requirement of the Module 4 Assessment, Evidence-Based Project, Part 4A: Critical Appraisal of Research
Author and year of selected article |
Article #1 |
Article #2 |
Article #3 |
Article #4 |
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Hempel, S., Newberry, S., Wang, Z., Booth, M., Shanman, R., Johnsen, B., & Ganz, D. A. (2017
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DiBardino, D., Cohen, E. R., & Didwania, A. (2014). |
Haines, T. P., Hill, K. D., Bennell, K. L., & Osborne, R. H. (2017). |
Spiva, L., & Hart, P. (2014). |
Study Design Theoretical basis for the study
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Systematic review using a qualitative method
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systematic reviews and meta-analyses |
Randomized controlled trial, subgroup analysis. |
Cluster randomized study |
Sample/Setting The number and characteristics of patients |
U.S. acute care hospitals. Information on number of fallers, number of falls, fall rate (per 1,000 patient days), and number eligible to fall. |
Sample sizes were not reported but the number of 1,000-patient days in treatment groups ranged from 4.3 to 160.3. |
5038 total participants. 1958 Male and 3080 Female. |
Comparing patient fall rates in 4 urban US hospitals in units that received usual care (4 units and 5104 patients) or the intervention (4 units and 5160 patients). |
Evidence Level * (I, II, or III)
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Level V |
Level VII |
Level 1 |
Level 1 |
Outcomes
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A critical analysis of the qualitative studies surrounding the use of interventions placed to reduce the number of elderly falls in the hospital. |
Fall prevention strategies had a statistically significant but small effect on fall rates despite the use of complex, multidisciplinary interventions. |
Provides a meta-analysis from randomized controlled trials involving exercise |
The review addressed a clear question and used broad eligibility criteria. |
General Notes/Comments |
N/A
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N/A |
N/A |
N/A |
* Evidence Levels:
· Level I
Experimental, randomized controlled trial (RCT), systematic review RTCs with or without meta-analysis
· Level II
Quasi-experimental studies, systematic review of a combination of RCTs and quasi-experimental studies, or quasi-experimental studies only, with or without meta-analysis
· Level III
Nonexperimental, systematic review of RCTs, quasi-experimental with/without meta-analysis, qualitative, qualitative systematic review with/without meta-synthesis
· Level IV
Respected authorities’ opinions, nationally recognized expert committee/consensus panel reports based on scientific evidence
· Level V
Literature reviews, quality improvement, program evaluation, financial evaluation, case reports, nationally recognized expert(s) opinion based on experiential evidence
Outcomes Synthesis Table
Use this document to complete the outcomes synthesis table requirement of the Module 4 Assessment, Evidence-Based Project, Part 4A: Critical Appraisal of Research
Author and year of selected article |
Article #1 |
Article #2 |
Article #3 |
Article #4 |
|
Hempel, S., Newberry, S., Wang, Z., Booth, M., Shanman, R., Johnsen, B., & Ganz, D. A. (2017
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DiBardino, D., Cohen, E. R., & Didwania, A. (2014). |
Haines, T. P., Hill, K. D., Bennell, K. L., & Osborne, R. H. (2017). |
Spiva, L., & Hart, P. (2014). |
Sample/Setting The number and characteristics of patients |
Same as above |
Same as above |
Same as above |
Same as above |
Outcomes
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Studies had to report on the outcome of inpatient falls. |
Fall prevention help should be considered along patient’s cultural differences. |
Properly implemented fall prevention strategies and interventions are important for older adults |
Falls cause injury and death for persons of all ages, but risk of falls increases markedly with age. |
Key Findings
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Meta-regressions showed some evidence of the importance of adherence levels to reduce falls |
Fall prevention strategies have a significant but small effect on fall rates despite the use of complex, multidisciplinary interventions.
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This exercise programme provided in addition to usual care may assist in the prevention of falls in the sub-acute hospital setting |
The analysis of this study show that fall prevention strategies according to risk category and insufficient to prevent falls, especially low risk patients. |
Appraisal and Study Quality
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Population control study |
Random control study |
Cohort review study |
True experiment evidence from the RCT |
General Notes/Comments |
Feasibility of the entire study through examination of recruitment, Eligibility, Protocol, adherence and missing data
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Comprehensively reviews literature thus efficient in boosting the knowledge of clinical experts on about the Clinical issue. Generally ineffective unless supported by other sources |
Comprehensively reviews literature thus efficient in boosting the knowledge of clinical experts on about the clinical issue. |
Being a level one evidence with favourable outcomes, it helps to solve the clinical question and provides a comprehensive answer to the study question |
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