Citation

Thomas S, Mackintosh S. Phys. Ther. 2014; 94(11): 1660-1675.

Affiliation

S. Mackintosh, PT, PhD, international Centre for Allied Health Evidence (iCAHE) and the Sansom Institute, University of South Australia, and School of Health Sciences, University of South Australia.

Copyright

(Copyright © 2014, American Physical Therapy Association)

DOI

10.2522/ptj.20130412

PMID

25035266

Abstract

PURPOSE: Older adults are at increased risk of falls following discharge from hospital. Guidelines to manage this falls risk are well documented but commonly not implemented. This paper aims to describe a novel approach using the Theoretical Domains Framework (TDF) to develop an intervention to change clinical behaviour of Physiotherapists. CASE DESCRIPTION: The study had 4 phases: (1) Identifying the evidence practice gap; (2) Identifying barriers and enablers that need to be overcome; (3) Identifying behaviour change techniques to overcome the barriers; and (4) Determining outcome measures to evaluate behaviour change. OUTCOMES: The evidence practice gap identified that few patients who had undergone surgery for hip fracture were recognised to have a falls risk or had a documented referral to a community agency for falls prevention follow up. Project aims aligned with best practice guidelines were established; twelve of the fourteen TDF domains were considered to be relevant to behaviours within this project and six behaviour change strategies were implemented; primary outcome measures included proportion of patients who have documentation of falls risk and are referred on for a comprehensive falls risk assessment following discharge from the hospital.

DISCUSSION: The use of a systematic approach involving the TDF was useful in designing a multi-faceted intervention to improve management of discharge falls risk by Physiotherapists in an acute care setting in South Australia. This framework enabled targeted intervention strategies to be identified that were likely to influence healthcare professional behaviour. Early case note audit results reflect positive changes to reduce the evidence practice gap.

Language: en