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Standing Balance Classes: improve balance and function for rehabilitation inpatients

Bankstown Lidcombe HospitalCamden Hospital
Project Added:
16 February 2015
Last updated:
17 February 2015

Standing Balance Classes: improve balance and function for rehabilitation inpatients

Summary

This project demonstrates the effective implementation of best evidence to improve patient outcomes in a rehabilitation setting. Patients consistently report poor balance as a significant factor in their recovery. Focusing on patient centred care, clinicians within the physiotherapy department performed an evidence based review aiming to identify the most effective way of improving balance.

This project was a finalist in the Translational Research category of the 2014 NSW Health Awards. Download a poster from the 2014 NSW Health Awards.

Aim

The aim of this program is to create improved outcomes and results for rehabilitation patients and empower patients to be able to get back into the community.

Benefits

  • Improved patient care and patient outcomes
  • Reduce unplanned readmissions and length of stay
  • Improving results within current resources and staffing levels.

Project Status

Sustained: The project has been implemented, is sustained in standard business.

Background

Patients admitted to a rehabilitation ward often present with poor mobility, impaired balance and a reduced ability to carry out activities of daily living1.

Poor balance and mobility impairment have consistently been associated with an increased risk of falling among rehabilitation inpatients and among patients transferred home from a rehabilitation setting2.

Falls are a frequent occurrence among patients admitted to a rehabilitation ward3,4 and once discharged home the likelihood of falling is significantly greater for these people than that for the general community5,6.

While specific balance exercise has been shown to improve balance7 and reduce fallsin the general older population, no previous study has examined the effects of a balance exercise program on balance among patients admitted to a general rehabilitation ward.

Implementation

A seven station standing balance circuit class was developed by clinicians applying the evidence from a systematic review by Sherrington8 to help improve patients’ balance and function.

The classes are run with up to eight patients, supervised by two therapists. The classes are run three times a week for one hour each class.

Partnerships 

The George Institute for Global Health, Sydney Medical School, The University of Sydney.

Implementation sites

  • Bankstown-Lidcombe Hospital
  • Camden Hospital

Results

A single blinded randomised controlled trial of 162 patients was designed to assess the effectiveness of two weeks of standing balance classes in addition to usual therapy compared to usual therapy alone9.

The addition of the standing balance circuit class improved balance and mobility at two weeks and three months, decreased length of stay, decreased inpatient falls and reduced the risk of readmission.

The outcomes are sustainable in the longer term and the standing balance circuit classes have the ability to be adopted as routine care in other rehabilitation units as no additional resources were required to translate this research into embedded practice.

The intervention was delivered within current staff resources to participants with a large range of differing diagnoses and levels of physical functioning. There was no additional equipment needed to run this class.

This class is now considered to be part of best practice and routine care for patients. It is embedded into routine practice and the standing balance circuit class has continued to be delivered to the rehabilitation wards at Bankstown-Lidcombe hospital.

References 

  1. Olivetti L, Schurr K, Sherrington C, Wallbank G, Pamphlett P, Kwan MM and Herbert R 2007, ‘A novel weight-bearing strengthening program during rehabilitation of older people is feasible and improves standing up more than a non-weight-bearing strengthening program: a randomised trial’, Australian Journal of Physiotherapy, vol. 53, no. 3, pp. 147–153.
  2. Sherrington C, Lord SR, Close JCT, Barraclough E, Taylor M, Cumming RG and Herbert RD 2010, ‘Mobility-related disability three months after aged care rehabilitation can be predicted with a simple tool: an observational study’, Journal of Physiotherapy, vol. 56, no. 2, pp. 121–127.
  3. Sherrington C, Lord SR, Close JC, Barraclough E, Taylor M, O'Rourke S, Kurrle S, Tiedemann A, Cumming RG and Herbert RD 2010, ‘Development of a tool for prediction of falls in rehabilitation settings (Predict_FIRST): a prospective cohort study’, Journal of Rehabilitation Medicine’, vol. 42, no. 5, pp. 482–488.
  4. Haines TP, Bennell KL, Osborne RH and Hill KD 2004, ‘Effectiveness of targeted falls prevention programme in subacute hospital setting: randomised controlled trial’, BMJ, vol. 328, no. 7441, pp. 676–679.
  5. Hall SE, Williams JA and Criddle RA 2001, ‘A prospective study of falls following hip fracture in community dwelling older adults’, Australasian Journal of Ageing, vol. 20, pp. 73–78.
  6. Sherrington C and Lord SR 1998, ‘Increased prevalence of fall risk factors in older people following hip fracture’, Gerontology, vol. 44, pp. 340–344.
  7. Howe TE, Rochester L, Jackson A, Banks PMH and Blair VA 2007, ‘Exercise for improving balance in older people’, Cochrane Database of Systematic Reviews, vol. 4:CD004963.
  8. Sherrington C, Whitney JC, Lord SR, Herbert RD, Cumming RG and Close JC 2008, ‘Effective exercise for the prevention of falls: a systematic review and meta-analysis’, Journal of the American Geriatric Society, vol. 56, no. 12, pp. 2234–2243.
  9. Treacy D, Schurr K and Sherrington C 2013, ‘Balance circuit classes to improve balance among rehabilitation inpatients: a protocol for a randomised controlled trial’, BMC Geriatrics, vol. 13, pp. 75.

Contact

Daniel Treacy
Physiotherapy Rehabilitation and Aged Care Team Leader
South Western Sydney Local Health District (SWSLHD)
Phone: 02 9722 7258
Email: Daniel.treacy@sswahs.nsw.gov.au

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