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Scalability evaluation of a complex community-based falls prevention intervention in Australian stroke rehabilitation
Ingrid Lin1, Sally Day2, Catherine M Dean1
1Department of Health Sciences, Macquarie University, Sydney, New South Wales, Australia.
Objectives:
To investigate the scalability of the multi-component Falls After Stroke Trial (FAST) intervention tailored to community-dwelling adults with stroke to enable post-trial implementation.
Design:
A mixed-methods formative evaluation of FAST data guided by the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework.
Setting:
Community settings across three states in Australia.
Participants:
Stroke participants were a subset of FAST trial participants (n=50) who were community-dwelling adults who had experienced a stroke up to 5 years prior and were at risk of falling. Therapists who delivered the intervention in the trial (interventionists) were physiotherapists and occupational therapists, trained in the FAST intervention.
Interventions:
The FAST intervention is an individually tailored home safety and functional exercise programme designed to reduce falls and improve community mobility. It is offered over a 6-month period using 10 home visits, two telephone calls and programme resources, for example, manual and worksheets.
Primary And Secondary Outcome Measures:
Trial data, including interventionist training records and delivery data, resources and stroke participants' adherence data were used to assess the Adoption, Implementation and Maintenance dimensions of the RE-AIM framework.
Results:
The FAST intervention was delivered by 22 interventionists. High implementation fidelity was shown with 90% of the stroke participants receiving FAST dose and content. Effective strategies supporting implementation included standardised programme resources, comprehensive pre-programme training, regular interventionist feedback and interventionist mentoring from experts. Online training and peer support networks will be required for scale up.
Conclusions:
This study identifies how a complex intervention to prevent falls after stroke was successfully delivered. The AIM dimensions provided insights to FAST features essential for scale-up. Interventionist training, resources and mentoring/feedback were essential for adoption within the trial. Training and resources should be accessible in an online format for scale up (maintenance).
Trial Registration Number:
ACTRN12619001114134.
