Publications - University of Nottingham

Related Publications

The Guide to Action Tool 2006 – 2012

– 2010 Thinking falls – taking action: a guide to action for falls prevention.

In this study, the Falls Research Group of the East Midlands area conducted a review of previously published studies and clinical guidelines. From this, they identified 34 risk factors for falling and actions that could be taken to reduce the risk. The researchers then gave this tool to people working in local NHS organisations in South Nottinghamshire and asked them about how easy it was to use, how useful it was, and how long it took to complete it. 186 people took part in the study, most of them were community nurses (60.7%) and found that it took around 15 minutes to fill in the tool. While most reviews of the tool were positive, common challenges to using it included a lack of time and a shortage of staff. More research was needed to study if the tool was effective at reducing falls when used.

– 2012 Thinking falls – taking action: a falls prevention tool for care homes.

In this study, the GtA tool was reviewed and adapted for use in Care Home settings to become the Guide to Action Tool for Care Homes or GtACH. Key changes that were made included adding new risk factors and actions related to thinking, understanding, mood, communicating and behaviour, and restructuring how the tool was laid out. This new GtACH tool, a 1-hour training session and an instruction manual were given to 10 care homes that took part in the study. Staff in the care homes were asked to use the GtACH tool with any residents who had fallen 1 month before the study started, and then for 2 months after they had the training. The researchers then also looked at the records of residents with whom the staff had completed the GtACH tool to see how well it was used.

Of the 10 care homes that signed up, 6 completed the study. The GtACH tool was used 26 times, 13 staff were trained on how to use the tool, and it took around 20 minutes on average to complete. 179 risk factors for falling were assessed, and 163 actions were recorded. However, it looked like only 86 of these actions were undertaken. The tool was generally well received, but similar challenges of a lack of time and a shortage of staff influenced whether and when the tool was used remained. The next research question looked at how well the GtACH tool performed at reducing falls in Care Home residents.

The FiCH Study 2012-2013/2015?

– 2015 The Falls In Care Homes study: a feasibility randomized controlled trial of the use of a risk assessment and decision support tool to prevent falls in care homes. (The FiCH Study)

In this feasibility study, the GtaCH tool was tested in 6 Care Homes in the Nottinghamshire area. The aim of this study was to see if the GtACH tool could be tested in clinical trial conditions to determine if using it was an effective way of preventing falls. The study participants were 52 Care Home residents. 27 of these residents received the control intervention (3 Care Homes), and 5 residents received the GtACH tool intervention (3 Care Homes). Both groups of residents were of similar ages, predominantly white British, married or widowed, and around 50% of the residents were able to consent to take part in the study by themselves. The rest of the residents had support to consent, or their next of kin provided consent.

After 6 months of using the GtACH tool in the care homes, residents who received the GtACH tool intervention had a reduction in the total rate of falls per year of 24 falls per year (from 35 to 11), compared to the control group, which had a reduction of 11 falls per year (from 40 to 29). Injuries from falling were also reduced in both groups. The staff in the Care Homes found the training useful and that it had a positive impact on their confidence and awareness of falls risk factors and actions to mitigate them.

The main learning from this study was that it was possible to study how well the GtACH tool and programme work to prevent falls in a clinical trial format. In addition, the GtACH tool and programme looked like a potentially effective intervention for falls prevention, but further research was needed to confirm this.

The FinCH Study 2015-2019

– 2021 Multifactorial falls prevention programme compared with usual care in UK care homes for older people: multicentre cluster randomised controlled trial with economic evaluation. (The FinCH Study)

In this study, the GtACH intervention was tested to see how well it prevented resident falls in Care Homes when compared to usual care. 84 Care Homes across England agreed to take part. 39 of these were randomly allocated to have the GtACH intervention (training, plus support and the checklist). This meant 45 care homes continued to provide usual care to their residents. After 4-6 months, the number of falls that occurred was compared, and we continued to measure how many falls happened for 6 months.

Overall, the rate of falls in the Care Homes that had the GtACH intervention was 43% less than in the Care Homes giving usual care. What was even better is that the GtACH intervention didn’t appear to cause unwanted effects like residents doing fewer activities because of trying to reduce the number of falls. Care Home staff and relatives were positive about the intervention. It was also found to be good value for money and likely cost-effective.

Although most of the results in this study were positive, the same challenges of changing practices and sustaining them remained. These were explored further in the process evaluation and the implementation study (FinCH Imp).

and – 2022 A multidomain decision support tool to prevent falls in older people: the FinCH cluster RCT plain language summary

and – The FinCH Study Infographic

Process Evaluation

– 2020 Contamination in complex healthcare trials: the falls in care homes (FinCH) study experience

In this research, the team behind the FinCH study looked at how consistently the GtACH intervention was delivered in the trial itself. This is known as a “process evaluation.” Process evaluations in clinical trials are an important step because the results can tell us if we can be confident that the results seen in the trial are due to the intervention, because it was delivered as intended. Process evaluations can also help us understand what challenges might affect the usability of the intervention after the study has ended.

This paper talks about “contamination bias”, which simply means actions or events that can alter how sure we are that the intervention is what caused the results and not something else. Contamination bias can affect any clinical trial, especially ones like FinCH, which had a number of components and people involved across different networks. In this study, the researchers found several possible sources of contamination bias, including the sharing of documentation through networks, the trainers training staff in the control groups using aspects of the GtACH intervention, movement of staff between care homes, and the inability to blind therapists to allocation and promotion of the study findings throughout the trial.

The research team suggested several ways to manage these potential sources of contamination bias. Ultimately, though, these centred on being transparent about the importance of evaluating the GtACH intervention before its widespread adoption. However, it is important to understand that this trial took place in uncontrolled circumstances. This meant that, because the GtACH intervention was developed from best available evidence, clinicians and staff in all parts of the study were being encouraged to change their normal practices based on the same evidence. It was important to help clinicians and staff participants understand how research evaluations work so they could appreciate why it was important to try to keep as many things consistent in the Care Homes included in the trial.

– 2021 Learning from a successful process evaluation in care homes

Following on from the previous paper, this paper talks about the learnings from undertaking a process evaluation in Care Homes and makes suggestions for researchers to consider to get the most out of future studies. The main findings were that successful research in Care Homes requires flexibility, building trust with staff over a period of time, and understanding that resident care comes first. Future research in Care Homes should be planned with these considerations in mind to ensure that the research is then representative of a range of voices in the Care Homes. Practically, this might look like collecting data either very early in the morning or late at night, shifting rapidly from focus groups to interviews, considering offering financial support for staff to be backfilled so they can participate and adopting a pragmatic mindset to achieving privacy.

The FinCH Imp Study 2021- Present

In this study, the GtACH intervention, now called Action Falls, was rolled out into 57 care homes across the UK. 1657 staff were trained in using Action Falls, and the researchers looked into what affected the implementation process. They found that the Care Home manager is pivotal in the success of Action Falls. Like previous research, they also found that all staff being trained in Action Falls make a positive difference, but this can be tricky given how mobile the Care Home workforce is.

More information from the findings of the FinCH Imp study can be found in the toolkit and in the infographic.