Occupational therapist led environmental assessment and modification to prevent falls: Review of current practice in an Australian rural health service district

Associate Professor Alison Pighills1,2, Dr Anna Tynan3, Ms Linda Furness3

1Mackay Hospital And Health Service, Mackay, Australia, 2James Cook University, Townsville, Australia, 3Darling Downs Health, Toowoomba, Australia

Background: Environmental assessment and modification (EAM) is an effective approach to reducing falls in high risk older people, if provided by occupational therapists (OTs). It has been incorporated into national and international falls prevention guidelines, however, evidence suggests that it is not being implemented in practice. This study aimed to identify factors that support the local adoption of best practice EAM within a rural health service.

Methods: A concurrent mixed methods study using the Integrated Promoting Action on Research Implementation in Health Services (iPARIHS) framework was conducted in a health service in Queensland, encompassing rural and regional populations. An audit was conducted on eligible medical charts. An online survey of occupational therapists’ knowledge, confidence, attitudes and experience of EAM was completed. Focus group discussions were also carried out.

Results: Survey results identified that most OTs were aware of, confident, and experienced in EAM for falls prevention. Chart audits, however, revealed that none of the patients received this intervention. Thematic analysis of focus group discussions identified three key themes which influenced uptake of EAM: confidence in, and awareness of evidence; key stakeholders’ support and knowledge of OT; and, time and resources required for implementation. Contextual issues unique to rural and regional service delivery also influenced uptake, including: geographical and sociocultural diversities of communities; differing organisational structures which result in OTs being line managed by other professions; and, limited access to professional development.  Availability of local peer support, and engagement of multiple stakeholders from various professions were highlighted as key facilitators to support change.

Discussion: Occupational therapists reported that they carried out best practice EAM for falls prevention but the medical chart audit provided no evidence of this happening in practice. This study provided an understanding of factors that influence whether OTs implement best practice EAM in a rural health service.


Alison completed her PhD in 2008 at the University of York, UK, which involved a RCT (n=238), to evaluate the clinical effectiveness of environmental assessment and modification to prevent falls in older people. She was awarded the University of York K M Stott prize for the best PhD thesis. She is currently a co-investigator on a multi-centre RCT in the UK (n=1333) which replicates her PhD research on a larger scale. Her research interests include: falls prevention, rural and remote models of care, professional skill sharing and delegation; and, research capacity development.

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