Physiotherapeutic Intervention for Fall Prevention: A Report

This report investigates physiotherapeutic interventions and exercise strategies for fall prevention in elderly adults. It begins by formulating a PICOT question to guide a systematic review of relevant research, outlining the search strategy and inclusion/exclusion criteria used to identify pertinent studies from databases such as CINAHL and PubMed. The report then synthesizes findings from multiple research articles, discussing the benefits of various exercise programs, including Otago exercise, cognitive behavioral therapy with balance training, and low extremity exercises. These interventions are shown to improve balance, increase muscle strength, and reduce the risk of falls, often more effectively than pharmacological interventions. The report also considers the impact of dietary interventions and local/national health policies related to fall prevention, highlighting the importance of comprehensive approaches to enhance the quality of life for elderly individuals at risk of falls. The report concludes by emphasizing the effectiveness of physiotherapy and exercise in promoting balance and stability, key factors in preventing falls and associated health complications.

Running head: HEALTH AND WELLBEING
FALL PREVENTION AND APPLICATION OF EXERCISE AS INTERVENTION
Name of the student
Name of the university
Author note

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Introduction
As per the Centers for Disease Control and Prevention (2019), one of the leading
causes of severe injuries and physical health complications is falling. Fall could be
determined as a situation in which the affected individual comes to resting state inadvertently
due to which their physical and mental health gets affected severely. The severity of this
condition, could be identified from the fact that fall is the second leading cause of increased
morbidity and mortality among the world population. Further the World Health Organisation
(2019) mentioned that every year more than 646000 people die of fall or related accidents
and within these, 80% of the cases are observed in the low or moderate income countries. It
was also observed that every year 37 million falls are registered around the in which, 90%
cases arte sever and majority of the affected individuals are above the age of 65.
Due to these expansion of healthcare risk related to fall among elderly people,
physiotherapeutic intervention should be implemented as El-Khoury et al. (2013) observed
majority of the falls among elderly population occurs due to improper balance, inability to
maintain a healthy and active lifestyle and loss of consciousness. Hence, the interventions for
fall prevention among elderly population should include physiotherapeutic interventions or
exercises so that the balance and consciousness among the elderly population could be
developed and their fall related episodes could be minimised (Uusi-Rasi et al., 2015).
The primary aim of this paper is to develop a PICOT question related to
physiotherapeutic intervention for the fall prevention among the elderly population and in this
aspect the research papers related to this PICOT question would be searched with systematic
review. Hence, a search strategy and Prisma diagram for the search strategy would be
developed. Further, in this aspect, with the help of the literatures, the national and local health

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policies of New Zealand so that the significance of this proposed intervention could be
discussed.
PICOT question
Population Intervention Comparison Outcome Timely
Elderly adults at
the risk of fall
Application of
exercise and
body balance
related
interventions or
exercise
standard
interventions
Effective and
improved results
related to
balance, and
stability
Within 3 months
The question: does the application of exercise and body balance related
intervention helps to improve the body balance and reinforce stability among the
elderly patients suffering from chronic diseases compared to standard interventions
within three months?
Search strategy
As per Colquhoun et al. (2014), search strategy is one of the critical aspect which is
used for the search and identification of accurate research articles so that with all the relevant
information found from the systematic search, effective results could be obtained. Further, it
was also mentioned that to find the accurate and relevant answer to the PICOT question of
the research, it is important to collect research findings from a wide array of appropriate
research articles. In this research paper, to understand the type of exercises that have been
used or could be used for the prevention of fall among elderly population. In this aspect, the

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databases such as CINAHL, and PubMed were used for the collection of latest research
articles of this particular or similar topic.
The time limit which was selected for the collection of research articles was 2012 to
2019 as selection of research articles within 10 years would help to identify relevant and
accurate research articles. Besides this, the keywords selected for this systematic search were
simple and accurately combined with the application of Boolean operators such as AND, OR
and NOT. Further as per Colquhoun et al. (2014), while selecting search strategy terms and
resources, it is important to review and refine results as well as select library resources so that
proximity searching could be utilised.
The keywords that were used for the search strategy were “fall prevention”, “elderly
patient”, “physiotherapeutic intervention”, “exercises”, “fall prevention and exercises”, fall
prevention and physiotherapy”, “fall prevention among elderly patients with exercise”. These
keywords were further connected through the Boolean operators so that refining the search
results could result in accurate finding. Further, in the search results obtained after several
hits in the selected databases, inclusion and exclusion criteria were applied in the found
research articles so that appropriate papers could be sieved through the search strategy and
then the finding of that paper could be critiqued and utilised for the development of the
research paper.
The inclusion criteria that was selected for this search strategy were related date of
publication (within 2012 to 2019), presence of English language, full text research articles
with adequate data collection and data interpretation, further, primary research articles with
accurate and identified research study were selected for this paper. Besides this, to exclude
the improper research articles exclusion criteria was applied that helped to remove descriptive

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papers, abstract papers, language other than English, and improper data collection and
interpretation methods.
The following section determines the search strategy through the help of a PRISMA
graph:

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Research findings and discussion
Several papers were found to be complying with the inclusion and exclusion criteria
after which 12 of the accurate research articles from PubMed and CINAHL was included in
(Developed By Author)

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the paper. All these research articles indicated to the fact that majority of the healthcare
complications faced by the elderly patients are associated to their healthcare complications
such as Rheumatoid arthritis, chronic healthcare diseases such as Parkinson’s disease, cancer
or other chronic conditions due to which physical strength and stability is lost Zieschang et al.
(2017). Hence, providing such patients with physical exercise or physiotherapeutic sessions
with strength and resistance training would be beneficial in maintaining their body balance
and prevent their fall related episodes (El-Khoury et al., 2013).
The first research article that should be discussed in this aspect is by Abdulrazaq et al.
(2017), in which the researchers aimed to understand the healthcare cost of falls and the
benefit Otago exercise program so that elderly patients suffering from rheumatoid arthritis
(RA) could be provided with increased functionality and their fall related episodes could be
eliminated. In this qualitative research, the prospective cohort study was included as the
research process and as intervention Otago exercise were selected as it is effective in
reinforcing stability and balance for the patients by increasing their leg muscle strength
(Abdulrazaq et al., 2017). Hence, application of this exercise of physiotherapeutic
intervention helped the healthcare professionals to provide the patients of RA with effective
intervention and it was seen that more than 500 patients were able to overcome their pain and
risk of fall due to their RA related health condition. However, the primary aim of this article
was to understand the way this physiotherapeutic intervention helps to reduce the economic
burden from the patients (Abdulrazaq et al., 2017). Therefore the healthcare benefits of
exercise and physiotherapeutic interventions were mentioned in the research articles of
Grossman et al. (2018), in which the US Preventive Services Task Force provided with
recommendations after conduction of extensive research with patients in different healthcare
facilities of the USA (Grossman et al., 2018).

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In this research paper, Grossman et al. (2018) provided a details of findings that
indicated that application of exercise intervention helped the elderly patients suffering from
healthcare conditions due to present or risk of fall risks by providing them with moderate
benefit from their fall related risks. It was mentioned that application of healthcare
interventions related to exercise helped the patients to develop strength and balance so that
while working or walking alone, their risk of fall decreased. It was also found that application
of vitamin D supplementation for their bone strength and development was failed to provide
similar results for the same type of patient (Zieschang et al., 2017). Hence, it was easily
proven that application of exercise and physiotherapeutic intervention helped to overcome the
patients; fall related risk more than any pharmacological intervention. Therefore, as per
Zieschang et al. (2017), application of physiotherapeutic intervention or exercise therapy is
able to make effective progress in the healthcare condition of patients suffering from
healthcare conditions.
Similar research was conducted by Liu, Ng and Ng (2018), in which their primary aim
was to understand the cognitive behavioural therapy in combination with balance training
skills related benefit that helps the elderly patients by reducing their risk of fall. This was a
qualitative research article and random control trail was chosen as the research process. In
this process, elderly patients with chronic health condition were provided with cognitive
behavioural therapy with task oriented balancing training (TOBT) (Liu, Ng & Ng, 2018). As
per Liang et al. (2017), TOBT is an effective an modern healthcare technique which is used
for the patients suffering from cortical healthcare conditions or trauma due to which they
require balancing of strength training for their quality of life. It was found after 8 weeks of
application of this intervention that patients were provided with cost-effective, safe and
transferable healthcare intervention for their increase stability and balancing to prevent
critical fall related conditions (Liang et al., 2017). Further, the primary finding which was

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achieved through the application of this intervention was related to the increase confidence,
reintegration of the community and the significant reduction in the risk and episodes of fall.
Therefore, application of balancing related physiotherapeutic intervention was useful in
reducing the severe risk of fall among patients and it was an effective intervention to enhance
the quality of life (Liang et al., 2017).
Another research article that was directed for the identification of exercises or
physiotherapy with controlled diet among 104 patients that were identified with increased fall
related risk factors (Elliot & Hamlin, 2018). This research was conducted in New Zealand
and after conduction of this physiotherapeutic interventions it was found that majority of the
patients at the high risk of fall were able to overcome 5.2 times faster than other patients.
However, in this aspect it was found that majority of the patients were provided with
improvement due to their ability to implement physiotherapeutic intervention however, in this
aspect, 7.2 times higher improvements were observed in the patients that were provided with
diet interventions as well (Elliot & Hamlin, 2018). However, this intervention comparison
was not able to find answer of the research question determined for this paper and hence, the
research of Chan et al. (2018) should be considered. In this research, a randomized control
trail was conducted so that effect of physiotherapeutic interventions or exercise among the
elderly patients at the risk of fall could be assessed. Researchers identified the effectiveness
of low extremities exercises and assess their risk of fall and subsequent fracture so that
identification of the effectiveness of the exercise regime could be understood (Chan et al.,
2018). The assessment tool for fracture risk assessment was selected and after 3 months all
the 55 patients were assessed for assessment of their improvement. Hence, it was found that
the low extremities exercises were able to provide the patients with leg muscle strength,
increased physical abilities and development of fat free mass so that they could develop their
healthcare conditions and reduce their risk of fall (Chan et al., 2018).

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Therefore, all these research articles and findings indicated towards the benefit of
application of physiotherapeutic interventions, exercises and application of low extremity
activities so that patients of such high of fall and other physiological complications could be
provided with help (Merom et al., 2012). Further, it was also noted that majority of the
healthcare intervention related to physiotherapy and exercise helped the elderly patients to
develop fat free muscle mass; develop balance and stability, which are the primary
requirements for the patients at the risk of severe fall (Uusi-Rasi et al., 2015).
Local and national healthcare policies of New Zealand
As found in the abovementioned literature review, one of the critical reason for fall
among elderly patients are their decreased leg strength, and their improper balance. Besides
this, their lack of nutrition, improper eye sight, their hazardous home environment and
nutritional deficiencies. Similar results were observed in the national healthcare policy and
recommendations developed for the fall prevention among elderly (Health Quality & Safety
Commission, 2019). As per Health Navigator NZ (2019), exercise is one of the primary
interventions which should be implemented for the patients with high risk of fall. As per
Health Navigator NZ (2019), benefits of exercises such as improved balance, increased
muscle strength, stronger bones and increased flexibility could improve the elderly patient’s
ability to decrease their physiological posture and balance related problems and then
implement the healthcare interventions. However, the commonwealth health service of the
New Zealand does not have any specific policy of recommendation for the fall prevention
among the elderly patients due to which no such specific intervention has been developed for
the fall prevention among elderly patients (Health Quality & Safety Commission, 2019).
However, it was mentioned that majority of the interventions that were provided for the fall
prevention were associated with medications, sharp vision, and making the environment of
the patient effective to reduce their risk of fall (Health Quality & Safety Commission, 2019).

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Hence, it was seen that majority of the elderly patients that were found to be highly affected
with the risk of fall were provided with medication and communication therapy with
supporting aids, which eventually decreases their confidence and fill them with negativity
(Iaboni & Flint, 2013). Hence, these interventions were important to apply in the healthcare
facilities for the elimination of the risk of fall among the elderly patients.
Type of interventions
The NZ health department mentioned that majority of the healthcare intervention
should be implemented for the elderly people and their risk of fall should be based on the
exercise and physiotherapeutic interventions. As per Sinaki (2012), application of balancing
training for improved balance and proper posture should be implemented in the care process.
These interventions are effective in making the patients stable with respect to their increased
ability, their increased strength and muscle mass. Further, it was mentioned that this
balancing technique helps to make the body posture of the elderly patients accurate due to
which, they are able to conduct their activities of daily life without any aid or support
(Canning et al, 2015).
The second intervention that should be applied for the fall prevention among elderly
patients as per the intervention of an advanced nursing practice is Tai Chi exercise (Health
Navigator NZ, 2019). Further, it was mentioned that majority of the fall in New Zealand were
seen in elders due to their imbalance (30%) and muscle strength (50%). Hence, Tai Chi is an
effective intervention using which muscle strength, muscle toning and helps to develop
flexibility, balance and strength (Health Quality & Safety Commission, 2019). Hence, it was
effective in maintaining the healthcare intervention for fall prevention among elderly patients
in New Zealand. Hence, with application of physiotherapy and exercise, multidisciplinary
team such as dieticians, occupational therapists, and healthcare physicians could help the
elderly elders to overcome their fall prevention related risk factors (Chan et al., 2018).

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Conclusion
Fall is one of the major concerns of the elderly adults throughout the world because of
its adverse effects on the patients that not only affects their physical health, but also affects
their mental and emotional wellbeing. Numerous conditions such as lack of balance, lack of
consciousness, lack of strength and improper stability with decreased muscle mass increases
the physical and mental complication of the elderly patients. Application of physical
activities and exercises helps the elderly patients with high risk of fall to overcome their risk
and develop stability. Hence, to find such interventions search strategy was conducted in this
paper with CINAHL and Pub Med as the databases and 2012 to 2019 as the time frame. From
the study, it was found that exercise and physiotherapy are interventions that could help the
elderly patients to maintain their body posture, their muscle strength and develop their
stability. Hence, it was mentioned in this paper that application of body balance training and
Tai Chi exercises could help the multidisciplinary team of dieticians, occupational therapists
so that increased balance, increases stability and developed body strength could be
developed.

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Appendix
CINAHL search strategy
PubMed search strategy