Online Delivery of the Individualized Reduction of Falls Intervention for Persons With Multiple Sclerosis Who Use a Wheelchair or Scooter Full-time: A Pilot Study.

BACKGROUND: People with multiple sclerosis (MS) who use a wheelchair or scooter full-time fall frequently; however, fall prevention programming that meets the unique needs of this population is limited. This study examined the preliminary efficacy of a group-based online fall prevention and management intervention designed specifically for people with MS. METHODS: This pre/post intervention, mixed-methods study included people with MS who used a wheelchair or scooter full-time, experienced at least 1 fall within the past year, and transferred independently or with minimal or moderate assistance. Participants engaged in a 6-week, online, individualized, multicomponent fall prevention and management intervention: Individualized Reduction of Falls-Online (iROLL-O). RESULTS: No statistically significant change in fall incidence occurred after iROLL-O. However, fear of falling significantly decreased (P < .01) and knowledge related to fall management (P = .04) and fall prevention and management (P = .03) significantly improved. Qualitative results indicated that participants valued the opportunity for peer learning and iROLL-O's attention to diverse influences on fall risk. CONCLUSIONS: This study is the first to examine the preliminary efficacy of an online fall prevention and management intervention for people with MS who use a wheelchair or scooter full-time. iROLL-O has promise, and participants found it valuable. Further efforts are needed to retain iROLL-O participants with lower confidence and functional mobility, and more research is needed to investigate the impact of the intervention on key outcomes over time.

Lower-Limb Factors Associated with Balance and Falls in Older Adults: A Systematic Review and Clinical Synthesis.

BACKGROUND: Despite sufficient evidence to suggest that lower-limb-related factors may contribute to fall risk in older adults, lower-limb and footwear influences on fall risk have not been systematically summarized for readers and clinicians. The purpose of this study was to systematically review and synethesize the literature related to lower-limb, foot, and footwear factors that may increase the risk of falling among community-dwelling older adults. METHODS: We searched PubMed, Embase, PsycINFO, CINAHL, Web of Science, Cochrane Library, and AgeLine. To describe the trajectory toward increasing risk of falls, we examined those articles that linked age-related changes in the lower limb or footwear to prospective falls or linked them to evidenced-based fall risk factors, such as gait and balance impairment. RESULTS: This systematic review consisted of 81 articles that met the review criteria, and the results reflect a narrative review of the appraised literature for eight pathways of lower-limb-related influences on fall risk in older adults. Six of the eight pathways support a direct link to fall risk. Two other pathways link to the intermediate factors but lack studies that provide evidence of a direct link. CONCLUSIONS: This review provides strong guidance to advance understanding and assist with managing the link between lower-limb factors and falls in older adults. Due to the lack of literature in specific areas, some recommendations were based on observational studies and should be applied with caution until further research can be completed.

A population-based study of fall risk factors among people with multiple sclerosis in Stockholm county.

OBJECTIVE: To identify factors associated with increased likelihood of reporting a recent fall among people with multiple sclerosis. This study was exploratory in its intent to examine sense of coherence as a contextual influence on fall risk. The study also sought to confirm that variables previously identified as fall risk factors for people with multiple sclerosis persist when tested in a population-based sample. DESIGN: The study was cross-sectional and data was obtained in the context of a population-based study of people with multiple sclerosis living in Stockholm. SUBJECTS: A total of 164 people with multiple sclerosis, age range 19-79 years. METHODS: Data were gathered through established instruments. Key instruments utilized included the sense of coherence scale, the Lindmark Motor Capacity Assessment's subscale for balance, and the 10-metre walking test. A logistic regression model examined factors associated with reporting a fall in the past 3 months. RESULTS: Of the participants, 62 (38%) reported experiencing at least one fall in the past 3 months. Reduced walking speed, impaired balance, and weak sense of coherence were associated with falls in the past 3 months. CONCLUSION: These findings underscore the importance of examining diverse and modifiable influences on fall risk, including walking speed, balance and sense of coherence, in future studies involving people with multiple sclerosis.

Completing the cycle of scholarship of practice: a model for dissemination and utilization of evidence-based interventions.

SUMMARY The scholarship of practice stresses that knowledge should arise out of a dialogue and collaboration between scholars and practitioners. Bringing evidence back to practice completes the scholarship of practice cycle. This article describes a strategic approach to the process of knowledge dissemination and utilization and how that approach was used to increase knowledge and utilization of the Matter of Balance fear of falling intervention among occupational therapy practitioners. To illustrate how the approach supported clinicians' efforts to engage in evidence-based practice, the paper features a description of actions taken by a Maine-based health care system to successfully integrate Matter of Balance into its programming. Recommendations to policy makers, researchers and clinicians based on the authors' experiences with approach are presented.

Combining roles as an academic instructor and a clinical practitioner in occupational therapy: benefits, challenges, and strategies for success.

SUMMARY Approximately 28% of the total occupational therapy (OT) faculty in higher education are adjunct faculty members. Adjunct faculty (i.e., faculty who teach a course or part of a course) have been used in higher education to maintain quality educational experiences while providing positive community connections and educational resources with first-hand experience. In occupational therapy, practitioners often assume adjunct faculty responsibilities, thereby significantly increasing professional workloads. Despite added effort, there are several benefits to adjunct teaching. However, there are equally as many challenges. Objectives of this article were to describe rewards and challenges of adjunct teaching and suggest strategies for successfully negotiating adjunct roles. The article summarizes findings from needs assessments undertaken to develop adjunct faculty programs. Results are relevant to practitioners with both clinical and teaching roles, and to their supervisors and peers.