Taxonomy to describe and conceptualise fall prevention interventions (Manual) 2
Taxonomy to describe and conceptualise fall prevention interventions (Manual)
(Lamb S, Becker C, Gillespie L, Smith J, Finnegan S, Potter R, Pfeiffer K on behalf of Taxonomy Investigators and the ProFaNE Group (www.profane.co))
5th April 2007
Table of content
Introduction 2
Study reference & design 4
Reference 4
Design 4
Domain 1: Approach 4
Primary Aims 4
Primary selection criteria 5
Population approach 5
Demographics 5
Chronic diseases, symptoms, impairments 5
Specific groups excluded 7
Domain 2: Base 8
Case Identification/Primary Site of Delivery 8
Hospitals/Departments/Wards (Inpatient: Acute or Sub-acute) 8
Nursing and residential care facilities (Non-acute) 9
Providers of ambulatory health care 9
Community based recruitment/delivery 11
Assessments delivered by 12
Interventions & postintervention follow-ups delivered by 13
Professionals 13
Trained non-professionals 14
Domain 3: Components 16
Assessment as part of the intervention (generic) 16
Assessment as part of the intervention (specific) 16
Combination 17
Domain 4: Descriptors 18
Exercises (supervised/unsupervised) 18
Medication (Drug Target) 21
Surgery 23
Management of urinary incontinence 24
Fluid or nutrition therapy 24
Psychological 24
Environment/Assistive technology 24
Environmental (social environment) 26
Knowledge 27
Other interventions/procedures 27
Further specifications of the intervention 27
Domain 4: Descriptors/Control Group 29
Supervised Exercises 29
Medication(Drug Target) 29
Social environment/Knowledge 29
References. 30
Introduction
The taxonomy is designed for three purposes
[1] To characterise and classify existing fall prevention interventions – such as those published in the literature as well as clinical services. It is being used by the Cochrane collaboration to characterise interventions, and by ProFaNE to map research activity to date and identify areas which need more research.
[2] To encourage authors of new interventions to report the intervention in such a way that it can be replicated and understood by others.
[3] To assist designers of new interventions to consider the range of factors that should be considered in developing and reporting a new intervention and to assist with pre-specification of a framework (model) explaining effectiveness for future testing.
You may be able to find more purposes for the taxonomy!
The study was developed by Workpackage 1 of the Prevention of Falls Network Europe project, a collaborative project to reduce the burden of fall injury in older people through excellence in research and promotion of best practice. (www.profane.eu.org).
Tips on using the taxonomy
The taxonomy is divided into four domains ( see Table 1 for definitions). Within each domain there are further sub-domains (shown by grey headings in the taxonomy), and then finally within in each sub-domain, a further breakdown of categories. This manual provides a detailed description of the domains, sub-domains and categories.
Domains Þ Sub-domain Þ Category
The taxonomy is a balance between detailed description and a more reductionist approach. Occasionally it maybe difficult to find an exact sub-domain or category for the intervention you are detailing. This is most likely to occur beyond the sub-domain level. Our advice is to select the domains, sub-domains, and categories which best describe the intervention. In each sub-domain there is an section marked “other“ which allows you to enter any interventions that you cannot classify under the sub-domains currently available.
It is also important to recognise that the taxonomy has been designed for international comparison. For example, we have used the International Classification for Health Accounts to classify organisations who deliver healthcare. We would encourage you to fit your situation into this classification as best you can.
The taxonomy is complementary to but does not replace the Consort Guidance in the reporting of complex interventions.
Feedback
The taxonomy will evolve and grow over time. Would welcome any feedback to inform revisions to
This manual should be read in conjunction with Lamb SE et al (Taxonomy paper).
Table 1. Domains and sub-domains of the ProFaNE taxonomy.
Domain 1: Approach: describes the theoretical approach in terms of the primary aims and whether and what selection or targeting criteria have been used to identify cases.Sub-domains
Primary aims of the intervention being developed
Primary selection criteria used for case identification.
Domain 2: Base: describes where participants have been selected from, where the intervention is delivered and by whom
Sub-domains
Recruitment site: the site at which participants of the intervention were identified;
Main site of delivery: the site at which the majority of the intervention is delivered or targeted.
Interventions delivered by : describes the individuals (professionals, trained professionals, etc) who deliver the majority of the intervention
Domain 3: Components: describes variations in assessments used for deciding treatments, and different methods of combining interventions
Sub-domains:
Assessments that are used as part of the intervention
Combination of interventions
Domain 4: Descriptors: describes each of the components delivered in the control and active intervention, including sub-classifications that are considered potentially important
Sub-domains:
Description of the test interventions components
Description of control group or sham interventions
Domain 1: Approach
Primary Aims
To reduce falls (A100)To reduce fall related injuries (A101)
To improve Quality of Life (A102) / A generic concept reflecting concern with the modification and enhancement of life attributes, e.g., physical, political, moral and social environment; the overall condition of a human life. [MeSH D011788]
To improve function/physical activity (A103) / e.g., mobility, body sway, balance etc.
To reduce hospitalisation/health care resource use (A104)
Safety monitoring (A105) / This category is likely to be used for retrospective data extraction from published studies only. It should be used where the primary aim of the intervention (listed under Others A199) tested was not to reduce falls, but falls were collected to monitor the safety of the intervention.
To improve psychological outcome (A106) / Outcome measures targeting mental or behavioural characteristics of an individual or a group. (e.g. fear, self-efficacy, activity avoidance, loss of confidence)
Others (A199/A199A) / All other primary aims not described under A100 to A106
A199A: Brief description (free text)
Primary selection criteria
Population approach (A200)
/ These are approaches in which the entire population of older people are targeted. Examples are television media campaigns or mail shoot campaigns. No targeting criteria are specified, with the exception of age and gender (sometimes).Selection criteria used
Demographics
Age group (A300) / ³ ….. years (Insert the minimum age of the participants according to the inclusion criteria)Male only (A301)
Female only (A302)
Selected ethnic group (A303) / Ethnic group: A group of people with a common cultural heritage that sets them apart from others in a variety of social relationships. [MeSH D005006].
If the inclusion and exclusion criteria for a study or programme did not state a specific ethnic group, but all members of the sample are from one ethnic group, then this box should not be ticked.
Others (A399/A399A) / Not described under A300-A303
A399A: Brief description (free text)
Previous falls (³ 1) (A400) / At least one fall during the last year (self report or any records)
Chronic diseases, symptoms, impairments
Osteoporosis / osteoporotic (bone fragility) fractures (A500) / Osteoporosis: Reduction of bone mass without alteration in the composition of bone, leading to fractures. Primary osteoporosis can be of two major types: postmenopausal osteoporosis (OSTEOPOROSIS, POSTMENOPAUSAL) and age-related or senile osteoporosis. [MeSH D010024]Osteoporosis, postmenopausal: Metabolic disorder associated with fractures of the femoral neck, vertebrae, and distal forearm. It occurs commonly in women within 15-20 years after menopause, and is caused by factors associated with menopause including estrogen deficiency. [MeSH D015663]
Parkinson’s disease/ syndrome (A501) / Parkinson disease: A progressive, degenerative neurologic disease characterized by a TREMOR that is maximal at rest, retropulsion (i.e. a tendency to fall backwards), rigidity, stooped posture, slowness of voluntary movements, and a masklike facial expression. Pathologic features include loss of melanin containing neurons in the substantia nigra and other pigmented nuclei of the brainstem. LEWY BODIES are present in the substantia nigra and locus coeruleus but may also be found in a related condition ( LEWY BODY DISEASE, DIFFUSE) cha racterized by dementia in combination with varying degrees of parkinsonism. (Adams et al., Principles of Neurology, 6th ed, p1059, pp1067-75) [MeSH D010300].
Cerebrovascular Disorders (A502) / A broad category of disorders characterized by impairment of blood flow in the arteries and veins which supply the brain. These include CEREBRAL INFARCTION; BRAIN ISCHEMIA; HYPOXIA, BRAIN; INTRACRANIAL EMBOLISM AND THROMBOSIS; INTRACRANIAL ARTERIOVENOUS MALFORMATIONS; and VASCULITIS, CENTRAL NERVOUS SYSTEM. In common usage, the term cerebrovascular disorders is not limited to conditions that affect the cerebrum, but refers to vascular disorders of the entire brain including the DIENCEPHALON; BRAIN STEM; and CEREBELLUM [MeSH D002561]
Eye diseases, visual impairments (A503) / § Eye diseases [Mesh D005128],
§ Vision disorders: Visual impairments limiting one or more of the basic functions of the eye: visual acuity, dark adaptation, colour vision, or peripheral vision. These may result from EYE DISEASES; OPTIC NERVE DISEASES; VISUAL PATHWAY diseases; OCCIPITAL LOBE diseases; OCULAR MOTILITY DISORDERS; and other conditions. Visual disability refers to inability of the individual to perform specific visual tasks, such as reading, writing, orientation, or travelling unaided. (From Newell, Ophthalmology: Principles and Concepts, 7th ed, p132) [MeSH D014786]
Dementia, cognitive impairment (A504) / Dementia: An acquired organic mental disorder with loss of intellectual abilities of sufficient severity to interfere with social or occupational functioning. The dysfunction is multifaceted and involves memory, behaviour, personality, judgment, attention, spatial relations, language, abstract thought, and other executive functions. The intellectual decline is usually progressive, and initially spares the level of consciousness. [Dementia: MeSH D003704]
This category includes also less severe cognitive impairments affecting the ability to think, concentrate, formulate ideas, reason and remember.
Depression symptoms (A505) / Depression: Depressive states usually of moderate intensity in contrast with major depression present in neurotic and psychotic disorders. [Depression: MeSH D003863]
Depressive disorder: An affective disorder manifested by either a dysphoric mood or loss of interest or pleasure in usual activities. The mood disturbance is prominent and relatively persistent. [MeSH D003866]
Dysthymic Disorder: Chronically depressed mood that occurs for most of the day more days than not for at least 2 years. The required minimum duration in children to make this diagnosis is 1 year. During periods of depressed mood, at least 2 of the following additional symptoms are present: poor appetite or overeating, insomnia or hypersomnia, low energy or fatigue, low self esteem, poor concentration or difficulty making decisions, and feelings of hopelessness. [MeSH D019263]
Syncope (A506) / A transient loss of consciousness and postural tone caused by diminished blood flow to the brain (i.e., BRAIN ISCHEMIA). Presyncope refers to the sensation of lightheadedness and loss of strength that precedes a syncopal event or accompanies an incomplete syncope. (From Adams et al., Principles of Neurology, 6th ed, pp367-9) [MeSH D013575].
Gait and/or balance impairment (A507) / Gait is the way one locomotes or walks [MeSH D005684]. Examples: walking patterns and running patterns; impairments such as spastic gait, hemiplegic gait, paraplegic gait, asymmetric gait, limping and stiff gait pattern [ICF b770].
Postural balance or musculoskeletal equilibrium: A state of the body being evenly balanced in POSTURE. The biomechanical responses of the MUSCULOSKELETAL SYSTEM during standing, walking, sitting, and other movements [MeSH D004856].
Balance impairments include impairments of sitting, static standing or dynamic balance. In the context of falls gait and balance impairments are often detected with timed or qualitative performance tests such as the get up and go test.
Urinary incontinence (A508) / Involuntary loss of URINE, such as leaking of urine. It is a symptom of various underlying pathological processes. Major types of incontinence include URINARY URGE INCONTINENCE and URINARY STRESS INCONTINENCE [MeSH D014549].
Screening tool (A509) / A fall screening tool is a short test intended to determine an older person’s risk of falling in order to determine eligibility for a fall risk intervention. It is not usually used to determine treatment received. Examples are the FRAT and AGS/BGS fall screening algorithm
Others (A599/A599A) / Not described under A500-A509.
A599A: Brief description (free text)
Medication specific (A600) / In which individuals have been selected as they are taking specified classes of medication with a known association with fall risk (e.g. SSRIs; sedatives; hypnotics) or as identified by the authors of the paper.
Specific groups excluded
Dementia, cognitive impairment (A700) / Dementia: An acquired organic mental disorder with loss of intellectual abilities of sufficient severity to interfere with social or occupational functioning. The dysfunction is multifaceted and involves memory, behaviour, personality, judgment, attention, spatial relations, language, abstract thought, and other executive functions. The intellectual decline is usually progressive, and initially spares the level of consciousness. [Dementia: MeSH D003704]This category includes also less severe cognitive impairments affecting the ability to think, concentrate, formulate ideas, reason and remember.
Other specified exclusion (A799/A799A) / Specific group(s) stated by authors and which are not codable elsewhere.
Don’t code “Other specified exclusion” if the criteria interferes obviously with the planned intervention or increases the risk of dropping out of the study in an obvious way:
Illustrative examples:
§ Terminal illness
§ Admitted for palliative care (institutional studies)
§ Enrolled in any other similar studies
§ Participating in any similar interventions
§ Receiving home nursing care on a regular basis (community studies)
§ Planning to be absent from the intervention location for a longer period or don’t expect to remain in the area during the intervention period
§ Psychiatric illness prohibiting participation
§ Too frail to withstand the exercises
§ Contraindication to treatment
§ Not speaking the language the intervention or assessment is delivered in
§ Living to far away from the research centre
§ Could not give informed consent (e.g.: cognitive impairment and no regular carer)
§ Unable or unwilling to complete the baseline assessments
§ Not ambulatory with or without an assistive device
§ Uncontrolled cardiac failure of hypertension
§ Chronic alcoholism