Case report: Contextual implications of an evidence-based falls intervention in a sub-acute setting for a frail, elderly patient with rhabdomyolysis
Abstract :
Background and Purpose: Falls in elderly can result in rhabdomyolysis from muscle damage. The Otago Exercise Program (OEP) is an evidence-based falls program that helps frail elderly over the age of 80 regain balance, strength, and walking. Subacute settings have a high falls risk population and skilled therapy. The purpose of this theory to practice case report is to expand on the contextual factors of a subacute setting that limit fidelity to an evidence-based falls intervention while postulating the benefits of a sustainable falls prevention network. Case Description: The patient was an 86-year-old community dwelling adult who met the criteria for the OEP after she fell and was diagnosed with rhabdomyolysis and subsequent exacerbation of chronic obstructive pulmonary disease. She was admitted to a sub-acute setting for therapy due to deficits in mobility. She had previously been independent with ambulation. Outcomes: The OEP protocols were not followed. Though her Six Minute Walk Test, Timed Up and Go, 30 second Chair Stand Test and Four Stage Balance Test had clinically significant improvements, she was discharged to an assisted living facility. Discussion: The fidelity to the OEP was not maintained. Function drove the exercise prescription. The focus on profit in subacute facilities appears to impact delivery of evidence-based falls programs. An opportunity exists for these facilities to be part of a unique healthcare delivery model for falls prevention. A falls prevention network could facilitate this and serve as a repository of programs, promote collaboration amongst healthcare professionals, and facilitate patient transitions
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