A new guide from Public Health England and the National Falls Prevention Coordination Group member organisations has been published, helping commissioning and strategic leads prevent falls through strength and balance programmes.

The guide – ‘Strength and balance quality markers: Supporting improvement through audit’ – is aimed at local commissioning and strategic leads in England who are interested in falls prevention, bone health and healthy ageing, as well as providers of strength and balance falls prevention exercise.

It identifies seven different quality markers for strength and balance exercise that can be used as criteria supporting local areas in carrying out self-audit for quality improvement. The purpose of the guide is to showcase that these exercises can prevent falls, which improves health outcomes and independence for older people, and reduces demand for health and care services.

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The guide suggests that muscle strengthening and balance improvement programmes should consist of one-to-one or group balance and task training exercises, plus resistance exercises delivered by an appropriately qualified instructor.

It also recommends that programmes should consist of a minimum of 50 hours with a weekly ‘dose’ of at least two to three hours, with a focus on assessing individual needs to ensure that the programme is suitable for them. Over time, these programmes should progress in terms of intensity and challenge.

For the balance training, the guide recommends that it should be challenging and involve movement of the centre of mass, narrowing of the base of support and minimising upper limb support. It should range from the re-education of basic functional movement patterns to a wide variety of dynamic activities that target more sophisticated aspects of balance and allow reactive strategies to recover balance to be practiced.

However, the guide realises that getting individuals to participate in strength and balancing programmes will mean an increase in activity for many participants, and says that participants need to remain motivated and barriers to physical activity must be removed. This involves discussing with individuals that falls can be prevented, encouraging activity uptake and monitoring outcomes.

In addition, the guide notes that after completing these exercise programmes, individuals should be encouraged to remain active to help reduce falls risk, which can be done through offering follow-on classes and other physical activity opportunities.

Clinical audit is a quality improvement process that seeks to improve patient care and outcomes by systematically reviewing care against agreed criteria.

The guide identifies seven different quality markers for commissioners to ensure that improvements in care are met and monitored.

The seven auditing factors the guide outlines are:

  1. Population level physical activity
  2. Integrated care
  3. Provision of evidence-based muscle strengthening and balance improvement exercise programmes
  4. Completion of muscle strengthening and balance improvement falls prevention exercise programmes
  5. Participant adherence to muscle strengthening and balance improvement falls prevention exercise programmes
  6. Demonstrating improvements in gait and balance
  7. Maintaining activity

These seven quality markers can be used to support improvement in the quality of muscle strengthening and balance improvement falls prevention programmes, the guide says.

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