Steady Stride Fall Prevention Protocol vs Standard of Care

1. Background/Literature Review 1.1 Background Falls are the leading cause of preventable morbidity and mortality in community dwelling older US adults (65 years old and older) . This is a research study to evaluate the comparative effectiveness of the structured physiatry-based Steady Strides Fall Prevention Protocol compared to the standard of care treatment in preventing falls in community-dwelling older adults. Current standard of care is for the primary care physicians to evaluate patients at risk of falls, order medical work up, specialist physician consultation(s), medication changes and other interventions as needed, and prescribe physical and/or occupational therapy. Widely publicized guidelines for primary care physicians managing older adults at risk of falls include the American Geriatrics Society (3) and/or the Center for Disease Control and Prevention Stopping Elderly Accidents Deaths and Injuries (STEADI) guidelines. The American Geriatrics Society recommends that older adults undergo annual fall risk screening by physicians , which is an essential component of the annual Medicare wellness visit . To support a structured approach for physician-led fall prevention, the Centers for Disease Control and Prevention's Stopping Elderly Accidents, Deaths, and Injuries (STEADI) initiative provides an algorithmic framework for identifying, risk stratifying, and managing older adults at risk for falls, specifically designed for primary care providers . The STEADI algorithm includes evaluations of fall frequency, fear of falling, assessments for postural hypotension, foot deformities, visual and cognitive deficits, a basic screen for balance and gait issues, and a review of medications that could increase fall risk . Importantly, the STEADI approach positions physicians as key leaders in fall prevention management, utilizing physical therapy, community evidence-based fall prevention programs, podiatry and other referrals as part of a comprehensive, multifactorial intervention protocol . Limited non-randomized data suggest that implementing the STEADI strategy in primary care settings can reduce fall-related hospitalizations . The intervention arm of the Steady Strides Protocol includes both standard care and a structured fall prevention program. The Steady Strides Protocol is not an experimental treatment, it has been practiced at our clinic for several years already and has been paid for by the insurance providers as regular physiatry and rehabilitation care since 2017.Steady Strides Fall Prevention Protocol has been already shown in retrospective studies to have significant efficacy in preventing falls in community dwelling older adults . Novelty of the protocol lies not in introducing new rehabilitation techniques but in translating evidence-based interventions into a structured, consistent and easily adoptable framework for clinical practice. Since systematic reviews consistently highlight the efficacy of functional, multifactorial interventions-such as exercise, environmental modifications, and comprehensive assessments-in mitigating fall risk ; Steady Strides Protocol includes utilizing multidisciplinary interventions using physical and occupational therapy providers working closely with physiatry providers and emphasizes close communication between the rehabilitation professionals to ensure optimal patient outcomes. Since functional deficits like self-care and gait or balance impairments are common in those with high fall risk ; Steady Strides Protocol involves functional medicine professionals: physiatrists (also know as physical medicine and rehabilitation, or PM\&R providers, mid-level and/or physician) to help evaluate and manage patient fall risk and barriers to rehabilitation, prescribe rehabilitation protocols and set rehabilitation-goals. Consistent with increased evidence that occupational therapy can help reduce falls ; Steady Strides protocol regularly promotes occupational therapy interventions. Since incorporating cognitive training together with physical therapy has been shown to reduce falls ; Steady Strides Protocol prescribes incorporating dual-tasking activities during rehabilitation. Since there is evidence that fear of falling is associated with increased fall risk ; Steady Strides Protocol systematically focuses on reducing fear of falling. To ensure consistency and reliability of care delivery Steady Strides Protocol uses a standardized hybrid on-line and in-person training for PM\&R clinicians and rehabilitation therapy providers. This course educates on how to perform a structured falls related history, physical exam, interventions and a how to set standardized set of rehabilitation goals in order to identify and treat chronic biomechanical factors contributing to increased fall risk. Steady Strides Protocol also focuses on increased patient engagement consistent with general good clinical practice, as well as in context of emerging evidence that patient engagement may reduce fall risk . 2. Rationale/Significance/Problem Statement