Engaging Older Adults in Fall Prevention Using Motivational Interviewing (MI)

Not Applicable

Completed

Conditions: Fall
Motivation
Coping Behavior
Behavior

Interventions: Behavioral: Motivational Interviewing

Registration Number: NCT04612842

Lead Sponsor: Oregon Health and Science University

Brief Summary: This mixed-methods, two-arm, randomized controlled trial will evaluate the impact of Motivational Interviewing (MI) as a follow-up care to patients who received fall prevention recommendations at Oregon Health \& Science University Internal Medicine and Geriatrics Clinic provided over 12 months.

Detailed Description: The goal of this mixed-methods, two-arm, randomized controlled trial of MI intervention for fall prevention is to evaluate the impact of Motivational Interviewing (MI) as a follow-up care to patients who received fall prevention recommendations at Oregon Health \& Science University Internal Medicine and Geriatrics Clinic provided over 12-months. Older adult participants (older than 65) who are at increased risk for falling will be enrolled into the study. Patients will be randomly assigned to two groups: MI and the standard of care group. All participants will have a baseline and 6-months study visit that will include self-report and physiologic assessment. In addition, all participants will receive study measurement phone call at 3-, and 12-months. MI will be provided via video, phone, or in-person one week after the initial visit and then monthly for 6 months. All MI sessions will be recorded and encounter notes will be completed. Purposefully selected participants' MI sessions will be transcribed for qualitative analysis.

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 200

Inclusion Criteria

Oregon Health & Science University (OHSU) Internal Medicine and Geriatrics Clinic patients
65 years old or older
Moderate-to-high risk for falling using the STEADI fall screening and management algorithm
Cognitively oriented (Mini-Cog≥ 3)
Able to converse audibly and coherently in English
Living independently in the community
Able to receive study phone calls
Ambulatory with or without assistive device use

Exclusion Criteria

Cognitively impaired patients (Mini-Cog< 2)
Patients who have sensory difficulty with verbal communication (hard-of-hearing despite the use of hearing aids or speech is hard to understand despite a talking device)
Living in institutions with 24-hour care such as skilled nursing facilities
Unable to stand without assistance by others
Life-expectancy of less than 3-months
Patients participating in other studies that may impact fall-related behavior change

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Motivational Interviewing (MI) goup	Motivational Interviewing	The MI experimental group will receive the same measurements as the control group, and in addition, receive MI-based communication about fall prevention at eight occasions during the 6-month period. MI is an evidence-based communication approach for various health behavior change.

Primary Outcome Measures

Name	Time	Method
Falls Self-Efficacy Scale-International (FES-I) Results	3-, 6-, and 12-months	A 7-item scale, 1-4 self-report rating, widely used to measure levels of concern related to preventing falls. Minimum value is 7 and maximum value is 28. Higher FES-I scores is a worse value since it has been positively correlated with decreased activities, future falls, and injury.
Fall Behavioral (FAB) Scale Results	3-, 6-, and 12-months	A 24-item, 1-4 self-report rating to measure frequency of protective strategies to prevent falling and risky behaviors that facilitate a fall. The average value is calculated with a minimum value of 1 and maximum value of 4. Higher FAB score is a better value since it indicates more consistent fall protective behaviors.

Secondary Outcome Measures

Name	Time	Method
Level of Importance to Prevent Falls	3-, 6-, and 12-months	1-item 10-point scale response. Often used in motivational interviewing sessions to gauge an individual's readiness to engage in certain health behaviors. Higher levels of importance are known to be associated with an increased rate of behavior change.
Balance Measure (Tandem Stand)	6-months	Individuals are asked to hold a tandem stand (one foot in front of the other- heel touching toe). The minimum is 0 and the maximum is 10. A higher number is a better outcome.
Patient Activation Measure Results	3-, 6-, and 12-months	100-point, quantifiable scale determining patient engagement in healthcare. Minimum value is 0 and the maximum value is 100. Higher value is a better value since it is indicative of participant's activation with their healthcare.
Balance Measure (Semi-tandem Stand)	6- months	Duration that participants can hold semi-tandem stand (heel to toe standing positions) will be measured up to 10 seconds. Minimum value is 0 seconds and maximum score is 10 seconds. Higher value is a better value since it is indicative of participants' ability to hold balance.
Balance Measure (One-leg Stand)	6- months	Individuals are asked to hold a balance position for 10 sections without moving their feet or needing support. This position require standing on one foot. The minimum is 0 and the maximum is 10. A higher number is a better outcome.
Level of Confidence to Prevent Falls	3-, 6-, and 12-months	1-item 10-point scale response. Often used in motivational interviewing sessions to gauge an individual's readiness to engage in certain health behaviors. Higher levels of confidence are known to be associated with an increased rate of behavior change.
Balance Measure (Feet Side by Side)	6- months	Duration that participants can hold feet side-by-side stand (heel to toe standing positions) will be measured up to 10 seconds. Minimum value is 0 seconds and maximum score is 10 seconds. Higher value is a better value since it is indicative of participants' ability to hold balance.
30-second Sit-to-stand Assessment	6-months	Instances that participants can stand from a sitting position will be measured. Minimum value is 0 times. Higher value is a better value since it is indicative of participants' ability to sit-to-stand.
Number of Participants With Self-reported Falls	1-year	Individuals were asked to mail-in reports of falls every month. Participants reporting a fall at least once are counted as a faller. Minimum value is 0. Higher value is worse value as it is indicative that there were more participants who fell during the year.