The iCARE feasibility non-experimental design study: An integrated collection of education modules for fall and fracture prevention for healthcare providers in long term care

Falls and hip fractures are a major health concern among older adults in long term care (LTC) with almost 50% of residents experiencing a fall annually. Hip fractures are one of the most important and frequent fall-related injuries in LTC. The purpose of this study was to determine the feasibility (recruitment rate and adaptations) of implementing the PREVENT (Person-centred Routine Fracture PreEVENTion) model in practice, with a subobjective to understand facilitators and barriers. The model includes a multifactorial intervention on diet, exercise, environmental adaptations, hip protectors, medications (including calcium and vitamin D), and medication reviews to treat residents at high risk of fracture. Our secondary outcomes aimed to assess change in knowledge uptake of the guidelines among healthcare providers and in the proportion of fracture prevention prescriptions post-intervention. We conducted a mixed-methods non-experimental design study in three LTC homes across southern Ontario. A local champion was selected to guide the implementation. We reported recruitment rates using descriptive statistics and adaptations using content analysis. We reported changes in knowledge uptake using the paired sample t-test and the percentage of osteoporosis medications prescriptions using absolute change. Within five months, we recruited three LTC homes. We required two months to identify and train the local champion over three 1.5-hour train-the-trainer sessions, and the champion required three months to deliver the intervention to the healthcare team. We identified several facilitators, barriers, and adaptations. Benefits of the model include easy access to the Fracture Risk Scale, clear and succinct educational material catered to each healthcare professional, and an accredited educational module for physicians and nurses. Challenges included misperceptions between the differences in fall and fracture prevention strategies, fear of perceived side effects associated with fracture prevention medications, and time barriers with completing the audit report. Our study did not increase knowledge uptake of the guidelines, but there was an increase in the proportion of osteoporosis medication post-intervention. ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Trial We registered our study on clinicaltrials.gov on July 6, 2022 ([NCT05445336][1]) we updated the registry on December 21, 2022. ### Clinical Protocols ### Funding Statement The authors would like to thank the following funding agents for their support with the project. The lead author (IBR) was funded by the McMaster Institute for Research on Aging (MIRA), AGE-WELL, the Hamilton Health Sciences New Investigator Fund, the Canadian Institutes of Health Research Postdoctoral Award. The corresponding author (AP) received funding from the Amgen Competitive Grant Program in Bone Research Award. The funders played no part in developing the research design, collecting data collection, analyzing the results, or writing the manuscript. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: We received ethics approval from the Hamilton Integrated Research Ethics Board (Project ID 14463). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data available upon request from corresponding author [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT05445336&atom=%2Fmedrxiv%2Fearly%2F2024%2F03%2F24%2F2024.03.22.24304705.atom