Understanding the theoretical underpinning of the exercise component in a fall prevention programme for older adults with mild dementia: a realist review protocol

Booth, Victoria; Harwood, Rowan H.; Hood, Victoria; Masud, Tahir; Logan, Phillipa A.

Abstract

Background

Older adults with mild dementia are at an increased risk of falls. Preventing those at risk from falling requires complex interventions involving patient-tailored strength- and balance-challenging exercises, home hazard assessment, visual impairment correction, medical assessment and multifactorial combinations. Evidence for these interventions in older adults with mild cognitive problems is sparse and not as conclusive as the evidence for the general community-dwelling older population. The objectives of this realist review are (i) to identify the underlying programme theory of strength and balance exercise interventions targeted at those individuals that have been identified as falling and who have a mild dementia and (ii) to explore how and why that intervention reduces falls in that population, particularly in the context of a community setting. This protocol will explain the rationale for using a realist review approach and outline the method.

Methods


A realist review is a methodology that extends the scope of a traditional narrative or systematic evidence review. Increasingly used in the evaluation of complex interventions, a realist enquiry can look at the wider context of the intervention, seeking more to explain than judge if the intervention is effective by investigating why, what the underlying mechanism is and the necessary conditions for success. In this review, key rough programme theories were articulated and defined through discussion with a stakeholder group. The six rough programme theories outlined within this protocol will be tested against the literature found using the described comprehensive search strategy. The process of data extraction, appraisal and synthesis is outlined and will lead to the production of an explanatory programme theory.

Discussion


As far as the authors are aware, this is the first realist literature review within fall prevention research and adds to the growing use of this methodology within healthcare. This synthesis of evidence will provide a valuable addition to the evidence base surrounding the exercise component of a fall intervention programme for older adults with mild dementia and will ultimately provide clinically relevant recommendations for improving the care of people with dementia.

Citation

Booth, V., Harwood, R. H., Hood, V., Masud, T., & Logan, P. A. (2016). Understanding the theoretical underpinning of the exercise component in a fall prevention programme for older adults with mild dementia: a realist review protocol. Systematic Reviews, 5, Article 119. https://doi.org/10.1186/s13643-016-0212-x

• Journal Article Type: Article
• Acceptance Date: Feb 16, 2016
• Online Publication Date: Jul 19, 2016
• Publication Date: Jul 19, 2016
• Deposit Date: Jan 30, 2017
• Publicly Available Date: Dec 3, 2018
• Journal: Systematic Reviews
• Electronic ISSN: 2046-4053
• Publisher: Springer Verlag
• Peer Reviewed: Peer Reviewed
• Volume: 5
• Article Number: 119
• DOI: https://doi.org/10.1186/s13643-016-0212-x
• Keywords: Realist review, Realist synthesis, Accidental falls, Fall prevention, Exercise, Dementia, Cognitive impairment
• Public URL: https://nottingham-repository.worktribe.com/output/800303
• Publisher URL: http://dx.doi.org/10.1186/s13643-016-0212-x
• Additional Information: Authors would like to thank Dr. Geoff Wong, the Nuffield Department of Primary Care Health Sciences, University of Oxford, for the invaluable help with developing the protocol and the expert knowledge of realist synthesis.
• Contract Date: Jan 30, 2017