European group addressing fall prevention

The U.K.-based organization consists of 25 members in 13 European countries and seeks input from experts worldwide.

Organizers of a network of health care professionals from 13 European countries are spearheading a continent-wide effort to prevent falls, especially among elderly people — a problem they say adds significantly to the overall orthopedic caseload throughout Europe.

To more closely focus on the key issues surrounding this costly problem, organizers formed four distinct work groups, which are focusing on the following areas:

Taxonomy and classification systems,
Clinical assessment and management of falling problems,
Assessing balance and function to prevent future falls, and,
Understanding psychological factors affected by falling.

Dawn Skelton, PhD, network coordinator, works with Chris Todd, PhD, Steve Richardson and Cindy Bramhall at the network center, which operates out of the University of Manchester in England. Skelton discussed the four-year goals of the European-wide network during a symposium in June at the 7th European Federation of National Associations of Orthopaedics and Traumatology Congress in Lisbon, Portugal.

Focus on prevention

Skelton said the Prevention of Falls Network Europe, or ProFaNE, was formed to assess what was already being done in different European countries to prevent falls. Early members of ProFaNE also wanted to ensure that the reporting of results of standard intervention programs became more consistent and user-friendly.

“The pathway for a faller differs considerably in different countries across Europe,” Skelton said. “The whole point of ProFaNE is to look at consensus across Europe to try and come up with a series of guidelines that works for all countries.” Better coordination across the European Union (EU), such as having clinicians in the United Kingdom use the same guidelines as those in Greece, would also help develop a consolidated approach to the problem, she added.

Although members of the ProFaNE organization do not perform research, they serve as a central organization point for those who do, as well as for anyone around the world who knows about the science, physiology and psychology of falls.

Another goal of the network is to ensure society “understands and appreciates that something can be done about falls,” Skelton said.

Each ProFaNE work group reports to the coordination center in Manchester but operates independently. During the symposium, Clemens Becker, MD, of Stuttgart, Germany, who heads the taxonomy and classification group with Sarah E. Lamb, DPhil, of Warwick, England, discussed those goals achieved recently by members of his group. Other work group coordinators spoke as well.

Developing appropriate standards for reporting results of falls studies lags far behind other areas of social medicine, they said. “There is no agreed taxonomy so far on fall prevention and fracture prevention trials,” said Becker, who heads the Department and Extension for Geriatric Medicine at the University of Bonn, Germany. Very few fall studies are even done prospectively, he added.

Becker’s group strongly recommended that those conducting research in this area use the SF-12 or the EuroQoL measurement instruments as a way to validate results.

Merging information

Some other work done to date included compiling information on about 100 worldwide randomized controlled trials and developing a useful matrix of interventions with their definitions.

“We will conduct this summer an inter-rater reliability process using the trials that have been published so far to test the proposal of this classification, and by the end of the year we hopefully will submit the paper to publish the proposal for the scientific community,” Becker said.

The taxonomy group also seeks to develop a set of shared outcome measures for falls studies. This would enable data sharing among groups in different European countries, he said.

For more information:
Skelton D. ProFaNE - Prevention of falls network Europe - a four-year thematic network.
Becker C. Fall prevention trials: The need for a taxonomy of interventions and agreed set of outcomes. Symposium 4: Fall prevention by a European network. Both presented at the 7th European Federation of National Associations of Orthopaedics and Traumatology Congress. June 4-7, 2005. Lisbon, Portugal.