Impact case study database

Context

In REF2014 we reported how our research had impacted policy and practice in falls prevention. That underpinning research has continued to be highly influential and has increased in reach and significance.

Pathways to Impact

Since 2014, the EU Prevention of Falls Network for Dissemination (ProFouND- led by UoM, 33 institutions, 14 countries) has extended the reach of impact, through the Falls Action Group: European Innovation Partnership on Active and Healthy Ageing. This group brought together 100 multi-stakeholder commitments/communities from across the EU to promote falls prevention, bringing research evidence to innovation and procurement processes [Ai], [Aii]. Since 2015, we have organised the annual European falls conference, and help organise the Falls World Congress, first held in 2019. Todd wrote briefings for the Department of Health and Social Care and the Chief Medical Officer on fall prevention and activity promotion and attended the House of Lords Select Committee (July 2019), to which UoM also submitted written evidence. Multiple stakeholders have taken up recommendations for practice based on UoM research. We worked with PHE and the Royal Society for the Prevention of Accidents (RoSPA) to influence policy and practice, including recommendations for use of FaME, FES-I, and positively framed messages [Bi]. Similar work was undertaken with the Centre for Ageing Better, AgeUK, British Geriatrics Society and national and international guideline development bodies (e.g NICE, US CDC).

The FaME Implementation Toolkit (developed by East Midlands CLAHRC (Collaboration for Leadership in Applied Health Research and Care), endorsed by NICE and downloaded >800 times) facilitates commissioners’ and providers’ uptake [C].

We worked with Greater Manchester Combined Authority on the devolved falls, fractures and frailty strategies and influenced service configuration, use of FaME and the positively framed “Taking Charge” falls prevention programme [Di].

Reach and significance of the impact

Non-UoM research (Proact65) continues to demonstrate the effectiveness of the FaME intervention at reducing falls by more than a quarter when compared with usual care at 12 month follow-up and increasing the number of participants reaching their physical activity target [E].

Falls interventions

New national and international guidance documents identifying evidence-based strength and balance exercise programmes recommend FaME, e.g NICE 2018 [Fi], US Centers for Disease Control and Prevention (US CDC) 2015 [Fii].

Leading on from the “Taking Charge” falls prevention programme, during 2020 COVID-19 lockdowns, we helped develop Keeping Well at Home and Keeping Well this Winter booklets including FaME exercises, distributed to >260,000 people and recognised as best practice by WHO [Dii].

FaME has been shown to have a financial impact, with PHE recommending the programme as a cost-effective intervention to reduce falls [Bii], estimating that FaME provides a societal return on investment for every GBP1.00 spent of GBP2.28 (1:2.28 ratio), although other estimates are much higher (1:18 and 1:50.5) [Gi], [Gii].

FaME has also been shown to be income-generating. There are 3,264 qualified FaME instructors in the UK (up from 2,000 reported in REF2014), enabling more people to participate in FaME classes, generating GBP813,837 income for Later Life Training, a not for profit training organisation [Giii].

Interim data from a survey undertaken for PHE reveals that 80% of responding falls services in England provided FaME to up to 300 participants per week during 2019-20.

In terms of patient outcomes, some 172,000 people in the UK received the FaME programme in 2019, suggesting that during 2014-2020, up to 424,554 falls and up to 21,000 fractures have been averted by participation in FaME. The Centre for Ageing Better present strong testimonial videos demonstrating FaME’s effect on individuals [H], along with case studies of FaME implementation in the UK.

FaME-based exercises have been implemented in exergames, providing a new cost-effective pathway to impact [I]. The UK company MIRA-Exergaming indicates that approximately 5,000 patients in >200 clinics worldwide have used the games in >67,000 sessions.

The COVID-19 pandemic has given further impetus to our work because of risk of deconditioning and falls resulting from lockdown. Policy briefings to the Department of Health and Social Care on virtual delivery exercise regimens including FaME have been downloaded >1,100 times.

Fear of Falling

FES-I/Short FES-I is now more widely used as a measure of fear-of-falling. It was internationally downloaded 18,274 times in 2020. The website www.fes-i.org alone has >18,000 page views per annum from >120 countries. FES-I is available in 35 languages, an increase of 17% since 2014.

FES-I has been added to the RoSPA “Stay Up Stand Up” core outcomes dataset for falls prevention services and it continues to be recommended by PHE [Bii] as well as by many organisations worldwide (e.g. American Physical Therapy Association, Danish Society for Physiotherapy, SRA-LAb Org USA).

Uptake and adherence

As reported in REF2014, our work published as “ Don’t mention the F-word” resulted in a change of underlying philosophy, with a move away from emphasising the dangers of falls to emphasising positive coping. This continues to influence how services are configured, emphasising the positives of participating in exercise rather than focusing on personal risk from falls. Evidence for this continued impact in the UK is provided in the Centre for Ageing Better Raising the Bar 2019 publication [J], which demonstrates the sustained use and impact of FaME in the UK. Internationally the notion of focusing on the positive rather than emphasising risk, as identified by our research, continues to be a keystone of policy across the EU, North America, Australia and New Zealand and more recently across Asia.