TY - JOUR
T1 - Scalability evaluation of a complex community-based falls prevention intervention in Australian stroke rehabilitation
AU - Lin, Ingrid
AU - Day, Sally
AU - Dean, Catherine M.
AU - Clemson, Lindy Maxted
AU - Glinsky, Joanne Valentina
AU - Cusick, Anne
AU - Lannin, Natasha A.
AU - Scrivener, Katharine
PY - 2025/9/25
Y1 - 2025/9/25
N2 - Objectives To investigate the scalability of the multi-component Falls After Stroke Trial (FAST) intervention tailored to community-dwelling adults with stroke to enable post-trial implementation. Design A mixed-methods formative evaluation of FAST data guided by the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework. Setting Community settings across three states in Australia. Participants Stroke participants were a subset of FAST trial participants (n=50) who were community-dwelling adults who had experienced a stroke up to 5 years prior and were at risk of falling. Therapists who delivered the intervention in the trial (interventionists) were physiotherapists and occupational therapists, trained in the FAST intervention. Interventions The FAST intervention is an individually tailored home safety and functional exercise programme designed to reduce falls and improve community mobility. It is offered over a 6-month period using 10 home visits, two telephone calls and programme resources, for example, manual and worksheets. Primary and secondary outcome measures Trial data, including interventionist training records and delivery data, resources and stroke participants’ adherence data were used to assess the Adoption, Implementation and Maintenance dimensions of the RE-AIM framework. Results The FAST intervention was delivered by 22 interventionists. High implementation fidelity was shown with 90% of the stroke participants receiving FAST dose and content. Effective strategies supporting implementation included standardised programme resources, comprehensive pre-programme training, regular interventionist feedback and interventionist mentoring from experts. Online training and peer support networks will be required for scale up. Conclusions This study identifies how a complex intervention to prevent falls after stroke was successfully delivered. The AIM dimensions provided insights to FAST features essential for scale-up. Interventionist training, resources and mentoring/feedback were essential for adoption within the trial. Training and resources should be accessible in an online format for scale up (maintenance).
AB - Objectives To investigate the scalability of the multi-component Falls After Stroke Trial (FAST) intervention tailored to community-dwelling adults with stroke to enable post-trial implementation. Design A mixed-methods formative evaluation of FAST data guided by the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework. Setting Community settings across three states in Australia. Participants Stroke participants were a subset of FAST trial participants (n=50) who were community-dwelling adults who had experienced a stroke up to 5 years prior and were at risk of falling. Therapists who delivered the intervention in the trial (interventionists) were physiotherapists and occupational therapists, trained in the FAST intervention. Interventions The FAST intervention is an individually tailored home safety and functional exercise programme designed to reduce falls and improve community mobility. It is offered over a 6-month period using 10 home visits, two telephone calls and programme resources, for example, manual and worksheets. Primary and secondary outcome measures Trial data, including interventionist training records and delivery data, resources and stroke participants’ adherence data were used to assess the Adoption, Implementation and Maintenance dimensions of the RE-AIM framework. Results The FAST intervention was delivered by 22 interventionists. High implementation fidelity was shown with 90% of the stroke participants receiving FAST dose and content. Effective strategies supporting implementation included standardised programme resources, comprehensive pre-programme training, regular interventionist feedback and interventionist mentoring from experts. Online training and peer support networks will be required for scale up. Conclusions This study identifies how a complex intervention to prevent falls after stroke was successfully delivered. The AIM dimensions provided insights to FAST features essential for scale-up. Interventionist training, resources and mentoring/feedback were essential for adoption within the trial. Training and resources should be accessible in an online format for scale up (maintenance).
KW - Behavior
KW - Clinical trials
KW - Implementation Science
KW - Randomized Controlled Trial
KW - REHABILITATION MEDICINE
KW - Stroke
UR - http://www.scopus.com/inward/record.url?scp=105017185798&partnerID=8YFLogxK
U2 - 10.1136/bmjopen-2024-093487
DO - 10.1136/bmjopen-2024-093487
M3 - Article
C2 - 40998446
AN - SCOPUS:105017185798
SN - 2044-6055
VL - 15
JO - BMJ Open
JF - BMJ Open
IS - 9
M1 - e093487
ER -
