{
  "abstract": "Background Falls amongst older adults are a major cause of pain and distress, injury, loss of independence, and mortality. The Falls Management Exercise (FaME) Programme, a 24-week group exercise class, has been shown in clinical trials to reduce falls amongst the over 65s. The current study is a formative process evaluation of FaME in a large, rural county in England measuring the impact on those completing FaME, and service reach, fidelity, acceptability, and maintenance of outcomes.Methods Anonymised routine data were collected from 110 participants at baseline, the end of the programme and at three-months follow-up. The primary outcome measure was a reduction in self-reported falls. Median and IQR at baseline and end of FaME for self-reported falls, fear of falling (FES-1), self-reported physical activity minutes per week, quality of life (EQ5D5L), and functional measures including Timed-up-and-go, Turn 1800 and Functional Reach tests were calculated, and differences compared using a Wilcoxon signed-rank test. Qualitative data were collected through in-depth interviews with intervention commissioners (N=5), delivery staff (N=9) and participants (N=32) and their carers (N=8) and eight structured observations of FaME classes. Qualitative data were analysed using the Framework method of thematic analysis.Results 65% of participants were female and mean age was 79.5 years; 57% had experienced at least one fall in the previous three months prior to starting FaME. 90% of participants remained on programme and completed the final 24th session. Self-reported falls, and fear of falling decreased on average by the end of the intervention (P<0.001). Median levels of Timed-up-and-go, Functional Reach and the Turn 180o test improved between baseline and the end of the FaME intervention (P<0.001). 87% of participants improved their physical activity levels between baseline and follow-up. Interviewed participants were highly motivated to attend, reporting increased strength, stamina and social benefits. Absolute service reach was as planned, however the absence of any strategic approach to locating FaME classes in area of higher economic deprivation in the county risked widening health inequalities. Maintenance of improved participant outcomes beyond the 24-week intervention was challenged by the absence of suitable physical activity opportunities across the county.Conclusion This study finds evidence that despite the anticipated challenges of implementation in a rural county with poor infrastructure, the intervention improved outcomes for participants. Efforts to improve availability, acceptability and accessibility of activities that promote muscle strength and balance will be necessary to maintain the positive effects of the FaME intervention.",
  "authors": [
    {
      "affiliations": [
        "Population Health Sciences, University of Bristol, Bristol, UK"
      ],
      "name": "Patricia Jessiman"
    },
    {
      "affiliations": [
        "Population Health Sciences, University of Bristol, Bristol, UK"
      ],
      "name": "Ruth Salway"
    },
    {
      "affiliations": [
        "Population Health Sciences, University of Bristol, Bristol, UK"
      ],
      "name": "Rona Campbell"
    }
  ],
  "title": "OP30 A mixed methods formative process evaluation of the falls management exercise programme in an English rural county",
  "uid": "a5fca7b5-d259-5bce-b34f-fa67a4bd60db"
}