Supporting implementation of occupational therapy led Falls Hazard Reduction at Home: A scoping review.
Susan Melchert, Daniel Lowrie, Alison Pighills
Across 19 studies, implementation of OT-led home falls hazard reduction leans on champion identification and stakeholder engagement.
Facilitation and interactive assistance are almost absent. OTs often assume the practice is already core, but chart audits show it is not delivered systematically.
Key findings
1The most frequently described implementation strategy was identifying and preparing champions, appearing in approximately 70% of included papers, within the stakeholder interrelationships cluster which accounted for 30% of all strategy descriptions.
2Occupational therapists in two included studies believed they were already delivering evidence-based FHR@Home, but a chart audit of 58 records in one of those studies found no evidence of comprehensive, validated home hazard assessment or standardised evaluation of functional capacity.
3Collaborative approaches were central to implementation success, but two papers reported the process only worked when the consumer considered themselves at risk of falls. One clinician described working with someone who did not see themselves as a falls risk as 'really difficult because they're not coming with you on that journey.'
Still to come
How it was doneWhat they foundWhat it means for OTs
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What it does not show
The 19 included studies varied widely in design, setting, and how much FHR@Home was actually part of the intervention, making synthesis difficult. Only two of the 19 studies used the ERIC taxonomy themselves; the review authors had to map strategies by searching for keywords and phrases, relying on their own interpretation of the taxonomy. Minimal studies focused solely on OT-led FHR@Home; most embedded it within a broader multifactorial programme, so the implementation strategies described apply to the whole package. No protocol was registered before the review was conducted. The review does not appraise the quality of included studies, so the strength of individual findings varies.
Declared interests
The authors declare no conflicts of interest. The work was funded by the Medical Research Future Fund.
The easy way to misread this
Do not read this as evidence that FHR@Home reduces falls. It maps how the intervention gets implemented, not whether it works. The 38% falls reduction cited in the introduction comes from a separate trial (Clemson et al., 2023), not from this review's findings. Also, 70% of included studies delivered FHR@Home as one part of a larger multifactorial package, so the implementation strategies described apply to the whole programme, not to FHR@Home alone.
Summarised by AI from the full paper, without a clinician reviewing it. Check it against the source before it changes what you do. Read it on PubMed →