TY - JOUR
T1 - Protocol for the home hazards removal program (HARP) study
T2 - a pragmatic, randomized clinical trial and implementation study
AU - Stark, Susan
AU - Somerville, Emily
AU - Keglovits, Marian
AU - Conte, Jane
AU - Li, Melody
AU - Hu, Yi Ling
AU - Yan, Yan
N1 - Publisher Copyright:
© 2017 The Author(s).
PY - 2017/4/20
Y1 - 2017/4/20
N2 - Background: Falls remain the leading cause of injury, long-term disability, premature institutionalization, and injury-related mortality in the older adult population. Home modifications, when delivered by occupational therapists, can reduce falls among high-risk community-dwelling older adults by 39%. However, home-modification implementation is not standard practice in the United States. The goal of the Home Hazard Removal Program (HARP) study is to implement an evidence-based home modification intervention for older adults designed to reduce the incidence of falls through an aging services network. Methods: We will conduct a hybrid effectiveness/implementation trial of 300 older adults at risk for a fall who are randomized and followed for 12 months. Participants who are randomized to treatment will receive the home modification intervention provided by an occupational therapist in addition to usual care, defined as continued services from the area agency on aging. We will compare the effectiveness of the program and usual care using survival analysis with the time to the first fall over 12 months as the primary outcome of interest. Secondary outcomes include daily activity performance, fall self-efficacy, and health-related quality of life. Fidelity, dose, adherence, safety, cost, and health care utilization will also be examined in the implementation component of this study. Discussion: This intervention targets an underserved, difficult to reach population of older adults. The tailored approach of the study intervention is a strength in improving adherence, as each recommendation is individualized to be acceptable to the participant. The effectiveness/implementation design of the study allows for rapid dissemination of results and implementation of the intervention in a United States social services agency. Trial registration: Clinicaltrials.gov identifier: NCT02392013 . Retrospectively registered on March 5, 2015.
AB - Background: Falls remain the leading cause of injury, long-term disability, premature institutionalization, and injury-related mortality in the older adult population. Home modifications, when delivered by occupational therapists, can reduce falls among high-risk community-dwelling older adults by 39%. However, home-modification implementation is not standard practice in the United States. The goal of the Home Hazard Removal Program (HARP) study is to implement an evidence-based home modification intervention for older adults designed to reduce the incidence of falls through an aging services network. Methods: We will conduct a hybrid effectiveness/implementation trial of 300 older adults at risk for a fall who are randomized and followed for 12 months. Participants who are randomized to treatment will receive the home modification intervention provided by an occupational therapist in addition to usual care, defined as continued services from the area agency on aging. We will compare the effectiveness of the program and usual care using survival analysis with the time to the first fall over 12 months as the primary outcome of interest. Secondary outcomes include daily activity performance, fall self-efficacy, and health-related quality of life. Fidelity, dose, adherence, safety, cost, and health care utilization will also be examined in the implementation component of this study. Discussion: This intervention targets an underserved, difficult to reach population of older adults. The tailored approach of the study intervention is a strength in improving adherence, as each recommendation is individualized to be acceptable to the participant. The effectiveness/implementation design of the study allows for rapid dissemination of results and implementation of the intervention in a United States social services agency. Trial registration: Clinicaltrials.gov identifier: NCT02392013 . Retrospectively registered on March 5, 2015.
KW - Falls
KW - Home hazards
KW - Implementation trial
KW - Medically underserved
KW - Older adults
KW - Randomized controlled trial
UR - http://www.scopus.com/inward/record.url?scp=85018484612&partnerID=8YFLogxK
U2 - 10.1186/s12877-017-0478-4
DO - 10.1186/s12877-017-0478-4
M3 - Article
C2 - 28427336
AN - SCOPUS:85018484612
SN - 1471-2318
VL - 17
JO - BMC Geriatrics
JF - BMC Geriatrics
IS - 1
M1 - 90
ER -