Effectiveness of interventions to prevent falls for people with multiple sclerosis, Parkinson’s disease and stroke: an umbrella review

Background The implementation of condition-specific falls prevention interventions is proving challenging due to lack of critical mass and resources. Given the similarities in falls risk factors across stroke, Parkinson’s Disease (PD) and Multiple Sclerosis (MS), the development of an intervention designed for groups comprising of people with these three neurological conditions may provide a pragmatic solution to these challenges. The aims of this umbrella review were to investigate the effectiveness of falls prevention interventions in MS, PD and stroke, and to identify the commonalities and differences between effective interventions for each condition to inform the development of an intervention for mixed neurological groups. Methods A systematic literature search was conducted using 15 electronic databases, grey literature searches and hand-screening of reference lists. Systematic reviews of studies investigating the effects of falls prevention interventions in MS, PD and stroke were included. Methodological quality of reviews was assessed using the A MeaSurement Tool to Assess Systematic Reviews 2. A matrix of evidence table was used to assess the degree of overlap. The Grading of Recommendations Assessments, Development and Evaluation framework was used to rate the quality of evidence. Findings were presented through narrative synthesis and a summary of evidence table. Results Eighteen reviews were included; three investigating effectiveness of falls prevention interventions in MS, 11 in PD, three in stroke, and one in both PD and stroke. Exercise-based interventions were the most commonly investigated for all three conditions, but differences were identified in the content and delivery of these interventions. Low to moderate quality evidence was found for the effectiveness of exercise-based interventions at reducing falls in PD. Best available evidence suggests that exercise is effective at reducing falls in stroke but no evidence of effect was identified in MS. Conclusions The findings suggest that exercise-based interventions are effective at reducing falls in PD, however, the evidence for MS and stroke is less conclusive. A strong theoretical rationale remains for the use of exercise-based interventions to address modifiable physiological falls risk factors for people with MS, PD and stroke, supporting the feasibility of a mixed-diagnosis intervention. Given the high overlap and low methodological quality of primary studies, the focus should be on the development of high-quality trials investigating the effectiveness of falls prevention interventions, rather than the publication of further systematic reviews.

Evidence table development as a novel teaching tool in cancer survivorship education.

3 Background: We established a novel curriculum in Cancer Survivorship Education (CSE), as a collaborative effort between our accredited training programs in Hematology/Oncology and Radiation Oncology. The conceptual framework for all our coursework in cancer survivorship was grounded in the recommendations from the Institute of Medicine report from 2006. As a means of refining our CSE curriculum, we introduced Evidence Table (ET) development. ETs are formatted summaries of methods, data, and outcomes from related studies used to answer specific questions. ETs facilitate the development of recommendations and standards of care. ET development was proposed to enhance the CSE experience allowing trainees to: 1) understand data supporting survivorship recommendations, 2) practice grading the evidence, 3) become more critical in appraisal of published studies, and 4) discover areas where further research is needed to substantiate cancer survivorship care plans. Methods: A total of 19 trainees participated in academic year 2013-2014 and 18 trainees in 2014-2015. Trainees were required to define key questions pertaining to survivorship, probe the literature for available data addressing these questions, and develop ETs in which the evidence was then graded. To ascertain the value of this experience from the trainees’ perspectives, anonymous and voluntary pre- and post-Workshop surveys were administered. The course was modified after the first academic year based on results of a trainee feed-back. Results: Following course modification in 2014-2015, 92% of trainees responded that they used some of the learned course information in their clinics. This represents significant improvement from 45% the previous year (p = 0.02). Significant improvement was observed (from 18% to 67%) in the perception that the course influenced trainees' approach to the medical literature. Ninety-two percent responded that they learned more about survivorship as a result of the CSE Workshop. All trainees reported that, to some extent, CSE has helped to make them better oncologists. Conclusions: ET development is a feasible, meaningful, and novel approach to fostering independent learning in cancer survivorship.