Methods

Nominal group study involving three separate groups of service users (n=15)

and health professionals (n=21); in three sequential rounds of individual

rating, group discussion and re-rating of 20 trigger statements5. Quantitative data

analysis evaluated development of consensus/ agreement and qualitative analysis

developed themes across groups

Building stakeholder consensus: Developing an MS falls

management intervention

Gunn H1, Endacott R2,Haas B1, Marsden J1, Freeman J1

1. School of Health Professions, Plymouth University. 2.School of Nursing and Midwifery, Plymouth University

Conclusions

The structure, format and approach for an MS falls programme is critical to its success and sustainability.

The programme needs to be MS specific, employ a collaborative approach and move away from the group-based, weekly

format common to many generic falls programmes

References: 1. Peterson et al. Fear of falling and associated activity curtailment among middle aged and older adults with multiple sclerosis. Mult Scler

2007;13:1186-1175. 2. Gunn, H., Creanor, S., Haas, B., Marsden, J., & Freeman, J. (2014). Frequency, characteristics and consequences of falls in multiple

sclerosis: findings from a cohort study. Archives of Physical Medicine and Rehabilitation, 95(2), 538–45. 3. Royal College of Physicians. (2011). The national

audit of services for people with multiple sclerosis 2011. London: Royal College of Physicians. 4. Yardley, L., Beyer, N., Hauer, K., McKee, K., Ballinger, C., &

Todd, C. (2007). Recommendations for promoting the engagement of older people in activities to prevent falls. Quality and Safety in Health Care, 16(3), 230–

234. 5. Jones, J., & Hunter, D. (1995). Consensus methods for medical and health services research. BMJ, 311(August), 376–380.

Funding: This study was supported by the Multiple Sclerosis Society in the UK (Grant ref: 990)

Figure 1: Weighing up the options

Both falls and participation-based

outcomes are important to measure

“If I was commissioning a group and everyone had

fallen 3 times before they joined and no times

afterwards, but had spent 6 weeks being miserable, or

living lesser lives because they were taking less risks ,

then that’s not an outcome I would be particularly

interested in”

(Service commissioner, n14)

The programme content, format and

approach should be tailored specifically

to the unique needs of people with MS

“By its nature it will tend to be older people who go [to the

falls service], and then if you’re someone young with say

progressive MS, you may be grieving for your former self

anyway without having it thrust in your face that you are

falling around like your Gran”. (Person with MS, n16)

“People with MS have very separate needs to ‘average’

users of falls services (e.g. over 65’s)”

(Health professional, n17)

Adequate funding and

support is essential

“There’s just not enough time to do

anything properly. It would just

be depressing if we spent a lot of time

developing a really lovely quality service

and they wouldn’t have the time anyway”

(Health professional, n13)

The programme must enable

participants to engage flexibly

according to their needs

and preferences

“The input needs to be given in such a way that we enjoy

it; we remember it or we have prompts to remember it,

and we go away and we do it…. because the only way

it’s going to work is with the time, motivation

and energy that we find to put into it”.

(Person with MS, n15)

Three overarching qualitative themes were developed

summarising the main issues likely to impact

programme feasibility and utility

Introduction

Falls are a significant issue for people with MS, leading to injury, activity curtailment and social isolation1,2. Evidence based interventions are urgently

needed to address this issue3. Stakeholder input is critical to ensure programmes are feasible and acceptable to service users and providers4.

Aim

To explore service users’ and providers’ views regarding the formats of delivery for

the proposed falls programme

Objectives

• Determine the best model for an MS falls programme (aims, outcomes and

approach)

• Recommend programme structure, format and delivery methods

• Explore factors affecting participant engagement with and adherence to the

programme

• Evaluate factors affecting programme sustainability and integration

within existing service provision

Results

Whilst consensus was achieved in only three statements, significant changes in the

level of agreement occurred during the process for all statements (p<0.05).

The results suggest that: • A hybrid model incorporating occasional attended sessions with a strong

home-based focus may be most appropriate

• Balance-focused exercise AND falls prevention advice should be included.

Exercise prescription and progression should be a collaboration between

the participants and group leader.

• Participants must be supported to engage particularly during home-based

activities, using methods such as online or tele-rehabilitation resources

• Experienced professional staff, with neurology-specific expertise and knowledge

of exercise prescription and falls prevention strategies,

should lead the programme.