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BASE Program:

Initial Study

Conducted at

Owensboro Health HealthPark

2021

Caregiver

Background and Oversight

About the BASE Program

The BASE program, first started in 2017, is a community-based falls prevention program operated through the Owensboro Health Healthpark.

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As apart of Owensboro Health and the Family Medicine Residency process to achieve IHI recognition as age friendly, the BASE program was evaluated according to DMADOV (Define, Measure, Analyze, Design, Optimize, and Validate) structure for clinical process improvement 

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IRB Approval 

The BASE program was approved by the University of Louisville IRB as a quality improvement project for data collection, analysis, and implementation. Additionally, the project was approved by the Owensboro Health Regional Hospital Research Review Committee.

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Goals and Analysis 

BASE Program Structure​

  • The BASE program is a12-week, physical therapist lead strength and balance course

  • Initial and final intake completed one-on-one with the physical therapist

  • BERG and DGI scores were completed pre/post intervention

  • Participants were in a group class of no more than 8-10 at a time or smaller 

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Statistical Analysis 

  • A t-test analysis was performed on the pre- and post-scores as stratified based on the minimal detectable difference

  • The mean score, standard deviation, confidence intervals, and p values were calculated for each intervention level in the BERG and DGI score

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Minimal Detectable Difference (MDD)

  • According to Donoghue (2009), a minimal detectable change in the BERG to be 95% confident  that a true change has occurred is as follows:

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  • For the Dynamic Gait Index (DGI) an average improvement of 4 points, regardless of the initial score is considered significant

MDD_Base.png

Changes in BERG and DGI Scores

 

Inclusion/Exclusion Criteria 

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Inclusion criteria: for the program consisted of patients who had a fear of falling, had a previous fall, recognized a declining strength, balance, agility, or coordination problem, and were not fully dependent on the mobility device for ambulation.

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Exclusion criteria: were individuals who were not cleared for participation

Changes in BERG Assessment

BERG_Base.png

The table and chart above shows the mean and standard deviation pre-intervention BERG score and the post- intervention BERG score. The mean difference in comparison to the minimal detectable change was calculated. For all ranges but the 53-56 group, there was a statistically and clinically significant improvement 

Change in DGI Assessment

DGI_Base.png

The above chart and table shows the mean and standard deviation pre-intervention DGI score and the post- intervention DGI score. The mean difference in comparison to the minimal detectable change was calculated. For all ranges but the >28 group, there was a statistically and clinically significant improvement 

BERG Trend

BERG_Trend_Base.png

DGI Trend

DGI_Trend_Base.png

BERG and DGI Trends

 

BERG and DGI Improvements 

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The average change in both the BERG and DGI scores demonstrated increasing  improvements with lower baseline scores which were both clinically and statistically significant and strongly correlate with improved physical strength and fall prevention for patients

 Conclusion

BASE Program

The changes in the BERG and DGI scores pre and post intervention for patients were both clinically and statistically significant. Both measures exceeded the thresholds for the minimal detectable change and correlate strongly with an improved balance and strength. The results, as demonstrated, suggest the BASE program has met and exceed its targeted objectives for fall’s prevention in aging patients.

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Acknowledgements 

We would like to acknowledge the hard work of the staff and faculty of the University of Louisville – Owensboro Family Medicine program and the Owensboro Health Regional Hospital HealthPark for their dedicated commitment to caring for the aging patient through innovative programs

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Authors and Contributors to BASE Program

  • Jerry Bradley, MD - Systems Engineering / Analysis 

  • Sarah Swift, PT, DPT (Owensboro Health) - Physical Therapy / Implementation / Development

  • Jan Young (Owensboro Health) -  Implementation / Development 

  • Jason Anderson (Owensboro Health) - Manager of Health and FItness / Implementation / Development 

  • Bruce Mauzy, PT, DPT (Owensboro Health) - Physical Therapy / Implementation / Development 

  • Collette Cart (Owensboro Health) - Director of the HealthPark / Implementation / Development / Oversight 

  • Bill Bryant, MD, FAAP, CMD, CPPS, CPHQ (Owensboro Health) - Vice President of Quality / Oversight / Project Champion

  • Jon Sivoravong, DO, FAAFP - (University of Louisville) - Program Director 

  • Darby Cole, MD - (University of Louisville) - Associate Program Director 

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