Authors: (including presenting author): :
LAI WY(1), HUI CY(2), SHE CYY(1), LAM PL(2)(1), CHAN GNY(1)
Affiliation: :
(1) Physiotherapy Department, David Trench Rehabilitation Centre (2) Physiotherapy Department, Queen Mary Hospital
Keyword 1: :
Fall Risk Assessment
Keyword 2: :
Risk Screening
Keyword 3: :
Outpatient Physiotherapy
Introduction: :
Falls are a major public health issue among older adults, responsible for nearly 90% of injury episodes in those aged 75 and above in Hong Kong. Although documented falls at the Physiotherapy Department of David Trench Rehabilitation Centre (DTRC) have been rare, the growing complexity of outpatient cases—encompassing neuromusculoskeletal and post-surgical conditions—highlights the need for proactive measures to tackle potential under-reporting and near-misses.
Objectives: :
To systematically identify fall risks in patients aged 75 and above, categorize them into distinct risk levels, and enable targeted interventions using a validated screening protocol, thereby promoting a standardized and safer care environment.
Methodology: :
Design, Setting and Participants: This prospective quality improvement project consisted of two phases. Phase I validated the reliability of an in-house fall risk screening tool, adapted from the Falls Risk Assessment Tool, in 30 patients. Phase II prospectively implemented the validated tool in routine outpatient physiotherapy practice at DTRC from 24 July 2025 to 25 December 2025. Interventions: The project followed the PRIME framework (Proactive Risk Identification, Refined Risk Categorization, Immediate Preventative Measures, Motivated Patient Education, and Empowering Exercise Prescription). Implementation emphasized the first three pillars: systematic screening at intake, refined risk categorization into tiers, and immediate preventative actions. These included environmental modifications and optimization of mobility aids, tailored to each patient’s risk level, while establishing a shared language for risk communication. Main Outcomes and Measures: Primary outcomes included inter-rater and intra-rater reliability of the screening tool (measured by Intraclass Correlation Coefficient) and the incidence of documented falls after implementation.
Result & Outcome: :
Results: Phase I showed excellent reliability, with ICC (2,1) = 0.916 (95% CI: 0.827–0.959, p < 0.001). In Phase II, 414 patients were screened (91% aged 75–89 years; 9% aged 90+). Risk stratification identified 375 (91%) as low risk, 23 (6%) as medium risk, and 16 (4%) as high risk. Despite 10% of patients being at medium or high risk, targeted interventions under the PRIME framework resulted in zero documented falls during the implementation period. Conclusions and Relevance: The physiotherapist-led PRIME programme provides a practical, resource-neutral approach to proactive fall prevention in outpatient settings. By embedding routine risk screening and immediate tiered interventions, it fills a key gap where standardized fall risk assessment is often lacking. This sustainable model aligns with Hospital Authority goals in clinical risk management and patient-centred care, laying a foundation for future expansion to include comprehensive patient education and tailored exercise prescriptions.
