***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Falling is a common and morbid condition among elderly persons . Effective strategies to prevent falls have been identified but are underutilized . METHODS Using a nonr and omized design , we compared rates of injuries from falls in a region of Connecticut where clinicians had been exposed to interventions to change clinical practice ( intervention region ) and in a region where clinicians had not been exposed to such interventions ( usual-care region ) . The interventions encouraged primary care clinicians and staff members involved in home care , outpatient rehabilitation , and senior centers to adopt effective risk assessment s and strategies for the prevention of falls ( e.g. , medication reduction and balance and gait training ) . The outcomes were rates of serious fall-related injuries ( hip and other fractures , head injuries , and joint dislocations ) and fall-related use of medical services per 1000 person-years  among persons who were 70 years of age or older . The interventions occurred from 2001 to 2004 , and the evaluations took place from 2004 to 2006 . RESULTS Before the interventions , the adjusted rates of serious fall-related injuries ( per 1000 person-years ) were 31.2 in the usual-care region and 31.9 in the intervention region . During the evaluation period , the adjusted rates were 31.4 and 28.6 , respectively ( adjusted rate ratio , 0.91 ; 95 % Bayesian credibility interval , 0.88 to 0.94 ) . Between the preintervention period and the evaluation period , the rate of fall-related use of medical services increased from 68.1 to 83.3 per 1000 person-years in the usual-care region and from 70.7 to 74.2 in the intervention region ( adjusted rate ratio , 0.89 ; 95 % credibility interval , 0.86 to 0.92 ) . The percentages of clinicians who received intervention visits ranged from 62 % ( 131 of 212 primary care offices ) to 100 % ( 26 of 26 home care agencies ) . CONCLUSIONS Dissemination of evidence about fall prevention , coupled with interventions to change clinical practice , may reduce fall-related injuries in elderly persons The aim of this evaluation study was to assess the impact of peer-presented education sessions on the falls-related attitude , knowledge and behaviour of older people .  The evaluation was undertaken on the Bellarine Peninsula in Victoria , Australia , and adopted a non-r and omised pre-test post-test design . Baseline , 3 and 12 months follow-up data were collected for 107 individuals who attended the education sessions and 116 controls , matched by age range and sex . The groups were not strictly equivalent at baseline , with the intervention group having a greater knowledge about falls and falls prevention . Analyses which controlled for baseline differences showed that those who attended the education sessions maintained a greater knowledge of factors that can prevent falls at 12 months follow-up . The intervention group also made more changes in and around their home to prevent falls by 3 and 12 months follow-up . Younger participants who reported a previous history of falls and having taken action to prevent falls were most likely to take additional action . The results can help target this type of education program and suggest that their major benefit may lie in providing those who voluntarily attend with the impetus to take the most effective preventative action OBJECTIVES To determine whether a practice -based intervention can improve care for falls , urinary incontinence , and cognitive impairment . DESIGN Controlled trial . SETTING Two community medical groups . PARTICIPANTS Community-dwelling patients ( 357 at intervention sites and 287 at control sites ) aged 75 and older identified as having difficulty with falls , incontinence , or cognitive impairment .  INTERVENTION Intervention and control practice s received condition case-finding , but only intervention practice s received a multicomponent practice -change intervention . MEASUREMENTS Percentage of quality indicators satisfied measured using a 13-month medical record abstract ion . RESULTS Before the intervention , the quality of care was the same in intervention and control groups . Screening tripled the number of patients identified as needing care for falls , incontinence , or cognitive impairment . During the intervention , overall care for the three conditions was better in the intervention than the control group ( 41 % , 95 % confidence interval (CI)=35 - 46 % vs 25 % , 95 % CI=20 - 30 % , P<.001 ) . Intervention group patients received better care for falls ( 44 % vs 23 % , P<.001 ) and incontinence ( 37 % vs 22 % , P<.001 ) but not for cognitive impairment ( 44 % vs 41 % , P=.67 ) than control group patients . The intervention was more effective for conditions identified by screening than for conditions identified through usual care . CONCLUSION A practice -based intervention integrated into usual clinical care can improve primary care for falls and urinary incontinence , although even with the intervention , less than half of the recommended care for these conditions was provided . More-intensive interventions , such as embedding intervention components into an electronic medical record , will be needed to adequately improve care for falls and incontinence BACKGROUND Since falling is associated with serious morbidity among elderly people , we investigated whether the risk of falling could be reduced by modifying known risk factors . METHODS We studied 301 men and women living in the community who were at least 70 years of age and who had at least one of the following risk factors for falling : postural hypotension ; use of sedatives ; use of at least four prescription medications ; and impairment in arm or leg strength or range of motion , balance , ability to move safely from bed to chair or to the bathtub or toilet ( transfer skills ) , or gait . These subjects were given either a combination of adjustment in their medications , behavioral instructions , and exercise programs aim ed at modifying their risk factors ( intervention group , 153 subjects ) or usual health care plus social visits ( control group , 148 subjects ) . RESULTS During one year of follow-up , 35 percent of the intervention group fell , as compared with 47 percent of the control group ( P = 0.04 ) . The adjusted incidence-rate ratio for falling in the intervention group as compared with the control group was 0.69 ( 95 percent confidence interval , 0.52 to 0.90 ) . Among the subjects who had a particular risk factor at base line , a smaller percentage of those in the intervention group than of those in the control group still had the risk factor at the time of re assessment , as follows : at least four prescription medications , 63 percent versus 86 percent , P = 0.009 ; balance impairment , 21 percent versus 46 percent , P = 0.001 ; impairment in toilet-transfer skills , 49 percent versus 65 percent , P = 0.05 ; and gait impairment , 45 percent versus 62 percent , P = 0.07 . CONCLUSIONS The multiple-risk-factor intervention strategy result ed in a significant reduction in the risk of falling  among elderly persons in the community . In addition , the proportion of persons who had the targeted risk factors for falling was reduced in the intervention group , as compared with the control group . Thus , risk-factor modification may partially explain the reduction in the risk of falling BACKGROUND AND PURPOSE An abundance of evidence suggests that interventions targeting fall risk factors are effective ; however , it remains unknown whether , or to what extent , this body of evidence has affected the clinical practice of physical therapy providers . The purpose s of this study were : ( 1 ) to describe knowledge of , and attitudes toward , fall risk factors and fall reduction strategies ; ( 2 ) to assess self-reported use of fall reduction strategies with patients ; and ( 3 ) to identify factors associated with increased use of fall reduction strategies with patients among physical therapy providers exposed to a behavioral change strategy . SUBJECTS AND METHODS A cross-sectional survey of physical therapy providers from hospital-based and freest and ing outpatient physical therapy facilities throughout north- central Connecticut was conducted between October 2002 and April 2003 . The participants were 94 physical therapy providers who had been exposed to the Connecticut Collaboration for Fall Prevention ( CCFP ) behavioral change effort . The CCFP program uses multicomponent professional behavioral change strategies to embed fall risk factor assessment and management , based on evidence from r and omized controlled trials , into the clinical care of older patients . A telephone question naire -- focusing on fall risk factor knowledge and attitudes and self-reported fall risk factor assessment and management practice s before and after exposure to the CCFP efforts -- was administered to consenting physical therapy providers . RESULTS Environmental hazards and gait and balance deficits were named as fall risk factors by 86 ( 91 % ) and 73 ( 78 % ) participants , respectively . All of the targeted risk factors were mentioned by at least 30 % of the participants . Sixty-four participants ( 68 % ) reported increased fall reduction practice behaviors . The area of multiple medications was noted most frequently , with 77 participants ( 82 % ) noting new practice s related to medication use . Only knowledge of fall risk factors and pre-CCFP behaviors were associated with increased fall reduction practice s. DISCUSSION AND CONCLUSION Physical therapy providers reported an increase in practice behaviors in response to the multicomponent behavioral change strategy . Knowledge of fall risk factors was associated with increased fall reduction practice behaviors , most likely due to the focused nature of the education strategy 
    Output:
    
The evidence around changing the way people who fall are managed within primary care practice s , and , layperson , peer or community delivered models was mixed .
IMPACT ON INDUSTRY Translating the evidence -base into practice involves changing the attitudes and behaviours of older people , healthcare professionals and organisations .