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Table 1 Overview of PreFIT MFFP intervention, as per TiDIER [12] criteria

From: The design and development of a complex multifactorial falls assessment intervention for falls prevention: The Prevention of Falls Injury Trial (PreFIT)

TiDIER criteria (12) Description of PreFIT falls assessment and quality control procedures
Staff training and participant referral
 Who provided training Consultant Geriatrician or Specialist Registrar in Geriatrics/Elderly Medicine with expertise in falls assessment delivered 5 h MFFP training.
 Who received training Primary care practice nurses and consultant-led falls team comprising trained healthcare professionals (e.g. registered nurse, occupational therapist or physiotherapist).
 Participants receiving MFFP intervention Trial participants aged 70 years or older, randomised to MFFP arm. Decision regarding eligibility for MFFP assessment based upon history of falls and balance problems.
 Referral procedure Participant invited to attend for 1-h individual ‘health assessment’ by general practice or falls team or service, depending upon locality. Written letter to confirm appointment location, time and date if this was local practice.
Assessment Procedure
 Materials required Metal tape measure*, stopwatch*, hard-backed arm chair of 40-50 cm height, Snellen chart (3 m)*, eye patch, calibrated manual or electronic sphygmomanometer, ECG machine, cotton wool balls for podiatry assessment.
 Where Falls assessment undertaken in suitable location with a quiet room. Access, parking and transport should be considered. A pragmatic approach was taken to select a location appropriate for each region or cluster e.g. general practice, community hospital or falls service, depending upon availability. The room must be of a comfortable temperature with ‘do not disturb’ signage on the door. Room must have bed or plinth with footstool to allow patient to lie in supine position. Correct distance for the TUGT and Snellen chart vision assessment clearly marked using floor tape.
 When Single 1-h assessment at time suitable for participant and assessor.
 Tailoring Every risk factor assessed on every participant. Additional assessment and referral arranged in the event of risk factor identified or suspected (see Table 2). Referral pathways can be tailored to local setting e.g. referral to NHS chiropody/podiatry if service available. Location of assessment and staff background varied between and within participating regions.
 Modifications Modifications were made to data collection forms during the pilot study. Minor adaptations included production of additional laminated materials as visual aids e.g. listing of psychotropic and culprit medications to aid drug screening.
Intervention Fidelity
 How well – Training Training Evaluation Forms completed by staff trained in MFFP intervention - asked to return anonymously using stamped addressed envelope to Trial Office. Asked to report on quality of MFFP training (presentations, content, risk factor assessment procedures, documentation, safety reporting, roles & responsibilities). Provided with free-text sections to comment on: whether to spend more or less time on particular aspects; confidence in delivering individual components of the intervention; quality of Therapist Reference Manual; data collection forms and overall rating of training delivered (very poor, poor, average, good or very good).
 How well – Intervention delivery (Who) Training emphasises adherence to the PreFIT standardised protocol. Quality Control (QC) visits to staff at every site undertaken by member of PreFIT team, Consultant Geriatrician or Specialist Registrar in Elderly Medicine. QC visit includes observation of trainee conducting 1-h MFFP assessment, with consent of participant. Aim to observe at least one MFFP assessment per trainee.
 How well – Intervention delivery (What) 5-page QC Assessment Form completed covering: accuracy of completion of trial paperwork; 15-point checklist of risk factors; whether any further referrals were warranted and actioned appropriately; whether the MFFP assessment was satisfactory or unsatisfactory (follow-up visit required). Also whether any serious concerns were identified that required reporting to Intervention Lead and/or any areas requiring further training. QC form signed and dated by assessor and trainee.
  1. *Provided by PreFIT team