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James Frith with Lisa Robinson

Meet the expert: Dr Lisa Robinson on physiotherapy

Below, Lisa answers James’ questions about what physiotherapists can do for people who fall, or are at risk of falling.

James: Lisa, thank you for joining us to explain a little bit about physiotherapy. You have been a physiotherapist in a falls clinic for over 10 years now, so have lots of experience to share with us. What are the main reasons why somebody might be referred to see a physiotherapist because of falls?

Lisa: Within the falls clinic, I see people of all ages and abilities. Most people will see a physiotherapist for the first time after they have experienced a fall, usually a serious fall resulting in a significant injury such as a broken bone.

However, many of the people I see in clinic haven’t yet fallen. It might be that they have been referred to see one of the medical team with blackouts or dizziness, and the doctors have picked up that the person is starting to feel unsteady or less confident in their balance or walking. This is a good time to see a physiotherapist, as it is often easier to address these problems when caught early, and to prevent future falls from happening.

James: We have seen in one of our videos last week what a general gait and balance assessment looks like. But what else might people expect to happen when they meet a physiotherapist for the first time?

Lisa: The physiotherapy assessment is usually individualised to meet the specific needs of the individual. However, there are common features of a physiotherapy assessment for falls. The physiotherapist will usually begin by taking quite a detailed history. He or she will ask about any previous falls that you might have had, whether you feel steady on your feet when walking around in the house or outdoors, and whether you feel worried about falling in the future.

The physiotherapist will also ask about any medical conditions or joint problems you might have, as these could be contributing to the problems with your balance or walking.

Finally, the physiotherapist will ask you about how you like to spend your time, and whether there are any activities that you have given up or are finding more difficult as a result of your balance or walking problem. This will help the physiotherapist to develop an individualised treatment programme to meet your specific needs and goals.

During the physiotherapy examination, the physiotherapist will often look at the movement in your joints, the strength in your muscles, and your balance and walking. The whole assessment usually takes about 1 hour to complete, but can be done over a couple of sessions depending on the needs and abilities of the individual.

Because the physiotherapist works as part of a multi-disciplinary team, it may be that he or she identifies some problems that would benefit from referral to another healthcare professional, such as an occupational therapist or podiatrist. If this is the case, the physiotherapist will discuss this with you at your first appointment.

James: Of course treatment will depend on identifying any risk factors or abnormalities that can be improved, but what are the general principles of physiotherapy treatment for falls?

Lisa: We are really fortunate as there is good evidence to suggest that participating in a structured exercise programme can reduce the risk of falling. Based on their assessment findings, the physiotherapist will develop an individualised exercise programme for you to do at home on a ‘little and often’ basis. As you begin to feel stronger and steadier, the physiotherapist will adjust this exercise programme to make it more challenging for you.

For those people who don’t like the thought of exercising at home, or for those who have made good progress with a home exercise programme and want to maintain the improvements in their strength and balance, the physiotherapist is often able to recommend an appropriate exercise class for you to attend in the hospital or community.

James: We have learned about fear of falling and the impact it can have on peoples’ lives, what is the physiotherapist’s role in relation to fear of falling?

Lisa: As a physiotherapist, I appreciate that fear of falling is common and can have a devastating impact on a person’s quality of life. Often, as people start to feel stronger and steadier, they naturally become more confident to get out and about and to do the things they previously enjoyed. However, sometimes it can take a bit of time for people to start to feel confident again, and that is when a physiotherapist might be able to help with setting appropriate goals to encourage the person to become more active and independent.

If fear of falling becomes a persistent problem, the physiotherapist might suggest referral to a clinical or health psychologist, who will use specific strategies, such as cognitive behavioural therapy, to reduce fear of falling.

James: Finally, Lisa, I wonder if you can give us your top tips for people to keep their joints and muscles healthy, to maintain good balance and to prevent falls?

Lisa: Of course! As I hope you can see, there is lots that can be done to improve balance and walking and reduce the risk of future falls. However, prevention is definitely better than cure! If you have started to notice that you are less steady or confident on your feet (regardless of whether you have fallen or not), it might be worth visiting the GP and asking if you can be referred to see a physiotherapist.

If you do not feel that your walking or balance is that bad, but want to make sure that you don’t start falling in the future, it would be a good idea to join an exercise class or go to the gym to keep your muscles and joints healthy. There is some evidence to suggest that Tai Chi is beneficial in this situation for preventing future falls, and several of my patients have told me that they really enjoy these classes.

Finally, keep active – there are lots of simple and effective things that you can do to keep fit and healthy (even if you don’t like the thought of formal exercise!) Walk to the paper shop rather than taking the car, use the stairs rather than the escalator when out shopping, take the dog for a walk or the grandchildren to the park – it all helps to keep your joints and muscles healthy and reduces your risk of future falls.

We will learn more about falls prevention in another meet the expert interview next week (Step 4.5).

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Ageing Well: Why Older People Fall

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