Date of Award


Degree Name

Doctor of Philosophy (School of Physiotherapy)

Schools and Centres


First Supervisor

Associate Professor Anne-Marie Hill

Second Supervisor

Professor Christopher Etherton-Beer


Falls in the residential aged care (RAC) sector are a global concern with humanitarian and economic consequences. Reducing falls using a multifactorial approach involving multidisciplinary staff is recommended, but it is not clear how RAC organisations in Australia can achieve this in a resource constrained environment. One potential solution is to develop a sustainable means of addressing falls prevention from within an organisation, creating a forum for staff to share ideas, expertise and achieve goals in a community of practice (CoP). The purpose of this research was to evaluate the impact of a falls prevention CoP on falls outcomes in a RAC setting.

A mixed methods design framed by a realist approach was undertaken, to better understand how CoP interventions were influenced by current conditions (contexts) in triggering (mechanisms) the observed outcomes. Diverse data sources including surveys, electronic CoP discussion transcripts, semi-structured interviews and organisational falls data were used to triangulate findings. The CoP was mapped across three phases. Phase 1 described how the CoP was developed, then evaluated its establishment and operation across 13 geographically diverse RAC sites. In Phase 2 the CoP identified gaps in falls prevention practice using evidence-based audit and feedback, determining the areas for priority intervention. Phase 3 comprehensively evaluated the impact of CoP activity at three levels; member, site and organisation.

Overall the CoP had a positive impact; members gained new peer connections and falls prevention knowledge, the proportion of residents supplemented with vitamin D improved significantly and a falls prevention policy and risk assessment tool were developed and implemented across the organisation. Management recognition and support were key mechanisms in achieving successful outcomes. Falls rates pre CoP were 10.1/1000 occupied bed days (OBD) compared with 10.9 /1000 OBD post CoP operation [coefficient 0.7, 95% CI (-33.5, 34.9) p = .967]. This was potentially confounded by an increased use of beds for short stay transition care services and identified differences in defining falls between sites. A downward trend in the rate of injurious falls resulting in fractures was observed (pre CoP 0.2/1000 OBD compared with 0.1/1000 OBD post CoP; [coefficient -0.3, 95% CI (-1.1, 0.4) p = .423]. As the prioritised CoP interventions required design and development, implementation only occurred towards the end of the research period meaning the intervention effect on falls outcomes may require longer term follow up. The CoP remains operational and is ideally positioned to continue to lead evidence-based falls prevention practice change as determined by its membership.

Files over 3MB may be slow to open. For best results, right-click and select "save as..."