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Background Disability, mortality and healthcare burden from fractures in older people is a growing problem worldwide. Observational studies suggest that aspirin may reduce fracture risk. While these studies provide room for optimism, randomised controlled trials are needed. This paper describes the rationale and design of the ASPirin in Reducing Events in the Elderly (ASPREE)-Fracture substudy, which aims to determine whether daily low-dose aspirin decreases fracture risk in healthy older people. Methods ASPREE is a double-blind, randomised, placebo-controlled primary prevention trial designed to assess whether daily active treatment using low-dose aspirin extends the duration of disability-free and dementia-free life in 19 000 healthy older people recruited from Australian and US community settings. This substudy extends the ASPREE trial data collection to determine the effect of daily low-dose aspirin on fracture and fall-related hospital presentation risk in the 16 500 ASPREE participants aged >70 years recruited in Australia. The intervention is a once daily dose of enteric-coated aspirin (100 mg) versus a matching placebo, randomised on a 1:1 basis. The primary outcome for this substudy is the occurrence of any fracture--vertebral, hip and non-vert-non-hip--occurring post randomisation. Fall-related hospital presentations are a secondary outcome. Discussion This substudy will determine whether a widely available, simple and inexpensive health intervention--aspirin--reduces the risk of fractures in older Australians. If it is demonstrated to safely reduce the risk of fractures and serious falls, it is possible that aspirin might provide a means of fracture prevention. Trial registration number The protocol for this substudy is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12615000347561). [ABSTRACT FROM AUTHOR]

Background Programme evaluations conducted alongside randomised controlled trials (RCTs) have potential to enhance understanding of trial outcomes. This paper describes a multi-level programme evaluation to be conducted alongside an RCT of a falls prevention programme (RESPOND). Objectives (1) To conduct a process evaluation in order to identify the degree of implementation fidelity and associated barriers and facilitators. (2) To evaluate the primary intended impact of the programme: participation in fall prevention strategies and the factors influencing participation. (3) To identify the factors influencing RESPOND RCT outcomes: falls, fall injuries and emergency department (ED) re-presentations. Methods/design 528 community-dwelling adults aged 60-90 years presenting to two EDs with a fall will be recruited and randomly assigned to the intervention or standard care group. All RESPOND participants and RESPOND clinicians will be included in the evaluation. A mixed methods design will be used and a programme logic model will frame the evaluation. Data will be sourced from interviews, focus groups, questionnaires, clinician case notes, recruitment records, participant-completed calendars, hospital administrative datasets and audio-recordings of intervention contacts. Quantitative data will be analysed via descriptive and inferential statistics and qualitative data will be interpreted using thematic analysis. Discussion The RESPOND programme evaluation will provide information about contextual and influencing factors related to the RESPOND RCT outcomes. The results will assist researchers, clinicians and policy makers regarding decisions about future falls prevention interventions. Insights gained may be applicable to a range of chronic conditions where similar preventive intervention approaches are indicated. [ABSTRACT FROM AUTHOR]

Introduction. Participation in falls prevention activities by older people following presentation to the emergency department (ED) with a fall is suboptimal. This randomised controlled trial (RCT) will test the RESPOND programme, an intervention designed to improve older persons’ participation in falls prevention activities through delivery of patient-centred education and behaviour change strategies. Design and setting. A RCT at two tertiary referral EDs in Melbourne and Perth, Australia. Participants. 528 community-dwelling people aged 60–90 years presenting to the ED with a fall and discharged home will be recruited. People who require an interpreter or hands-on assistance to walk; live in residential aged care or >50 km from the trial hospital; have terminal illness, cognitive impairment, documented aggressive behaviour or a history of psychosis; are receiving palliative care or are unable to use a telephone will be excluded. Methods. Participants will be randomly allocated to the RESPOND intervention or standard care control group. RESPOND incorporates (1) a home-based risk factor assessment; (2) education, coaching, goal setting and follow-up telephone support for management of one or more of four risk factors with evidence of effective interventions and (3) healthcare provider communication and community linkage delivered over 6 months. Primary outcomes are falls and fall injuries per person-year. Discussion. RESPOND builds on prior falls prevention learnings and aims to help individuals make guided decisions about how they will manage their falls risk. Patient-centred models have been successfully trialled in chronic and cardiovascular disease; however, evidence to support this approach in falls prevention is limited [ABSTRACT FROM AUTHOR]

Objective To assess the personal, physical and psychosocial factors associated with wrist or hand pain in Australian hospital-based nurses. Methods Wrist or hand pain, associated disability and sickness absence, demographic, occupational, physical, psychosocial and personal factors among nurses working for three hospitals in Melbourne, Australia, were assessed in a cross-sectional study. Factors associated with wrist or hand pain in the past month were assessed using logistic regression. Results This analysis was based on 1111 participants. The prevalence of wrist or hand pain in the past month was 15.3%. Repeated movements of the wrist or finger >4 h (OR 2.63, 95% CI 1.80 to 3.84), high job strain (1.54, 1.04 to 2.28), job insecurity (1.55, 1.04 to 2.28), somatisation tendency (2.73, 1.75 to 4.26), pain catastrophising (1.56, 1.03 to 2.37), better mental (0.97, 0.95 to 0.99) and physical (0.96, 0.94-0.98) health and well-being were associated with wrist or hand pain in the past month, after adjusting for possible confounding factors. When all significant factors were examined in the same model, repeated movements of the wrist or finger >4 h (2.50, 1.71 to 3.67), somatisation (2.61, 1.65 to 4.13) and better physical health and well-being (0.96, 0.94 to 0.99) remained independently associated with wrist or hand pain in the past month. Conclusions This study highlights that wrist or hand pain is prevalent in hospital nurses. Workplace physical factors and personal factors were associated with wrist or hand pain. Further longitudinal investigation is needed to examine the predictive nature of these factors. [ABSTRACT FROM AUTHOR]

Background: Owing to the difficulty in prospectively measuring pre-injury health status and health-related quality of life (HRQL) in an injured cohort, population norms or retrospective baseline scores are often used as comparators for evaluating post-injury losses. However, there has been little discussion in the literature or research into the soundness of these approaches for this purpose. Objectives: To investigate the appropriateness of the retrospectively measured baseline health status and HRQL in an injured population for the purpose of evaluating post-injury losses. Methods: A cohort of injured admitted to hospital (n = 186) was followed up for 12 months after injury. Retrospectively measured pre-injury health status and HRQL scores were compared with those at 12 months after injury for participants who reported complete recovery (n = 61) and those who did not. Retrospective baseline scores for the whole cohort were also compared with Australian population norms. Results: For participants who completely recovered, no significant difference was observed between scores at baseline (measured retrospectively) and those at 12 months after injury (36-item Short Form Questionnaire physical component summary z= -1.274, p=0.203 36-item Short Form Questionnaire mental component summary z= -1.634, p=0.102 Short Form 6 Dimensions: z= -1.405, p=0.296). A borderline significant difference was observed in HRQL as measured by the Assessment of Quality of Life (z = -1.970, p = 0.049). Retrospectively measured pre-injury scores were consistently higher than Australian norms for all measures. Conclusions: The injured population may not be representative of the general population. Consequently, retrospective baseline measurement of pre-injury health states may be more appropriate than general population norms for the purpose of evaluating post-injury losses in this population. [ABSTRACT FROM AUTHOR]