Research has demonstrated that some exercise programs are effective for reducing fall rates in community-dwelling older people; however, the literature is limited in providing clear recommendations of individual or group training as a result of economic evaluation. The objective of this study was to assess the cost-effectiveness of the Otago Exercise Program (OEP) for reducing the fall risk in healthy, non-institutionalized older people. An economic evaluation of a multicenter, blinded, randomized, non-inferiority clinical trial was performed on 498 patients aged over 65 in primary care. Participants were randomly allocated to the treatment or control arms, and group or individual training. The program was delivered in primary healthcare settings and comprised five initial sessions, ongoing encouragement and support to exercise at home, and a reinforcement session after six months. Our hypothesis was that the patients who received the intervention would achieve better health outcomes and therefore need lower healthcare resources during the follow-up, thus, lower healthcare costs. The primary outcome was the incremental cost-effectiveness ratio, which used the timed up and go test results as an effective measure for preventing falls. The secondary outcomes included differently validated tools that assessed the fall risk. The cost per patient was USD 51.28 lower for the group than the individual sessions in the control group, and the fall risk was 10% lower when exercises had a group delivery. The OEP program delivered in a group manner was superior to the individual method. We observed slight differences in the incremental cost estimations when using different tools to assess the risk of fall, but all of them indicated the dominance of the intervention group. The OEP group sessions were more cost-effective than the individual sessions, and the fall risk was 10% lower.

Introduction: The Best Practice Guidelines Implementation Programme, called in Spain “Centros Comprometidos con la Excelencia en Cuidados®”, started in 2010 thanks to the collaboration between the Nursing and Healthcare Research Unit (Investén-isciii), in Spain, the Spanish Collaborating Centre of the Joanna Briggs Institute for evidence based healthcare, and the Registered Nurses’ Association of Ontario (RNAO), Canada. It is based on the same fundaments of Best Practice Spotlight Organizations (BPSO®) Program, initiated by RNAO, in 1999, in Canada. Objective: To describe the implementation of Best Practice Guidelines developed by RNAO in the context of Centros Comprometidos con la Excelencia en Cuidados® Program. The program aims to promote, facilitate and support the implementation, evaluation and sustainability of nursing best practices, for the period 2012-2014. Methodology and Results: Eight healthcare institutions and one university were selected to implement RNAO Best Practice Guidelines aligned with their needs. Twenty-four months into the implementation Programme healthcare professionals have been trained, work teams have been established, nursing care protocols and records have been developed or updated, and process and patient results have been systematically evaluated. Also, all main achievements of the Programme have been actively disseminated. Conclusions: Candidates centers committed to excellence in cuidados® are working hard and the results are starting to show positive, with a growing culture of evidence-based care, and the promotion of research and the start of work collaborative networking.[Albornos-Muñoz L, González-María E, Moreno-Casbas T. Best Practice Guidelines Implementation in Spain. Best Practice Spotlight Organizations. MedUNAB 2015; 17 (3): 163-169]. Introducción: El programa de implantación de Guías de Buenas Prácticas, denominado en España Centros Comprometidos con la Excelencia en Cuidados®, se inició en 2010 tras un acuerdo de colaboración entre la Unidad de Investigación en Cuidados de Salud (Investén-isciii) de España, el Centro Colaborador Español del Instituto Joanna Briggs para los Cuidados de Salud basados en la Evidencia y la Registered Nurses' Association of Ontario (RNAO), siguiendo los mismos principios que el programa Best Practice Spotlight Organizations (BPSO®) iniciado por RNAO, en Canadá, en 1999. Objetivo: Describir la implantación de Guías de Buenas Prácticas de RNAO en el marco del programa de Centros Comprometidos con la Excelencia en Cuidados® (Best Practice Spotlight Organizations®) en España. El programa tiene como objetivo fomentar, facilitar y apoyar la implantación, evaluación y mantenimiento de buenas prácticas en cuidados, para el periodo 2012-2014. Metodología y Resultados: se han seleccionado 8 instituciones de salud y una universidad que implantan las guías de buenas prácticas de RNAO en función de sus necesidades. Tras los 24 primeros meses de implantación se ha formado a los profesionales de salud, constituido grupos estables de trabajo, desarrollado o actualizado protocolos de cuidados y registros correspondientes, también se han evaluado de forma sistemática los resultados de proceso y de salud de los pacientes. También se han difundido activamente los principales logros del programa. Conclusiones: Los candidatos a Centros Comprometidos con la Excelencia en Cuidados® están realizando un gran esfuerzo y los resultados empiezan a mostrar que son positivos, con una creciente cultura de cuidados basados en la evidencia, y el impulso de la investigación y el inicio de un trabajo colaborativo en red.[Albornos-Muñoz L, González-María E, Moreno-Casbas T. Implantación de guías de buenas prácticas en España. Programa de centros comprometidos con la excelencia en cuidados. MedUNAB 2015; 17 (3): 163-169].

Fall prevention is a key priority in healthcare policies. Multicomponent exercises reduce the risk of falls. The purpose of this study is to describe the relationship between functional performance and falls after following the Otago multicomponent exercise programme and previous falls. A prospective multi-centre intervention study was performed on 498 patients aged over 65 in primary care, with or without a history of previous falls. Sociodemographic, anthropometric and functionality data were collected. The primary outcome was the occurrence of falls; functional performance was measured using the Tinetti, Short Physical Performance Battery and Timed Up and Go tests. Among the patients, 29.7% referred to previous falls. There was a statistically significant (p < 0.001) increase in falls at 6 months (10.1%) and at 12 months (7.6%) among participants with previous falls in the baseline assessment compared to those without. In addition, the existence of previous falls could be considered a risk factor at 6 and 12 months (OR =2.37, p = 0.002, and OR = 1.76, p = 0.046, respectively). With regard to balance and gait, differences between the groups were observed at 6 months in the Tinetti score (p < 0.001) and in the baseline assessment Timed Up and Go score (p < 0.044). Multicomponent exercises improve the fall rate, balance and gait in older people, although this improvement is less in people with previous falls. Earlier intervention and tailoring of exercises in patients with previous falls could help improve outcomes.