Your comments: 3 January 2018

Join the community

People with cystic fibrosis (CF), their carers and physiotherapists can join Pactster, an online gym, free of charge. Developed to overcome barriers to exercise and improve adherence, Pactster’s specialist videos are led by specialist physiotherapists and fitness instructors with CF.

CF can be isolating and finding the motivation to exercise can be tough – especially with the burden of other treatments. With Pactster, patients can confidently exercise wherever and whenever suits them, alone or in a group workout for added accountability, enjoyment and support, without the risk of cross-infection.

Nuala Harnett, chair of the Association of Chartered Physiotherapists in CF says: ‘Pactster is an excellent resource and we are delighted that it is now widely available. We also appreciate the support from the Cystic Fibrosis Trust and look forward to continuing to help develop Pactster.’ Paul Rymer from the Cystic Fibrosis Trust, says: ‘We are thrilled to have obtained a license agreement to make Pactster accessible to the CF community.’

• Pamela Scarborough, Pactster co-founder and CF physio

Falls coverage

Thank you for highlighting the most recent Royal College of Physician’s National Audit of Inpatient Falls (NAIF) report. But I am concerned that focusing on the use of risk screening/prediction tools could cause confusion around guidelines that are frequently misinterpreted. It is critical to clarify the difference between risk prediction and risk assessment.

The National Institute for Health and Care Excellence (NICE) guideline 161 says risk prediction is a ‘tool that aims to calculate a person’s risk of falling, either in terms of at risk/not at risk or low/medium/high risk’. On the other hand, a multifactorial falls risk assessment is an assessment with multiple components designed to identify a person’s individual risk factors for falling. NICE 161 advises that in hospital inpatient populations, risk prediction tools should not be used.

The NAIF report was based on NICE 161 and it does not make recommendations for practice outside these published guidelines.

The use of fall risk prediction tools has been contentious and the audit question measured compliance with the current recommendation. It was not an attempt to use a risk prediction tool to screen hospital inpatients. This does not refer to detailed risk factor assessment designed to lead to preventive interventions. Neither does it relate to older people living in the community, where prediction tools more accurately identify patients most likely to benefit from further assessment and interventions.

The reason for not recommending risk prediction tools in inpatient settings is that none of the existing tools can identify those at high risk of falling with acceptable accuracy. If a prediction tool is not accurate, there will be patients who are incorrectly classified as low risk, who do not receive any focused intervention. As a result, NICE recommended that all inpatients aged over 65 should be considered high risk and receive a multi-factorial assessment with targeted intervention as required.

Neither NICE nor the NAIF report suggest that patients should not receive assessment – in fact, the opposite is the case.

• Julie Whitney NIHR clinical lecturer, King’s College Hospital, London