4 Monitoring and Evaluation

Monitoring participant outcomes and evaluating programme performance are crucial for the successful delivery of high-quality programmes with fidelity. Data collected from participants is important for two reasons: to ensure the FaME programme is tailored to that individual, their functional ability, comorbidities and cognitive capability; and to ensure that participants are improving in their strength, balance, confidence and fear of falling.  

Another key consideration when delivering FaME is whether your programme retains the quality and fidelity of delivery set out in the clinical trials when commissioned and delivered in a non-research setting. To answer this question, it is recommended that FaME programme delivery has built in quality assurance – either procured and delivered externally or delivered through internal peer‑led approaches.  

This quality assurance process will also ensure that programmes include the essential components of FaME delivery. A list of these components is provided to help make sure your programmes include all the unique ingredients that makes FaME, ‘FaME’.  

4.1 Essential Components of the FaME Intervention 

FaME is not a generic strength and balance programme. There are key elements that make it FaME and are vital to the effectiveness, and return on investment, of the programme. It is important that all providers of FaME consider these Essential Elements in the commissioning of FaME to have the best timely outcomes for older people at risk of falls. These are what distinguish FaME from any generic Strength and Balance Programme (to reduce risk of falls) and ensure it reduces falls rate, increases habitual physical activity, reduces concern about falls and the chances of long lies and improve confidence. 

These do not focus on the quality of delivery (PSI skills) but on the unique aspects of FaME delivery. It is assumed that Postural Stability Instructors (PSI), trained by Later Life Training, understand these aspects in greater detail than presented here. PSIs are expected to maintain a focus on quality of delivery and to deliver FaME to best possible fidelity for best impact but they must be supported in the design and delivery of programmes to be able to deliver FaME with fidelity. 

This checklist is a useful starting point to ensure that your programme includes all of the key elements of FaME. The checklist can be downloaded below.  

[LINK TO ESSENTIAL COMPONENTS CHECKLIST] 

4.2 Quality assurance checklist 

Quality assurance (QA) supports the delivery of the FaME programme by ensuring programmes are high quality and have fidelity to the published clinical trials. Any QA should be a positive experience for the workforce, providing support and guidance for optimum exercise delivery/outcomes. 

Quality assurance of FaME classes using peer observations by a qualified has been shown to be an effective way of identifying PSI delivery strengths and areas for improvement. The QA resources in this toolkit provide a systematic method of carrying out and documenting such observations and of providing consistent feedback on outcomes and recommendations for improvement. 

[LINK TO QA CHECKLIST] 

4.3 Reflective practice and self-evaluation 

PSI reflective practice is the first measure to support quality assurance of FaME delivery. Some services call in Later Life Training (as the original trainer of the PSIs) to provide observation of classes and support PSIs and services. Others have coordinators that do the same locally. Others just ask (and pay) the PSIs to observe another PSIs class a few times a year and provide constructive reflection on their delivery and discuss improvements. The two documents below are designed to support and encourage PSIs and line managers to work towards and maintain the highest standards of FaME delivery and consider their own practice and to seek further support and advice when required. 

[LINK TO SELF EVALUATION TOOL] 

4.4 Data collection for FaME programme monitoring and evaluation  

Why collect data?

Data collection for the FaME programme is important at two levels: 

Individual assessment level: To determine suitability or eligibility of individuals for the local programme; To ensure each programme is tailored to an individual’s functional ability; To monitor an individual’s progress and provide individualised feedback throughout the programme 

Programme assessment level: To use aggregate data to monitor the overall performance of the programme against local performance indicators and quality criteria (usually set out in the service specification) 

Individual level assessment 

Depending upon the locally agreed referral pathways for the FaME programme, participants may or may not be able to self‑refer to the programme as well as being signposted or referred by healthcare providers to the programme. If a healthcare referral is required a local referral form should be developed in order to provide the necessary clinical information. If a healthcare professional referral is not required, there needs to be a local decision regarding whether or not the GP is notified of participation. 

Irrespective of the entry route, postural stability instructors (PSIs) need to undertake an incoming assessment of health and function prior to people starting exercise to ensure that individuals are suitable for the programme and to allow involvement/referral onto other health professionals if required (i.e. to ensure the multifactorial nature of falls is addressed). It also allows the instructor to tailor an individual’s exercises in class and at home. As PSIs are trained to collect data to undertake these individual-level assessments further guidance is not given here.