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The Research

Stepping On was first tested in a randomised trial in 2004 (Clemson 2004) with a 31% fall reduction. There are now 18 studies supporting this program. A process evaluation helped us understand key features that ensure fidelity of program implementation (Mahoney, 2016, 2017). Other studies have demonstrated behaviour change (Tiedemann 2020; Strommen 2017) and maintenance of physical outcomes (Ory 2017).

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The Impact

A major Implementation and scale up study of Stepping On, led by Jane Mahoney in the US, demonstrated that the trial results can be replicated in practice (Mahoney 2020). A cross over trial of Stepping On showed a reduction in hospital readmissions due to a fall in a 6 month follow up (Ford, 2017). A series of recent observational studies by Paul (2021-2) showed that fall-related health service use increases for the target population but Stepping On appears to mitigate the effects of this. Important news for policy makers investing in fall prevention.

There have been adaptations of stepping on with a  Spanish version (Pinzon 2019), adapted for  people with mild cognitive impairment (Fischer 2021), and for people after a stroke (Xu, 2019; 2020).

The following is a list of publications:

  • Clemson L, Cumming RG, Kendig H, Swann M, Heard R, Taylor K. The effectiveness of a community-based program for reducing the incidence of falls among the elderly:  A randomized trial. Journal of American Geriatrics Society. 2004;52(9):1487-94.
  • Carande-Kulis V, Stevens JA, Florence CS, Beattie BL, Arias I. A cost-benefit analysis of three older adult fall prevention interventions. Journal of Safety Research. 2015;52:65-70.
  • Ford JH, II, et al. Bringing healthy aging to scale: a randomized trial of a quality improvement intervention to increase adoption of evidence-based health promotion programs by community partners. Journal of Public Health Management and Practice 2016; 23(5): e17–e24.
  • Garcia, A., Marciniak, D., McCune, L., Smith, E., & Ramsey, R. (2012). Promoting Fall Self-Efficacy and Fall Risk Awareness in Older Adults. Physical & Occupational Therapy in Geriatrics, 30(2), 165-175. doi:10.3109/02703181.2012.681431
  • Guse, C. E., Peterson, D. J., Christiansen, A. L., Mahoney, J., Laud, P., & Layde, P. M. (2015). Translating a Fall Prevention Intervention Into Practice: A Randomized Community Trial. American Journal of Public Health, 105(7), 1475-1481. doi:10.2105/AJPH.2014.302315
  • Liddle JLM, Lovarini M, Clemson LM, Jang HY, Willis K, Lord SR, et al. Men’s perspectives on fall risk and fall prevention following participation in a group-based programme conducted at Men’s Sheds, Australia. Health & Social Care in the Community. 2017;25(3):1118-26.
  • Mahoney JE. “Stepping On”: Stepping over the chasm from research to practice. Front. Public Health 2:148, 2015.
  • Mahoney J, Clemson L, Schlotthauer A, Mack K, Shea T, Gobel V, et al. Modified Delphi Consensus to Suggest Key Elements of Stepping On Falls Prevention Program. Frontiers in Public Health 2017;5(4):February.
  • Mahoney, J. E., Gangnon, R., Clemson, L., Jaros, L., Cech, S., & Renken, J. (2020). Outcomes associated with scale-up of the Stepping On falls prevention program: A case study in redesigning for dissemination. Journal of Clinical and Translational Science, 4, 250-259. doi: https://doi.org/10.1017/cts.2020.17
  • Mahoney JE, Gobel VL, Shea T, Janczewski J, Cech S, Clemson L. Improving Fidelity of Translation of the Stepping On Falls Prevention Program through Root Cause Analysis. Frontiers in Public Health. 2016;14 November
  • Mahoney J, Clemson L, Lovarini M. Stepping On, a community-based fall prevention program. In: Malone ML, Capezuti E, Palmer RM, editors. Geriatrics Models of Care Bringing ‘Best Practice’ to an Aging America. Switzerland: Springer International  Publishing; 2015. p. 193-8.
  • Ory MG, Smith ML, Jiang L, Lee R, Chen S, Wilson AD, et al. Fall prevention in community settings: results from implementing stepping on in three states. Front Public Health (2014) 2:232. doi:10.3389/fpubh.2014
  • Paul, S. S., Li, Q., Harvey, L., Carroll, T., Priddis, A., Tiedemann, A., Clemson, L. . . . Sherrington, C. (2020). Scale-up of the Stepping On fall prevention program amongst older adults in NSW: Program reach and fall-related health service use. Health Promot J Austr. doi:10.1002/hpja.413
  • Paul SS, T. J., Tiedemann A, Harvey L, Clemson L, Lord SR, Dolja-Gore X, Close JCT, Sherrington C. (2022). Patterns of health service use before and after a statewide fall prevention initiative for older adults at risk of falls. Australasian Journal on Ageing, 10.1111/ajag.13053. Advance online publication. . doi:org/10.1111/ajag.13053
  • Paul SS, Khalatbari-Soltani S, Doja-Gore X, Clemson L, Lord S, Harvey, L. et al. (2012)Fall-related health service use in Stepping On program participants and matched controls: A non-randomised observational trial within the 45 and Up Study. Age and Ageing. Accepted for publication 21 Sept.
  • Peterson DJ, Christiansen AL, Guse CE, Layde PM. Community translation of fall prevention interventions: the methods and process of a randomized trial. Journal of Community Psychology. 2015;43(8):1005-18.
  • Pinzon MM, Myers S, Jacobs EA, Ohly S, Bonet-Vazquez M, Villa M, et al. “Pisando Fuerte”: an evidence-based falls prevention program for Hispanic/Latinos older adults: results of an implementation trial. BMC Geriatrics. 2019;19(1).
  • Schlotthauer AE, Mahoney JE, Christiansen AL, Gobel VL, Layde P, Lecey V, Clemson, L.. Research on the Translation and Implementation of Stepping On in Three Wisconsin Communities. Frontiers in Public Health. 2017;5(128).
  • Strommen J, Brotherson S, Yang Z. Older adult knowledge and behavior change in the Stepping On fall prevention program in a community setting. Journal of Human Sciences and Extension. 2017;5(3):99-121.
  • Smith, M. L., Durrett, N. K., Schneider, E. C., Byers, I. N., Shubert, T. E., Wilson, A. D., . . . Ory, M. G. (2018). Examination of sustainability indicators for fall prevention strategies in three states. Evaluation and Program Planning, 68, 194-201. doi:10.1016/j.evalprogplan.2018.02.001
  • Stevens JA, Burns ER, CDC: Compendium of Effective Fall Interventions: What Works for Community-Dwelling Older Adults. In., 3rd edn. Atlanta,GA: Centres for Disease Control and Prevention, National Center for Injury Prevention and Control; 2015.
  • Tiedemann A, Sherrington C, Lord S, Purcell K, Clemson L. Fall prevention behaviour after participation in the Stepping On program: a pre-post study with 6-month follow-up. Public Health Research & Practice 2020;Published online online 22 April
  • Wildes, T. M., Cordner, T., Depp, B., Coyne, T., Hungerford, J., Tymkew, H., . . . Stark, S. (2018). Stepping On: Cancer Edition: A fall-prevention intervention adapted for older adults with cancer. Journal of Clinical Oncology, 36(15_suppl), e22020-e22020. doi:10.1200/JCO.2018.36.15_suppl.e22020
  • Xu, T. M., O’Loughlin, K., Clemson, L., Lannin, N. A., Dean, C., & Koh, G. (2019). Developing a falls prevention program for community-dwelling stroke survivors in Singapore: client and caregiver perspectives. Disability and Rehabilitation, 41(9), 1044-1054. doi:10.1080/09638288.2017.1419293
  • Xu, T. M., O’Loughlin, K., Clemson, L., Lannin, N. A., Koh, G., & Dean, C. (2019). Therapists’ perspectives on adapting the Stepping On falls prevention programme for community-dwelling stroke survivors in Singapore. Disability and Rehabilitation, 41(21), 2528-2537. doi:10.1080/09638288.2018.1471168
  • Xu, T., Clemson, L., O’Loughlin, K., Lannin, N., Dean, C. M., & Koh, G. (2020). Stepping On after Stroke falls-prevention programme for community stroke survivors in Singapore: A feasibility study. British Journal of Occupational Therapy, 84(6), 366-375. doi:10.1177/0308022620946640