• Lisa Robinson, Julia L Newton, Diana Jones, and Pamela Dawson.
• Falls and Syncope Service and NIHR Biomedical Research Centre in Ageing, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK.
• J Eval Clin Pract. 2014 Aug 1; 20 (4): 318-26.

Rationale, Aims And ObjectivesIn the context of an ageing population, increasing numbers of older people with long-term conditions are presenting to secondary health care facilities in the United Kingdom having experienced a fall or fall-related injury. Despite such observations, falls and long-term conditions have traditionally been regarded as entirely separate entities. The purpose of this study was to explore the process of behaviour change in a small sample of older people with the fall-associated chronic liver disease primary biliary cirrhosis (PBC) receiving either a standard or an enhanced programme of strength and balance training (SBT).MethodsA qualitatively driven mixed-methods approach was employed that juxtaposed semi-structured interviews with graphical representations of patient-reported outcome measures collected during the course of an experimental case series in nine older people with the fall-associated chronic liver disease PBC.ResultsParticipants receiving both the standard and enhanced intervention completed the programme of SBT as instructed throughout the course of the case series. However, only the enhanced intervention, which focused on self-determination and self-management support, was associated with continued active participation on completion of the programme.ConclusionsLonger, but not necessarily more intensive, periods of clinical intervention are necessary to support individuals at risk of falling to move through the incremental stages of behaviour change. Effective self-management support should focus on the development of a wide range of strategies and behaviours to empower older people with long-term conditions develop an ongoing active commitment to SBT.© 2014 John Wiley & Sons, Ltd.

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