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STAIR OF KNOWLEDGE intervention shows feasibility in Swedish nursing homes for multiple geriatric risksNew Program Shows Promise for Improving Care in Nursing Homes

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Key Takeaway
Interpret these feasibility results as supportive for a definitive trial, not as evidence of clinical benefit.

This cluster randomized pilot study evaluated the feasibility of the STAIR OF KNOWLEDGE intervention in 8 Swedish nursing homes involving 309 older persons. The intervention aimed to address pressure ulcers, malnutrition, oral health issues, and falls. The comparator was not reported. The primary outcome was feasibility of recruitment, randomization, retention, data collection, and analysis of intended clinical outcomes.

All 8 nursing homes completed the 12-month follow-up. For at-risk individuals, actions were planned for 96.8% (299/309) of residents, and 90.3% (270/299) of those planned actions were implemented. However, a reduction in implemented actions was observed after 12 months. Safety and adverse events were not reported.

Key limitations include the pilot nature of the study, limited sample size, and small number of clusters (8). The results support proceeding with a definitive trial as feasibility criteria were met, but no conclusions about clinical efficacy can be drawn. The study does not provide evidence for reducing adverse outcomes.

How this fits prior evidence

This pilot study addresses a gap in prior coverage by testing a multicomponent intervention in nursing homes, whereas prior items focused on prediction models (risk prediction models showing 0.83 discriminatory performance for malnutrition) or single-condition interventions (strengthened care continuum for wasting). It extends the concept of integrated care to multiple geriatric risks but does not yet provide efficacy data, contrasting with the fracture prevention benefit found lacking for calcium and vitamin D in low-risk adults. The feasibility results are preliminary and do not yet address the high bias noted in fall prediction models.

Researchers conducted a pilot study to see if the 'STAIR OF KNOWLEDGE' program could work in Swedish nursing homes. The study involved 309 older residents who were at risk for several health issues, including pressure ulcers, malnutrition, and falls. The goal was to see if staff could successfully identify these risks and take action.

The results showed that the program was very feasible. Staff members created specific care plans for nearly 97% of the seniors involved. Of those who had a plan, about 90% of the actions were actually put into practice by the nursing home staff. All eight participating locations completed the study successfully.

Because this was a small pilot study with only eight locations, it is not a final word on how well the program works for everyone. However, it shows that the system is practical enough to move forward with larger trials. It provides a helpful framework for improving daily care and safety for elderly residents.

What this means for you:
The STAIR OF KNOWLEDGE program successfully helped nursing home staff create and implement care plans for seniors.

Common questions

What specific health issues does this program address?

The STAIR OF KNOWLEDGE intervention was designed to help manage several serious risks for older adults in nursing homes. These include the prevention of pressure ulcers, addressing malnutrition, improving oral health, and reducing the risk of falls.

How many residents were involved in this study?

The pilot study included 309 older persons living in Swedish nursing homes. Out of these individuals, actions were planned for 299 people (96.8%), and those actions were successfully implemented for 270 of them (90.3%).

Is this program a proven cure for nursing home issues?

This was a pilot study designed to test if the program's methods were feasible and easy for staff to use. While it showed high success rates in planning and implementation, more large-scale trials are needed to confirm its long-term clinical effects.

Study Details

Study typeRct
EvidenceLevel 2
Follow-up1224.0 mo
PublishedJun 2026
View Original Abstract ↓
OBJECTIVES: This external pilot study aimed to evaluate whether a definitive trial of the STAIR OF KNOWLEDGE intervention is warranted. The specific outcomes concerned the trial procedure, including the recruitment, randomisation and retention of nursing homes and the clinical outcomes required for a definitive trial. DESIGN: The study is an external pilot cluster randomised controlled trial. SETTING: Swedish nursing homes participated. PARTICIPANTS: The inclusion criteria for participation in the study were nursing homes working with in the Swedish national quality registry Senior Alert. Data from 309 older persons were extracted from the registry. Of these, 214 were women and 95 men, ages 65-102 years. INTERVENTION: The intervention aims to support nursing staff in providing preventive care regarding pressure ulcers, malnutrition, poor oral health and falls to older persons in nursing homes. OUTCOME MEASURES: Following the Medical Research Council and the Knowledge to Action frameworks and guided by predefined progression criteria, we conducted an external pilot study to determine whether to proceed with a definitive trial. The outcome measures concerned testing nursing homes' recruitment and randomisation procedures, their retention and the selection of the most appropriate primary outcome measures. RESULTS: We recruited eight nursing homes and randomised four to each study arm. All participating nursing homes completed the study, supporting its overall feasibility. The data collection and analysis for the intended clinical outcomes were also feasible. A total of 309 older persons were included in the study sample and were identified as being at risk of pressure ulcers, malnutrition, poor oral health and falls. Among these, actions were planned for 299 (96.8%). Of those for whom actions were planned, actions were implemented on 270 older persons (90.3%). After 12 months, a reduction in implemented actions was observed. CONCLUSION: Conducting the current pilot study was a critical step towards preparing for a future definitive trial. The predefined progression criteria were successfully met, demonstrating the feasibility of the specific objectives-including the recruitment, randomisation and retention of nursing homes-as well as the data collection and analysis of intended clinical outcomes. The results of this external pilot study support proceeding with a definitive trial. TRIAL REGISTRATION NUMBER: NCT05308862.
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