ProFaNE, Prevention of Falls Network Europe, is a thematic web-based network aimed at promoting best practice in falls prevention and management across Europe.  Originally set up in 2003, coordinated by the University of Manchester, UK, with 25 partners across Europe and funded by the European Community Framework 6, the Network continues now as a web-based resource. 

The work of ProFaNE is practical, in terms of developing the evidence base for implementation of effective interventions, standardising the health processes for people with a history of falls and encouraging best practice across Europe.

Over the life of the Network many key publications by the members have been regularly cited, the web membership has increased to nearly 4000 members from 30 countries, there is an active discussion board and there are nearly 1300 resources available to download.  The success of the networking and relationship building has resulted in many countries adopting evidence based practice and introducing new National strategies to prevent falls and injuries.

Introduction: Falls Across Europe
Falling is a common problem of old age (1).  Approximately 30% of people aged over 65 years fall each year and after the age of 75 the rates are higher (1).  Falls are the dominant cause of the injuries among elderly people, and 40 - 50,000 older people in the 28 countries in EU25 and EEA will die due to a fall every year (2). There is a ten-fold difference in mortality due to falls across the European countries which must be addressed (2). Between 20 and 30% of those who fall suffer injuries that reduce mobility and independence and increase risk of premature death (1).  Older people make up a large and increasing percentage of the population of European countries. As people grow older they are increasingly at risk of falling and suffering injury from falling (3).

Falls are also associated with significant social and psychological consequences, as people lose confidence and become isolated and restrict their activity (4). A fall may be the first indication of undetected illness (3). Repeated falls often herald a decline in an older person’s functional ability (1,3).   Unless action is taken, the number of falls and fall related injuries is likely to increase over the next 25-30 years (1,3). A number of assessment strategies and interventions targeted at specific groups of individuals in specific settings have been shown to work (5,6).  In practice however, successful interventions have been put into practice with different population groups and in different settings than the original research suggests they were efficacious.  There is an overall need to standardise assessment procedures and tailor interventions to individual situations for effective practice.  So far, population-based strategies have not been properly evaluated (7) and there is no evidence that successful falls reduction interventions can actually significantly reduce fractures and health care costs (1).  This points to the need for monitoring, implementation and further evaluation of intervention strategies.

ProFaNE (Prevention of Falls Network Europe) (8,9) was originally funded by the European Commission (EC) to consolidate and disseminate good practice in taxonomy and clinical trial methodology as well as detailed clinical assessment and management protocols for those ‘at risk’ of falls.  It comprised four work packages (8,9) which addressed key areas in the field of trial design, assessments of risk in different settings and fear of falling:

1. taxonomy and co-ordination of trials
2. clinical assessment and management
3. assessment of balance function
4. psychological aspects of falling.

Working across Europe
The essence of ProFaNE’s methodology is to engender joint working across disciplines, specialties and sites as well as breaking down barriers (by speaking plain English, standardised terminology and exchange programmes) to build a critical mass of scientists and clinicians focusing on falls assessment and effective implementation of interventions.  This is facilitated by a state of the art web-based project management system supplied and maintained by the co-ordinating centre in Manchester (www.profane.eu.org, below), which acts both as communication medium within the network and a user-friendly window for the outside world to access the work of ProFaNE. 

Work to date
The original EU funded Network ran for three years, with Network and combined Work package Meetings and over 20 workshops. ProFaNE’s work has been disseminated at over 50 pan-European and International conferences. A key document for policy makers around Europe, written by ProFaNE members during 2003, was published by the World Health Organisation (1) and we have been recently asked to update it.  New funding for research by members (in their own countries) and collaborative pan-European bids have been successful.  Some of this success may be due to the backing that the ProFaNE Network can provide to their work.  Although aimed at improving practice across Europe, the Network has forged strong links with other groups in Australia, New Zealand and Canada.

Experience from the Cochrane Review of Fall Prevention (6) has shown that the manner in which interventions are defined and described in primary research has a large effect on interpretation of pooled analyses. ProFaNE have come to Consensus on a core-set of outcome measures and descriptors that would make comparisons much easier (10).  This work has been made possible by a series of systematic reviews on falls definitions (11), psychological outcomes (12), physical activity measures (13) and the use of force platforms to measure balance (14).

In 2007 a fully interactive online assessment and management protocol was published on the ProFaNE site that can be used as a decision making tree following the pathway of a faller through the healthcare process.  One of ProFaNE’s original workpackages (WP3) focussed on the use of lightweight ambulatory equipment that allows for the measurement of human movement under real-life conditions.  This novel approach to the analysis of human movement can potentially fill the need for objective field instruments (15,16,17).  The group continued their work in another EU funded network, SENSACTION-AAL (http://www.sensaction-aal.eu/) to develop valid, reliable and easy-to-use objective measures of balance function, the level of activity and the occurrence of falls in older people. 

Another original workpackage (WP4), originally brought together clinicians working with different populations of older people at risk of falling, and social scientists with expertise in psychology of falling, behavioural change, interview-based research, and questionnaire design (18).  The group’s continued interest is in what motivates older people to engage in, or reject, a variety of interventions intended to reduce the risk of falls and injury. The work package has accumulated qualitative primary and secondary data on attitudes, uptake and adherence to different interventions in different populations in order to identify common relevant motivations and concerns (19,20).  This workpackage has produced and validated a new questionnaire, based on the well known Falls Efficacy Scale (4) which comprehensively assesses all aspects of falling-related anxiety (FES-I, Falls Efficacy Scale-International) (21,22)  and this is now available in over fifteen different languages on the ProFaNE website.  There has been a cross-cultural validation of the  FES-I in the UK, the Netherlands and Germany (23).  The short FES-I, with 7 rather than 16 questions, has been validated and published (24).  Many recent published trials and current trials are using the FES-I and SFES-I, including one which compared responses to self completion and interview in those with cognitive impairment (25).

The workpackage also worked on what attitudes and beliefs predict intention to undertake strength and balance training (26) and have designed a questionnaire (Attitudes to Falls-Related Interventions Scale (AFRIS)) which is available on the ProFaNE website.  Work on a web-site giving information on balance exercise, with tailored information based on user’s views (27), was developed and showed an improvement in intention to carry out balance exercises with its tailored approach versus general information (28).  A review to explore how allied health professionals can improve uptake of and adherence to falls prevention interventions was published recently (29).  Finally members of ProFaNE have continued their interest in what motivates older people to take part in exercise to reduce falls risk (30) and have shown the importance of the primary health care physician (31). Difference in socioeconomic status and ethnicity have also been explored in a review for the World Health Organisation (32).

The wider impact of ProFaNE
Partners, Members and Network Associates of ProFaNE have been invited to join committees for National, Governmental and Non Governmental Organisations on injury prevention; have contributed to many National guidelines on falls prevention; have contributed to the revised AGS, BGS Guidelines on falls prevention (33); the recent Department of Health Prevention Package (34); are connected with other European Networks on Injury Prevention (EuroSafe, APOLLO, EUNESE); have been invited to contribute to Australian and New Zealand Networks on Falls Prevention; have been invited to join programme committees and present at International Conferences in a number of disciplines.

Being involved in a European funded project
For members of ProFaNE, the benefit was clear. EU funding allowed travel to enable both learning and dissemination of information to a wider audience and allow a greater understanding of clinical pathways within different countries.  Academically, it has allowed joint working and publication with a much wider field and has facilitated cross-national funded projects and further research.  For the co-ordination centre, working with and reporting to 13 different EU organisations, and indeed the European Commission, presented some difficulties but nothing that could not be overcome.  In order to run a successful EU project the necessity of a full time co-ordination team (administrator, web-developer and co-ordinator) allowed the multitude of reporting forms to be followed up, completed and reported and a chance for the academics and others involved within the Network to concentrate on their main tasks.  The sustainability of such a successful Network was vital.  Since early 2007, the ProFaNE website has continued running with support from Help the Aged and the British Geriatrics Society Falls and Bone Health Section.  Input is essentially from the worldwide falls community through the discussion board and through information submitted to be added to the two-monthly newsletter. Resources are added by a few committed academics to ensure the most up to date evidence is still available and of course, research proposals are still being submitted through links made through the Network.

Conclusions
EU funded Thematic Networks, such as ProFaNE, allow cross-disciplinary networking and research and can be extremely influential both through academic learning and dissemination as well as through influence on policy.

Acknowledgements
The author(s) were participants in the Prevention of Falls Network Europe (PROFANE) Thematic Network; which was a project within Key Action #6 (The Ageing Population and their Disabilities), part of the European Commission 5th Framework, Quality of Life and Management of Living Resources Programme, funded by the European Commission (QLRT-2001-02705).  The content of the manuscript does not represent the opinion of the European Community and the Community is not responsible for any use that might be made of the information presented in the text.

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