A multicentre randomised controlled trial of day hospital-based falls prevention programme for a screened population of community-dwelling older people at high risk of falls

Abstract

Objective: to determine the clinical effectiveness of a day hospital-delivered multifactorial falls prevention programme, for community-dwelling older people at high risk of future falls identified through a screening process.Design: multicentre randomised controlled trial.Setting: eight general practices and three day hospitals based in the East Midlands, UK.Participants: three hundred and sixty-four participants, mean age 79 years, with a median of three falls risk factors per person at baseline.Interventions: a day hospital-delivered multifactorial falls prevention programme, consisting of strength and balance training, a medical review and a home hazards assessment.Main outcome measure: rate of falls over 12 months of follow-up, recorded using self-completed monthly diaries.Results: one hundred and seventy-two participants in each arm contributed to the primary outcome analysis. The overall falls rate during follow-up was 1.7 falls per person-year in the intervention arm compared with 2.0 falls per person-year in the control arm. The stratum-adjusted incidence rate ratio was 0.86 (95% CI 0.73–1.01), P = 0.08, and 0.73 (95% CI 0.51–1.03), P = 0.07 when adjusted for baseline characteristics. There were no significant differences between the intervention and control arms in any secondary outcomes.Conclusion: this trial did not conclusively demonstrate the benefit of a day hospital-delivered multifactorial falls prevention programme, in a population of older people identified as being at high risk of a future fall.

Strength and Balance Training for Adults With Peripheral Neuropathy and High Risk of Fall: Current Evidence and Implications for Future Research

“…Numerous studies, primarily in the physical therapy and geriatric literature, support the use of strength and balance training exercises among community dwelling adults with postural instability or high risk for falls (Allet et al, 2010; Arampatzis et al, 2011; Beling & Roller, 2009; Clemson et al, 2010; Comans et al, 2010; Conroy et al, 2010; Hagedorn & Holm, 2010; Iwamoto et al, 2009; Kruse et al, 2010; Miller et al, 2010; Morrison et al, 2010; Persch et al, 2009). These studies have direct application to oncology practice and research because many patients, particularly during chemotherapy or radiation therapy, or in advanced stages of disease, experience generalized weakness, muscle weakness, unsteadiness, or problems maintaining balance.…”

“…Strength and balance training exercises can easily be provided by a physical therapist and there is a great deal of data that supports physical therapist led exercise interventions that include specific exercises to strengthen the lower extremities and improve balance (Allet et al, 2010; Arampatzis et al, 2011; Beling & Roller, 2009; Clemson et al, 2010; Comans et al, 2010; Conroy et al, 2010; Hagedorn & Holm, 2010; Iwamoto et al, 2009; Kruse et al, 2010; Miller et al, 2010; Morrison et al, 2010; Persch et al, 2009). Participation in exercise programs focused on improving lower extremity strength and balance has been repeatedly demonstrated as safe, even among people with a very high risk of falls (Clemson et al, 2010; Comans et al, 2010; Conroy et al, 2010).…”

“…Several recent studies have demonstrated reductions in falls or fall risk in older adults participating in strength and balance training programs. Persons at greatest fall risk, who are the most likely to benefit from a falls prevention program, may also have the greatest difficulty participating (Conroy et al, 2010). Researchers in Australia identified the need for a strength and balance training program that imbedded strength and balance training exercises into daily activities.…”

“…A Cochrane Review published in 2009 analyzed the strength of evidence to support interventions for preventing falls in community dwelling older adults (Gillespie et al, 2009). Falls were defined as an unintentionally and sudden vertical decline to the floor or ground (Conroy et al, 2010). Fall risk measurement included measures of gait, balance, and performance status using measures such as the Timed Up and Go, which measures the time it takes to arise from a chair, walk 10 feet, turn around, walk back, and sit down and is highly sensitive and specific for fall prediction (Shumway-Cook, Brauer, & Woollacott, 2000).…”

Priorisierung: Klinische Perspektive

“…Negative Ergebnisse randomisierter Studien (i. S. von Nichtüberlegenheit) fanden sich z. B. zur Sturzprophylaxe bei ambulanten geriatrischen Patienten [ 13 ] . Es kann und soll hier kein Überblick über die vorliegenden randomisierten Studien zur Rehabilitation bei unterschiedlichen Indikationen gegeben werden.…”