Critical Appraisal on Randomized Factorial Trial of Falls Prevention Among Older People Living in Their Own Homes
Volume 3, Issue 1, March 2018, Pages: 17-22
Received: Nov. 12, 2017;
Accepted: Jan. 2, 2018;
Published: Feb. 23, 2018
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Nadia Mahmoud Ali Abuzied, Federal Ministry of Health, Khartoum, Sudan
Objective To test the effectiveness of, and explore interactions between, three interventions to prevent falls among older people. Design a randomized controlled trial with a full factorial design. Setting Urban community in Melbourne, Australia. Participants1090 aged 70 years and over and living at home. Most were Australian born and rated their health as good to excellent; just over half lived alone. Interventions Three interventions (group based exercise, home hazard management, and vision improvement) delivered to eight groups defined by the presence or absence of each intervention. Main outcome measure Time to first fall ascertained by an 18 month falls calendar and analyzed with survival analysis techniques. Changes to targeted risk factors were assessed by using measures of quadriceps strength, balance, vision, and number of hazards in the home. Results the rate ratio for exercise was 0.82 (95% confidence interval 0.70 to 0.97, P=0.02), and a significant effect (P < 0.05) was observed for the combinations of interventions that involved exercise. Balance measures improved significantly among the exercise group. Neither home hazard management nor treatment of poor vision showed a significant effect. The strongest effect was observed for all three interventions combined (rate ratio 0.67 (0.51 to 0.88, P=0.004)), producing an estimated 14.0% reduction in the annual fall rate. The number of people needed to be treated to prevent one fall a year ranged from 32 for home hazard management to 7 for all three interventions combined. Conclusions group based exercise was the most potent single intervention tested, and the reduction in falls among this group seems to have been associated with improved balance. Falls were further reduced by the addition of home hazard management or reduce division management, or both of these. Cost effectiveness is yet to be examined. These findings are most applicable to Australian born adults aged 70-84 years living at home who rate their health as good.
Nadia Mahmoud Ali Abuzied,
Critical Appraisal on Randomized Factorial Trial of Falls Prevention Among Older People Living in Their Own Homes, Rehabilitation Science.
Vol. 3, No. 1,
2018, pp. 17-22.
Feder G, Cryer C, Donovan S, Carter Y on behalf of the guidelines' devel≠opment group. Guidelines for the prevention of falls in people over 65. BMJ2000; 321:1007≠11.
Campbell AJ, Robertson CM, Gardner MM, Norton RN, Buchner DM. Psychotropic medication withdrawal and a home based exercise programme to prevent falls: a randomised controlled trial. J Am GeriatrSoc1999; 47:850≠3.
Cummings RG, Thomas M, Szonyi G, Salkeld G, O'Neill E, Westbury C, et al. Home visits by an occupational therapist for assessment and modi≠fication of environmental hazards: a randomised trial of falls prevention. J Am Geriatr Soc1999; 47:1397≠402.
Smith J, Laidlaw C, Matthews JRANDOM. Computer program. Melbourne: Statistical Centre, Peter MacCallum Cancer Institute, 1996.
Pfieffer E. A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients. J Am Geriatr Soc1975; 23:433≠41.
Casagrande JT, Pike MC, Smith PG. An improved approximate formula for calculating sample sizes for comparing two binomial distributions. Biometrics1978; 34:483≠96.
Tinetti ME, Baker DI, McAvay G, Claus EB, Garrett P, Gottschalk M, et al. A multifactorial intervention to reduce the risk of falling among elderly people living in the community. N Engl J Med1994; 331:821≠7.
Hallett BYouth participation in Australia. Stockholm: Institute For Democ≠racy And Electoral Assistance, 1999. (International forum on youth and democracy).
Lawton MP, Moss M, Fulcomer M, Kleban MH. A research and service oriented multilevel assessment instrument. J Gerontol1982; 37:91≠9.
[10 Hill KD, Schwarz JA, Kalogeropoulos AJ, Gibson SJ. Fear of falling revis≠ited. Arch Phys Med Rehabil1996; 77:1025≠9.
Lord SR, Ward JA, Williams P. The effect of exercise on dynamic stabilityin older women: a randomised controlled trial. Arch Phys Med Rehabil1996; 77:232≠6.
Podsialdo D, Richardson S. The timed “up and go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc1981; 39:142≠8.
Lord SR, Clark RD, Webster IW. Visual acuity and contrast sensitivity in relation to falls in an elderly population. Age Ageing1991; 20:175≠81.
Verbaken J. Dual contrast visual acuity chart, chart 5. Melbourne, Victoria: Australian Vision Charts, 1986.
Random dot stereo butterfly test. Chicago: Stereo Optical, 1988.
OKP glaucoma screening test. Hoddesdon, Hertfordshire: Merck Sharp and Dohme Ophthalmic Services, 1989.
Domato BE, Ahmed J, Allen D, McClure E, Jay JL. The detection of glau≠comatous visual field defects by oculokinetic perimetry: which points arebest for screening? Eye1989; 3:727≠31.
Maxwell SE, Delaney HD. Designing experiments and analysing data. Belmont, CA: Wadsworth, 1990.
Grambsch P, Therneau T. Proportional hazard tests and diagnostics based on weighted residuals. Biometrika1994; 81:515≠26.
Buchner DM, Cress ME, de Lateur BJ, Esselman PC, Margherita AJ, PriceR, et al. The effect of strength and endurance training on gait, balance, fall risk, and health services use in community≠living older adults. J Gerontol ABiol Sci Med Sci1997; 52: M218≠25.
Campbell AJ, Robertson CM, Gardner MM, Norton RN, Tilyard MW, Buchner DM. Randomised controlled trial of a general practice programme of home based exercise to prevent falls in elderly women. BMJ1997; 315:1065≠9. (Accepted 2 January 2002.