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Multiple component interventions for preventing falls and fall-related injuries among older people: systematic review and meta-analysis.

Goodwin VA, Abbott RA, Whear R, Bethel A, Ukoumunne OC, Thompson-Coon J, Stein K - BMC Geriatr (2014)

Bottom Line: The study objective was to determine the effect of multiple component interventions on fall rates, number of fallers and fall-related injuries among older people and to establish effect sizes of particular intervention combinations.Data synthesis took place in 2013.There was a small amount of statistical heterogeneity (I(2) =20%) across studies for fall rate and no heterogeneity across studies examining number of people that fell.

View Article: PubMed Central - HTML - PubMed

Affiliation: PenCLAHRC, University of Exeter Medical School, Veysey Building, Salmon Pool Lane, Exeter EX2 4SF, UK. V.Goodwin@Exeter.ac.uk.

ABSTRACT

Background: Limited attention has been paid in the literature to multiple component fall prevention interventions that comprise two or more fixed combinations of fall prevention interventions that are not individually tailored following a risk assessment. The study objective was to determine the effect of multiple component interventions on fall rates, number of fallers and fall-related injuries among older people and to establish effect sizes of particular intervention combinations.

Methods: Medline, EMBASE, CINAHL, PsychInfo, Cochrane, AMED, UK Clinical Research Network Study Portfolio, Current Controlled Trials register and Australian and New Zealand Clinical Trials register were systematically searched to August 2013 for randomised controlled trials targeting those aged 60 years and older with any medical condition or in any setting that compared multiple component interventions with no intervention, placebo or usual clinical care on the outcomes reported falls, number that fall or fall-related injuries. Included studies were appraised using the Cochrane risk of bias tool. Estimates of fall rate ratio and risk ratio were pooled across studies using random effects meta-analysis. Data synthesis took place in 2013.

Results: Eighteen papers reporting 17 trials were included (5034 participants). There was a reduction in the number of people that fell (pooled risk ratio = 0.85, 95% confidence interval (95% CI) 0.80 to 0.91) and the fall rate (pooled rate ratio = 0.80, 95% CI 0.72 to 0.89) in favour of multiple component interventions when compared with controls. There was a small amount of statistical heterogeneity (I(2) =20%) across studies for fall rate and no heterogeneity across studies examining number of people that fell.

Conclusions: This systematic review and meta-analysis of randomised controlled trials found evidence that multiple component interventions that are not tailored to individually assessed risk factors are effective at reducing both the number of people that fall and the fall rate. This approach should be considered as a service delivery option.

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Related in: MedlinePlus

Flow chart of included studies.
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Figure 1: Flow chart of included studies.

Mentions: The database search identified 3691 citations. Eighteen papers, representing seventeen studies were included (Figure 1). One paper [34] reported additional analyses from the study reported by Day et al. [32]. Two studies were not included in the meta-analysis due to insufficient data. One study [35] had too small a sample size (10 participants in each arm) to calculate valid confidence intervals for the risk ratio. Another study [36] combined results from single and multiple component interventions and it was not possible to extract the data for the multiple component intervention in relation to falls or fractures. Three studies [20,31,32] had several intervention groups, and thus, we had 19 estimates of effect to synthesise in the meta-analysis for fall risk ratio and 17 estimates in the meta-analysis of fall rate ratio. Four studies [25,31,36,37] reported injury data with two studies reporting fractures [25,36] and one reporting serious injuries (that comprised fractures and hospital admissions due to injury) [31]. One study provided no definition of fall-related injuries [37]. Egger’s test indicated little evidence of publication bias for the analyses of fall risk (p = 0.13) or fall rate (p = 0.76).


Multiple component interventions for preventing falls and fall-related injuries among older people: systematic review and meta-analysis.

Goodwin VA, Abbott RA, Whear R, Bethel A, Ukoumunne OC, Thompson-Coon J, Stein K - BMC Geriatr (2014)

Flow chart of included studies.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC3928080&req=5

Figure 1: Flow chart of included studies.
Mentions: The database search identified 3691 citations. Eighteen papers, representing seventeen studies were included (Figure 1). One paper [34] reported additional analyses from the study reported by Day et al. [32]. Two studies were not included in the meta-analysis due to insufficient data. One study [35] had too small a sample size (10 participants in each arm) to calculate valid confidence intervals for the risk ratio. Another study [36] combined results from single and multiple component interventions and it was not possible to extract the data for the multiple component intervention in relation to falls or fractures. Three studies [20,31,32] had several intervention groups, and thus, we had 19 estimates of effect to synthesise in the meta-analysis for fall risk ratio and 17 estimates in the meta-analysis of fall rate ratio. Four studies [25,31,36,37] reported injury data with two studies reporting fractures [25,36] and one reporting serious injuries (that comprised fractures and hospital admissions due to injury) [31]. One study provided no definition of fall-related injuries [37]. Egger’s test indicated little evidence of publication bias for the analyses of fall risk (p = 0.13) or fall rate (p = 0.76).

Bottom Line: The study objective was to determine the effect of multiple component interventions on fall rates, number of fallers and fall-related injuries among older people and to establish effect sizes of particular intervention combinations.Data synthesis took place in 2013.There was a small amount of statistical heterogeneity (I(2) =20%) across studies for fall rate and no heterogeneity across studies examining number of people that fell.

View Article: PubMed Central - HTML - PubMed

Affiliation: PenCLAHRC, University of Exeter Medical School, Veysey Building, Salmon Pool Lane, Exeter EX2 4SF, UK. V.Goodwin@Exeter.ac.uk.

ABSTRACT

Background: Limited attention has been paid in the literature to multiple component fall prevention interventions that comprise two or more fixed combinations of fall prevention interventions that are not individually tailored following a risk assessment. The study objective was to determine the effect of multiple component interventions on fall rates, number of fallers and fall-related injuries among older people and to establish effect sizes of particular intervention combinations.

Methods: Medline, EMBASE, CINAHL, PsychInfo, Cochrane, AMED, UK Clinical Research Network Study Portfolio, Current Controlled Trials register and Australian and New Zealand Clinical Trials register were systematically searched to August 2013 for randomised controlled trials targeting those aged 60 years and older with any medical condition or in any setting that compared multiple component interventions with no intervention, placebo or usual clinical care on the outcomes reported falls, number that fall or fall-related injuries. Included studies were appraised using the Cochrane risk of bias tool. Estimates of fall rate ratio and risk ratio were pooled across studies using random effects meta-analysis. Data synthesis took place in 2013.

Results: Eighteen papers reporting 17 trials were included (5034 participants). There was a reduction in the number of people that fell (pooled risk ratio = 0.85, 95% confidence interval (95% CI) 0.80 to 0.91) and the fall rate (pooled rate ratio = 0.80, 95% CI 0.72 to 0.89) in favour of multiple component interventions when compared with controls. There was a small amount of statistical heterogeneity (I(2) =20%) across studies for fall rate and no heterogeneity across studies examining number of people that fell.

Conclusions: This systematic review and meta-analysis of randomised controlled trials found evidence that multiple component interventions that are not tailored to individually assessed risk factors are effective at reducing both the number of people that fall and the fall rate. This approach should be considered as a service delivery option.

Show MeSH
Related in: MedlinePlus