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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

Forest plot from the meta-analysis of multiple component interventions on number of fallers showing estimates of risk ratio, 95% confidence intervals and relative weight of each study. Meta-analysis of intervention effect on number of fallers.
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Figure 2: Forest plot from the meta-analysis of multiple component interventions on number of fallers showing estimates of risk ratio, 95% confidence intervals and relative weight of each study. Meta-analysis of intervention effect on number of fallers.

Mentions: A beneficial effect of multiple component interventions was observed for the number of people that fall (risk ratio =0.85, 95% CI 0.80 to 0.91, Figure 2) and fall rate (rate ratio =0.80, 95% CI 0.73 to 0.88, Figure 3). Two studies were undertaken in a care home setting, which may represent a very different population to those seen in a community or clinic setting. We therefore undertook a sensitivity analysis by removing the results of these papers from the meta-analyses but this made little difference (risk ratio = 0.86, 95% CI 0.80 to 0.92; rate ratio = 0.78, 95% CI 0.71 to 0.85). No heterogeneity was found across studies evaluating the number of people that fell (I2 =0%). There was a small amount of heterogeneity (I2 = 20%) across studies of fall rate. This heterogeneity was entirely due to one study [33] and sensitivity analysis made little difference (rate ratio = 0.77, 95% CI 0.70 to 0.85) and, therefore, it was not considered appropriate for sub-group analyses or exploration of variability between studies to be undertaken. Only one study [25] reported the number of people sustaining a fracture (risk ratio 0.14, 95% CI 0.02 to 1.15). Campbell and colleagues [31] reported serious injuries that included fractures, hospitalisation and injuries requiring stitches but there was no evidence at the 5% level of significance of an effect for either exercise and Vitamin D (risk ratio =0.98, 95% CI 0.25 to 3.84) or exercise, Vitamin D and home safety (risk ratio =2.7, 95% CI 0.89 to 8.17) versus control. One study [37] reported injurious falls but did not define this (incidence rate ratio = 1.02, 95% CI 0.54 to 1.95).


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)

Forest plot from the meta-analysis of multiple component interventions on number of fallers showing estimates of risk ratio, 95% confidence intervals and relative weight of each study. Meta-analysis of intervention effect on number of fallers.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: Forest plot from the meta-analysis of multiple component interventions on number of fallers showing estimates of risk ratio, 95% confidence intervals and relative weight of each study. Meta-analysis of intervention effect on number of fallers.
Mentions: A beneficial effect of multiple component interventions was observed for the number of people that fall (risk ratio =0.85, 95% CI 0.80 to 0.91, Figure 2) and fall rate (rate ratio =0.80, 95% CI 0.73 to 0.88, Figure 3). Two studies were undertaken in a care home setting, which may represent a very different population to those seen in a community or clinic setting. We therefore undertook a sensitivity analysis by removing the results of these papers from the meta-analyses but this made little difference (risk ratio = 0.86, 95% CI 0.80 to 0.92; rate ratio = 0.78, 95% CI 0.71 to 0.85). No heterogeneity was found across studies evaluating the number of people that fell (I2 =0%). There was a small amount of heterogeneity (I2 = 20%) across studies of fall rate. This heterogeneity was entirely due to one study [33] and sensitivity analysis made little difference (rate ratio = 0.77, 95% CI 0.70 to 0.85) and, therefore, it was not considered appropriate for sub-group analyses or exploration of variability between studies to be undertaken. Only one study [25] reported the number of people sustaining a fracture (risk ratio 0.14, 95% CI 0.02 to 1.15). Campbell and colleagues [31] reported serious injuries that included fractures, hospitalisation and injuries requiring stitches but there was no evidence at the 5% level of significance of an effect for either exercise and Vitamin D (risk ratio =0.98, 95% CI 0.25 to 3.84) or exercise, Vitamin D and home safety (risk ratio =2.7, 95% CI 0.89 to 8.17) versus control. One study [37] reported injurious falls but did not define this (incidence rate ratio = 1.02, 95% CI 0.54 to 1.95).

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