Rethinking individual and community fall prevention strategies: a meta-regression comparing single and multifactorial interventions
- Address correspondence to: A. john Campbell. Email: john.campbell@stonebow.otago.ac.nz
Abstract
Background guidelines recommend that fall prevention programmes for older people include multifactorial interventions.
Objective we aimed to determine if randomised controlled trial evidence supports interventions with multiple components over single
strategies in community based fall prevention.
Methods we searched the
literature for trials of interventions aimed at preventing falls. We
included trials if they met the following
criteria: (i) participants were randomly allocated
to intervention and control groups, (ii) all participants were aged
65 years
or older, (iii) the majority lived independently in
the community, (iv) fall events were recorded prospectively using a
diary
or calendar during the entire trial and monitored
at least monthly, (v) follow up was for 12 months or longer, (vi) at
least
70% of participants completed the trial, (vii) all
falls during the trial for at least 50 participants were included in the
analysis, and (viii) a relative rate ratio with 95%
CI comparing the number of falls in the intervention and control groups
was reported. We calculated a pooled rate ratio
separately for trials testing multifactorial and single interventions
and
compared their overall efficacy using
meta-regression.
Results meta-regression showed that single interventions were as effective in reducing falls as interventions with multiple components
(pooled rate ratios 0.77, 95% CI 0.67–0.89 and 0.78, 0.68–0.89 respectively).
Conclusion multifactorial
fall prevention interventions are effective for individual patients.
However, for community programmes for
populations at risk, targeted single interventions
are as effective as multifactorial interventions, may be more acceptable
and cost effective.
Quelle: http://ageing.oxfordjournals.org/content/36/6/656.full
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