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Effects of a multifactorial fall prevention program on fall incidence and physical function in community-dwelling elderly with risk of fall
Lee H-C, Chang K-C, Tsauo J-Y, Hung J-W, Huang Y-C, Lin S-I
Archives of Physical Medicine and Rehabilitation 2013 Apr;94(4):606-615e1
clinical trial
7/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

OBJECTIVE: To evaluate effects of a multifactorial fall prevention program on fall incidence and physical function in community-dwelling older people. DESIGN: Multi-center randomized controlled clinical trial SETTING: Three medical centers and adjacent community health centers in Taiwan. PARTICIPANTS: Community-dwelling elderly who had fallen in the previous year or with risk of fall. INTERVENTIONS: After baseline assessment, eligible subjects were randomly allocated into the intervention group (IG) or control group (CG) stratified by Physiological Profile Assessment (PPA) fall-risk level. IG received a 3-month multifactorial intervention program including 8-week exercise training, health education, home hazards evaluation/modification, along with medication review and ophthalmology/other specialty consult. CG got health education brochures, referrals and recommendations without direct exercise intervention. MAIN OUTCOME MEASURES: Primary outcome was fall incidence within 1-year. Secondary outcomes were PPA battery (overall fall-risk index, vision, muscular strength, reaction time, balance and proprioception), timed up-and-go (TUG), Taiwanese-International Physical Activity Questionnaire, EuroQoL-5D, Geriatric Depression Scale (GDS), and Fall Efficacy Scale at 3 month after randomization. RESULTS: There were 616 participants with 76 +/- 7 years, including low risk 25.6%, moderate risk 25.6% and marked risk 48.7%. The cumulative 1-year fall incidence was 25.2% in IG and 27.6% in CG (HR 0.90, 95% CI 0.66 to 1.23). IG improved more favorably than CG on overall PPA fall-risk index, reaction time, postural sway with eyes open, TUG, and GDS, especially for those with marked fall-risk. CONCLUSIONS: The multifaceted fall prevention program with exercise intervention improved functional performance at 3-months for community-dwelling elders with risk of fall, but did not reduce falls over 1-year follow-up. Fall incidence might have been decreased simultaneously in both groups by heightened awareness engendered during assessments, education, referrals, and recommendations.

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