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Fall prevention in a primary care setting -- the effects of a targeted complex exercise intervention in a cluster randomized trial [with consumer summary]
Siegrist M, Freiberger E, Geilhof B, Salb J, Hentschke C, Landendoerfer P, Linde K, Halle M, Blank WA
Deutsches Arzteblatt International 2016 May 27;113(21):365-372
clinical trial
4/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: No; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

BACKGROUND: Falls and fall-related injuries are common in community-dwelling elderly people. Effective multifactorial fall prevention programs in the primary care setting may be a promising approach to reduce the incidence rate of falls. METHODS: In a cluster randomized trial in 33 general practices 378 people living independently and at high risk of falling (65 to 94 years old; 285 women) were allocated to either a 16 week exercise-based fall prevention program including muscle strengthening and challenging balance training exercises, combined with a 12 week home-based exercise program (222 participants), or to usual care (156 participants). The main outcome was number of falls over a period of 12 months. Secondary outcomes were the number of fall-related injuries, physical function (Timed-Up-and-Go-Test, TUG, Chair-Stand-Test, CST, modified Romberg Test), and fear of falling. RESULTS: In the intervention group (n = 222 patients in 17 general practices) 291 falls occurred, compared to 367 falls in the usual care group (n = 156 patients in 16 general practices). We observed a lower incidence rate for falls in the intervention group (incidence rate ratio/IRR 0.54; 95% confidence interval (CI) 0.35 to 0.84, p = 0.007) and for fall-related injuries (IRR 0.66; 0.42 to 0.94, p = 0.033). Additionally, patients in the intervention group showed significant improvements in secondary endpoints (TUG -2.39 s, -3.91 to -0.87, p = 0.014; mRomberg 1.70 s, 0.35 to 3.04, p = 0.037; fear of falling -2.28 points, -3.87 to -0.69, p = 0.022) compared to usual care. CONCLUSION: A complex falls prevention program in a primary care setting was effective in reducing falls and fall-related injuries in community dwelling older adults at risk.

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