Multifactorial interventions for preventing falls in older people living in the community: a systematic review and meta-analysis of 41 trials and almost 20 000 participants.
elderly people
exercise rehabilitation
physiotherapy
Journal
British journal of sports medicine
ISSN: 1473-0480
Titre abrégé: Br J Sports Med
Pays: England
ID NLM: 0432520
Informations de publication
Date de publication:
Nov 2020
Nov 2020
Historique:
accepted:
24
07
2019
pubmed:
23
8
2019
medline:
18
11
2020
entrez:
23
8
2019
Statut:
ppublish
Résumé
To assess the longer term effects of multifactorial interventions for preventing falls in older people living in the community, and to explore whether prespecific trial-level characteristics are associated with greater fall prevention effects. Systematic review with meta-analysis and meta-regression. MEDLINE, EMBASE, CINHAL, CENTRAL and trial registries were searched up to 25 July 2018. We included randomised controlled trials (≥12 months' follow-up) evaluating the effects of multifactorial interventions on falls in older people aged 65 years and over, living in the community, compared with either usual care or usual care plus advice. Two authors independently verified studies for inclusion, assessed risk of bias and extracted data. Rate ratios (RaR) with 95% CIs were calculated for rate of falls, risk ratios (RR) for dichotomous outcomes and standardised mean difference for continuous outcomes. Data were pooled using a random effects model. The Grading of Recommendations, Assessment, Development and Evaluation was used to assess the quality of the evidence. We included 41 trials totalling 19 369 participants; mean age 72-85 years. Exercise was the most common prespecified component of the multifactorial interventions (85%; n=35/41). Most trials were judged at unclear or high risk of bias in ≥1 domain. Twenty trials provided data on rate of falls and showed multifactorial interventions may reduce the rate at which people fall compared with the comparator (RaR 0.79, 95% CI 0.70 to 0.88; 20 trials; 10 116 participants; I Multifactorial interventions (most of which include exercise prescription) may reduce the rate of falls and slightly reduce risk of older people sustaining one or more falls and recurrent falls (defined as two or more falls within a specified time period). CRD42018102549.
Identifiants
pubmed: 31434659
pii: bjsports-2019-100732
doi: 10.1136/bjsports-2019-100732
pmc: PMC7606575
doi:
Types de publication
Journal Article
Meta-Analysis
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
1340-1350Informations de copyright
© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: None declared.
Références
Int J Technol Assess Health Care. 2008 Spring;24(2):193-202
pubmed: 18400123
Control Clin Trials. 2002 Aug;23(4):409-21
pubmed: 12161083
J Clin Epidemiol. 2019 Feb;106:32-40
pubmed: 30266633
BMJ. 1992 Apr 4;304(6831):888-90
pubmed: 1392755
Clin Interv Aging. 2014 Feb 25;9:383-93
pubmed: 24596458
J Am Geriatr Soc. 2008 Aug;56(8):1383-9
pubmed: 18808597
Age Ageing. 2017 Mar 1;46(2):200-207
pubmed: 28399219
N Engl J Med. 1994 Sep 29;331(13):821-7
pubmed: 8078528
Med J Aust. 2001 Jul 16;175(2):104-7
pubmed: 11556409
Age Ageing. 2005 Mar;34(2):162-8
pubmed: 15716246
Age Ageing. 2009 Jan;38(1):33-40
pubmed: 18829689
N Engl J Med. 1988 Dec 29;319(26):1701-7
pubmed: 3205267
Cochrane Database Syst Rev. 2018 Sep 07;9:CD005465
pubmed: 30191554
J Am Geriatr Soc. 2009 Jun;57(6):971-7
pubmed: 19507291
J Am Geriatr Soc. 1999 Jul;47(7):775-83
pubmed: 10404919
Lancet. 1999 Jan 9;353(9147):93-7
pubmed: 10023893
Trials. 2011 May 17;12:125
pubmed: 21586143
Arch Phys Med Rehabil. 2012 Oct;93(10):1677-84
pubmed: 22609117
Cochrane Database Syst Rev. 2018 Jul 23;7:CD012221
pubmed: 30035305
BMC Musculoskelet Disord. 2010 Sep 29;11:225
pubmed: 20920220
Cochrane Database Syst Rev. 2012 Sep 12;(9):CD007146
pubmed: 22972103
Age Ageing. 2009 Nov;38(6):724-30
pubmed: 19767629
Clin Interv Aging. 2013;8:697-702
pubmed: 23788832
Br J Sports Med. 2017 Dec;51(24):1750-1758
pubmed: 27707740
JAMA. 2017 Nov 7;318(17):1687-1699
pubmed: 29114830
J Am Geriatr Soc. 2005 Sep;53(9):1618-22
pubmed: 16137297
J Epidemiol Community Health. 2003 Sep;57(9):740-4
pubmed: 12933783
BMJ. 1990 May 12;300(6734):1253-6
pubmed: 2354297
Home Health Care Serv Q. 1995;15(2):81-97
pubmed: 10143898
Inj Prev. 2002 Dec;8(4):280-3
pubmed: 12460962
Gerontologist. 1994 Feb;34(1):16-23
pubmed: 8150304
J Am Geriatr Soc. 1994 Jun;42(6):630-8
pubmed: 8201149
Epidemiology. 2010 Sep;21(5):658-68
pubmed: 20585256
CMAJ. 2001 Sep 4;165(5):537-43
pubmed: 11563205
J Am Geriatr Soc. 2009 Nov;57(11):2020-8
pubmed: 19793161
Public Health. 2009 Dec;123(12):809-13
pubmed: 19958918
Age Ageing. 2006 Sep;35 Suppl 2:ii60-ii64
pubmed: 16926208
Age Ageing. 2010 Nov;39(6):704-10
pubmed: 20823124
Am J Phys Med Rehabil. 2002 Apr;81(4):247-52
pubmed: 11953541
Arch Intern Med. 2010 Jul 12;170(13):1110-7
pubmed: 20625015
J Aging Phys Act. 2014 Oct;22(4):457-64
pubmed: 24152667
Am J Public Health. 1994 Nov;84(11):1800-6
pubmed: 7977921
BMJ. 2010 May 11;340:c2102
pubmed: 20460331
J Clin Epidemiol. 1995 Jan;48(1):45-57; discussion 59-60
pubmed: 7853047
Age Ageing. 2014 Sep;43(5):616-22
pubmed: 24381025
Age Ageing. 1990 Mar;19(2):136-41
pubmed: 2337010
BMJ. 1993 Jul 3;307(6895):27-32
pubmed: 8343668
J Med Assoc Thai. 1998 May;81(5):352-6
pubmed: 9623035
J Am Geriatr Soc. 2007 Feb;55(2):166-74
pubmed: 17302651
JAMA. 2018 Apr 24;319(16):1705-1716
pubmed: 29710140
J Gerontol A Biol Sci Med Sci. 2007 Dec;62(12):1420-7
pubmed: 18166695
BMJ. 2008 Jan 19;336(7636):130-3
pubmed: 18089892
BMJ. 2013 Sep 10;347:f5264
pubmed: 24022033
BMJ. 2000 Oct 21;321(7267):994-8
pubmed: 11039967
J Am Geriatr Soc. 2005 Aug;53(8):1296-304
pubmed: 16078954
J Am Geriatr Soc. 2010 Dec;58(12):2265-74
pubmed: 21143436
J Am Geriatr Soc. 2011 Jan;59(1):148-57
pubmed: 21226685
Injury. 2014 Jan;45(1):265-71
pubmed: 23579066