Effect of a Multifactorial Fall Injury Prevention Intervention on Patient Well-Being: The STRIDE Study.

Accidental Falls / prevention & control Aged, 80 and over Anxiety / psychology Depression / psychology Female Humans Independent Living Male Nurse's Role Patient Reported Outcome Measures Patients / statistics & numerical data Primary Health Care Risk Assessment
fall injury prevention older persons pragmatic trials well-being

Journal

Journal of the American Geriatrics Society
ISSN: 1532-5415
Titre abrégé: J Am Geriatr Soc
Pays: United States
ID NLM: 7503062

Informations de publication

Date de publication:
01 2021
Historique:
received: 24 07 2020
revised: 02 09 2020
accepted: 06 09 2020
pubmed: 11 10 2020
medline: 15 9 2021
entrez: 10 10 2020
Statut: ppublish

Résumé

In the Strategies to Reduce Injuries and Develop Confidence in Elders (STRIDE) study, a multifactorial intervention was associated with a nonsignificant 8% reduction in time to first serious fall injury but a significant 10% reduction in time to first self-reported fall injury relative to enhanced usual care. The effect of the intervention on other outcomes important to patients has not yet been reported. We aimed to evaluate the effect of the intervention on patient well-being including concern about falling, anxiety, depression, physical function, and disability. Pragmatic cluster-randomized trial of 5,451 community-living persons at high risk for serious fall injuries. A total of 86 primary care practices within 10 U.S. healthcare systems. A random subsample of 743 persons aged 75 and older. The well-being measures, assessed at baseline, 12 months, and 24 months, included a modified version of the Fall Efficacy Scale, Patient-Reported Outcomes Measurement Information System (PROMIS) anxiety and depression scales, and Late-Life Function and Disability Instrument. Participants in the intervention (n = 384) and control groups (n = 359) were comparable in age: mean (standard deviation) of 81.9 (4.7) versus 81.8 (5.0) years. Mean scores were similar between groups at 12 and 24 months for concern about falling, physical function, and disability, whereas the intervention group's mean scores on anxiety and depression were .7 points lower (i.e., better) at 12 months and .6 to .8 points lower at 24 months. For each of these outcomes, differences between the groups' adjusted least square mean changes from baseline to 12 and 24 months, respectively, were quantitatively small. The overall difference in means between groups over 2 years was statistically significant only for depression, favoring the intervention: -1.19 (99% confidence interval, -2.36 to -.02), with 3.5 points representing a minimally important difference. STRIDE's multifactorial intervention to reduce fall injuries was not associated with clinically meaningful improvements in patient well-being.

Sections du résumé

BACKGROUND/OBJECTIVES
In the Strategies to Reduce Injuries and Develop Confidence in Elders (STRIDE) study, a multifactorial intervention was associated with a nonsignificant 8% reduction in time to first serious fall injury but a significant 10% reduction in time to first self-reported fall injury relative to enhanced usual care. The effect of the intervention on other outcomes important to patients has not yet been reported. We aimed to evaluate the effect of the intervention on patient well-being including concern about falling, anxiety, depression, physical function, and disability.
DESIGN
Pragmatic cluster-randomized trial of 5,451 community-living persons at high risk for serious fall injuries.
SETTING
A total of 86 primary care practices within 10 U.S. healthcare systems.
PARTICIPANTS
A random subsample of 743 persons aged 75 and older.
MEASUREMENTS
The well-being measures, assessed at baseline, 12 months, and 24 months, included a modified version of the Fall Efficacy Scale, Patient-Reported Outcomes Measurement Information System (PROMIS) anxiety and depression scales, and Late-Life Function and Disability Instrument.
RESULTS
Participants in the intervention (n = 384) and control groups (n = 359) were comparable in age: mean (standard deviation) of 81.9 (4.7) versus 81.8 (5.0) years. Mean scores were similar between groups at 12 and 24 months for concern about falling, physical function, and disability, whereas the intervention group's mean scores on anxiety and depression were .7 points lower (i.e., better) at 12 months and .6 to .8 points lower at 24 months. For each of these outcomes, differences between the groups' adjusted least square mean changes from baseline to 12 and 24 months, respectively, were quantitatively small. The overall difference in means between groups over 2 years was statistically significant only for depression, favoring the intervention: -1.19 (99% confidence interval, -2.36 to -.02), with 3.5 points representing a minimally important difference.
CONCLUSIONS
STRIDE's multifactorial intervention to reduce fall injuries was not associated with clinically meaningful improvements in patient well-being.

Identifiants

DOI: 10.1111/jgs.16854 PMID: 33037632 PMC: PMC8178516
pubmed: 33037632
doi: 10.1111/jgs.16854
pmc: PMC8178516
mid: NIHMS1695647
doi:

Banques de données

ClinicalTrials.gov
['NCT02475850']

Types de publication

Journal Article Pragmatic Clinical Trial Randomized Controlled Trial Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

173-179

Subventions

Organisme : NIA NIH HHS
ID : P30AG028748
Pays : United States
Organisme : NIA NIH HHS
ID : P30AG024832
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR002541
Pays : United States
Organisme : NIA NIH HHS
ID : K08 AG050808
Pays : United States
Organisme : NIA NIH HHS
ID : P30 AG024824
Pays : United States
Organisme : NIA NIH HHS
ID : P30AG2874106
Pays : United States
Organisme : NIA NIH HHS
ID : P30 AG021342
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR001102
Pays : United States
Organisme : NIA NIH HHS
ID : U01AG048270
Pays : United States
Organisme : NIH HHS
ID : UL1TR000142
Pays : United States
Organisme : NIA NIH HHS
ID : P30AG021342
Pays : United States
Organisme : NIA NIH HHS
ID : P30AG024824
Pays : United States
Organisme : NIA NIH HHS
ID : K07 AG043587
Pays : United States
Organisme : NIA NIH HHS
ID : P30 AG028741
Pays : United States
Organisme : NIA NIH HHS
ID : U01 AG048270
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR001863
Pays : United States
Organisme : NIA NIH HHS
ID : P30 AG031679
Pays : United States
Organisme : NIA NIH HHS
ID : P30 AG028747
Pays : United States
Organisme : NIH HHS
ID : UL1TR000114
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR000114
Pays : United States
Organisme : NCATS NIH HHS
ID : KL2 TR000113
Pays : United States
Organisme : NIA NIH HHS
ID : P30 AG028748
Pays : United States
Organisme : NIA NIH HHS
ID : P30 AG022845
Pays : United States
Organisme : NIH HHS
ID : KL2TR000113
Pays : United States
Organisme : NIA NIH HHS
ID : K07AG043587
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR000142
Pays : United States
Organisme : NIA NIH HHS
ID : P30AG021332
Pays : United States
Organisme : NIA NIH HHS
ID : P30 AG024832
Pays : United States
Organisme : NIH HHS
ID : UL1TR001102
Pays : United States
Organisme : NIA NIH HHS
ID : P30 AG021332
Pays : United States
Organisme : NIA NIH HHS
ID : P30AG013679
Pays : United States

Informations de copyright

© 2020 The American Geriatrics Society.

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Auteurs

Thomas M Gill (TM)

Yale Claude D. Pepper Older Americans Independence Center, Yale University, New Haven, Connecticut, USA.
ORCID: 0000-0002-6450-0368

Shalender Bhasin (S)

Boston Claude D. Pepper Older Americans Independence Center, Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Boston, Massachusetts, USA.

David B Reuben (DB)

Multicampus Program in Geriatric Medicine and Gerontology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.

Nancy K Latham (NK)

Boston Claude D. Pepper Older Americans Independence Center, Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Boston, Massachusetts, USA.

Katy Araujo (K)

Yale Center for Analytical Sciences, Yale University, New Haven, Connecticut, USA.

David A Ganz (DA)

Multicampus Program in Geriatric Medicine and Gerontology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
Geriatric Research, Education and Clinical Center; Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA.

Chad Boult (C)

Johns Hopkins University, Baltimore, Maryland, USA.

Albert W Wu (AW)

Johns Hopkins University, Baltimore, Maryland, USA.

Jay Magaziner (J)

University of Maryland School of Medicine, Baltimore, Maryland, USA.

Neil Alexander (N)

University of Michigan, Ann Arbor, Michigan, USA.

Robert B Wallace (RB)

University of Iowa, Iowa City, Iowa, USA.

Michael E Miller (ME)

School of Medicine, Wake Forest University, Winston-Salem, North Carolina, USA.

Thomas G Travison (TG)

Boston Claude D. Pepper Older Americans Independence Center, Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, Massachusetts, USA.

Susan L Greenspan (SL)

Pittsburgh Claude D. Pepper Older Americans Independence Center, Division of Geriatrics and Gerontology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.

Jerry H Gurwitz (JH)

Meyers Primary Care Institute, A Joint Endeavor of Reliant Medical Group, Fallon Health and University of Massachusetts Medical School, Worcester, Massachusetts, USA.

Jeremy Rich (J)

HealthCare Partners, El Segundo, California, USA.

Elena Volpi (E)

University of Texas Medical Branch Claude D. Pepper Older Americans Independence Center; Sealy Center on Aging, The University of Texas Medical Branch, Galveston, Texas, USA.

Stephen C Waring (SC)

Essentia Health, Duluth, Minnesota, USA.
ORCID: 0000-0002-9674-0083

Todd M Manini (TM)

Department of Aging and Geriatric Research, University of Florida, Gainesville, Florida, USA.

Lillian C Min (LC)

University of Michigan, Ann Arbor, Michigan, USA.

Jeanne Teresi (J)

Research Division, Hebrew Home at Riverdale, RiverSpring Health, Bronx, New York, USA.

Patricia C Dykes (PC)

Brigham and Women's Hospital, Boston, Massachusetts, USA.

Siobhan McMahon (S)

School of Nursing, University of Minnesota, Minneapolis, Minnesota, USA.

Joanne M McGloin (JM)

Yale Claude D. Pepper Older Americans Independence Center, Yale University, New Haven, Connecticut, USA.

Eleni A Skokos (EA)

Yale Claude D. Pepper Older Americans Independence Center, Yale University, New Haven, Connecticut, USA.

Peter Charpentier (P)

Yale Center for Analytical Sciences, Yale University, New Haven, Connecticut, USA.

Shehzad Basaria (S)

Boston Claude D. Pepper Older Americans Independence Center, Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Boston, Massachusetts, USA.

Pamela W Duncan (PW)

School of Medicine, Wake Forest University, Winston-Salem, North Carolina, USA.

Thomas W Storer (TW)

Boston Claude D. Pepper Older Americans Independence Center, Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Boston, Massachusetts, USA.

Priscilla Gazarian (P)

Brigham and Women's Hospital, Boston, Massachusetts, USA.
University of Massachusetts, Boston, Massachusetts, USA.

Heather G Allore (HG)

Yale Center for Analytical Sciences, Yale University, New Haven, Connecticut, USA.

James Dziura (J)

Yale Center for Analytical Sciences, Yale University, New Haven, Connecticut, USA.

Denise Esserman (D)

Yale Center for Analytical Sciences, Yale University, New Haven, Connecticut, USA.

Martha B Carnie (MB)

Brigham and Women's Hospital, Boston, Massachusetts, USA.

Catherine Hanson (C)

University of Miami Health System, Miami, Florida, USA.

Fred Ko (F)

Icahn School of Medicine at Mount Sinai, New York, New York, USA.

Neil M Resnick (NM)

Pittsburgh Claude D. Pepper Older Americans Independence Center, Division of Geriatrics and Gerontology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.

Jocelyn Wiggins (J)

University of Michigan, Ann Arbor, Michigan, USA.

Charles Lu (C)

Yale Center for Analytical Sciences, Yale University, New Haven, Connecticut, USA.

Can Meng (C)

Yale Center for Analytical Sciences, Yale University, New Haven, Connecticut, USA.

Lori Goehring (L)

Boston Claude D. Pepper Older Americans Independence Center, Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Boston, Massachusetts, USA.

Maureen Fagan (M)

University of Miami Health System, Miami, Florida, USA.

Rosaly Correa-de-Araujo (R)

National Institute on Aging, Bethesda, Maryland, USA.

Carri Casteel (C)

University of Iowa, Iowa City, Iowa, USA.

Peter Peduzzi (P)

Yale Center for Analytical Sciences, Yale University, New Haven, Connecticut, USA.

Erich J Greene (EJ)

Yale Center for Analytical Sciences, Yale University, New Haven, Connecticut, USA.

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Classifications MeSH

questionsmedicales.fr › Environnement et santé publique › Santé publique › Accidents › Chutes accidentelles › Effect of a Multifactorial Fall Injury...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Sujet âgé › Sujet âgé de 80 ans ou plus › Effect of a Multifactorial Fall Injury...
questionsmedicales.fr › Comportement et mécanismes comportementaux › Émotions › Anxiété › Effect of a Multifactorial Fall Injury...
questionsmedicales.fr › Comportement et mécanismes comportementaux › Émotions › Dépression › Effect of a Multifactorial Fall Injury...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Effect of a Multifactorial Fall Injury...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Mesures épidémiologiques › Démographie › Caractéristiques de l'habitat › Vie autonome › Effect of a Multifactorial Fall Injury...
questionsmedicales.fr › Qualité, accès, évaluation des soins de santé › Prestations des soins de santé › Attitude du personnel soignant › Rôle de l'infirmier › Effect of a Multifactorial Fall Injury...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Collecte de données › Enquêtes et questionnaires › Enquêtes sur les soins de santé › Mesures des résultats rapportés par les patients › Effect of a Multifactorial Fall Injury...
questionsmedicales.fr › Personnes › Patients › Effect of a Multifactorial Fall Injury...
questionsmedicales.fr › Administration des services de santé › Gestion des soins aux patients › Services de santé polyvalents › Soins de santé primaires › Effect of a Multifactorial Fall Injury...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Statistiques comme sujet › Probabilité › Risque › Appréciation des risques › Effect of a Multifactorial Fall Injury...