David B Matchar1, Pamela W Duncan2, Christopher T Lien3, Marcus Eng Hock Ong4, Mina Lee5, Fei Gao6, Rita Sim7, Kirsten Eom7. 1. Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore; Department of Internal Medicine (General Internal Medicine), Duke University Medical Center, Durham, NC. Electronic address: david.matchar@duke-nus.edu.sg. 2. Department of Neurology and Sticht Center on Aging Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC. 3. Department of Geriatric Medicine, Changi General Hospital, Singapore. 4. Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore; Department of Emergency Medicine, Singapore General Hospital, Singapore. 5. Community Programs, St. Andrew's Community Hospital, Singapore. 6. Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore; National Heart Centre Singapore, Singapore. 7. Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore.
Abstract
OBJECTIVE: To evaluate the effectiveness of a multifactorial, tailored program of physical therapy to reduce the occurrence of falls among a heterogeneous group of high-risk elderly Singaporeans recently discharged from the emergency department (ED). DESIGN: Randomized controlled trial. SETTING: Communities. PARTICIPANTS: Adults (N=354) aged ≥65 years who were seen in the ED for a fall or fall-related injuries and discharged home. INTERVENTIONS: The intervention primarily consisted of a tailored program of physical therapy focused on progressive training in strength, balance, and gait for a period of 3 months. Participants in the intervention group also received screening and follow-up for vision, polypharmacy, and environmental hazards. Participants in the control group received usual care prescribed by a physician and educational materials on falls prevention. MAIN OUTCOME MEASURES: The primary outcome measure was experiencing at least 1 fall during the 9-month study period (a 3-mo active intervention phase and a 6-mo maintenance phase). Secondary outcome measures were the occurrence of at least 1 injurious fall during the study period and a change in the Short Physical Performance Battery (SPPB) score. Participants were assessed both after 3 and 9 months. RESULTS: During the 9-month study period, 37.8% of the control group and 30.5% of the intervention group fell at least once, which was not statistically significantly different (odds ratio [OR]=.72; 95% confidence interval [CI], .46-1.12; P=.146). The intervention group had statistically significantly fewer individuals with injurious falls (OR=.56; 95% CI, .32-.98; P=.041) and less deterioration in physical performance, reflected by a mean difference of 0.6 in SPPB scores (P=.029). Multivariate analyses indicated a strong interaction effect between the intervention and the presence of 2 or more major comorbidities; after accounting for this effect, the intervention program reduced the number of people experiencing at least 1 fall (OR=.34; 95% CI, .17-.67; P=.002). CONCLUSIONS: We observed that in this heterogeneous population, the proportion of participants experiencing at least 1 fall during the study period was not statistically significantly lower in the intervention group compared with the control group. Secondary analyses strongly suggest that individuals with 2 or more major comorbidities do not benefit from a tailored physical therapy program; however, individuals with less comorbidity may substantially benefit.
RCT Entities:
OBJECTIVE: To evaluate the effectiveness of a multifactorial, tailored program of physical therapy to reduce the occurrence of falls among a heterogeneous group of high-risk elderly Singaporeans recently discharged from the emergency department (ED). DESIGN: Randomized controlled trial. SETTING: Communities. PARTICIPANTS: Adults (N=354) aged ≥65 years who were seen in the ED for a fall or fall-related injuries and discharged home. INTERVENTIONS: The intervention primarily consisted of a tailored program of physical therapy focused on progressive training in strength, balance, and gait for a period of 3 months. Participants in the intervention group also received screening and follow-up for vision, polypharmacy, and environmental hazards. Participants in the control group received usual care prescribed by a physician and educational materials on falls prevention. MAIN OUTCOME MEASURES: The primary outcome measure was experiencing at least 1 fall during the 9-month study period (a 3-mo active intervention phase and a 6-mo maintenance phase). Secondary outcome measures were the occurrence of at least 1 injurious fall during the study period and a change in the Short Physical Performance Battery (SPPB) score. Participants were assessed both after 3 and 9 months. RESULTS: During the 9-month study period, 37.8% of the control group and 30.5% of the intervention group fell at least once, which was not statistically significantly different (odds ratio [OR]=.72; 95% confidence interval [CI], .46-1.12; P=.146). The intervention group had statistically significantly fewer individuals with injurious falls (OR=.56; 95% CI, .32-.98; P=.041) and less deterioration in physical performance, reflected by a mean difference of 0.6 in SPPB scores (P=.029). Multivariate analyses indicated a strong interaction effect between the intervention and the presence of 2 or more major comorbidities; after accounting for this effect, the intervention program reduced the number of people experiencing at least 1 fall (OR=.34; 95% CI, .17-.67; P=.002). CONCLUSIONS: We observed that in this heterogeneous population, the proportion of participants experiencing at least 1 fall during the study period was not statistically significantly lower in the intervention group compared with the control group. Secondary analyses strongly suggest that individuals with 2 or more major comorbidities do not benefit from a tailored physical therapy program; however, individuals with less comorbidity may substantially benefit.
Authors: Matthew C Lohman; Rebecca S Crow; Peter R DiMilia; Emily J Nicklett; Martha L Bruce; John A Batsis Journal: J Epidemiol Community Health Date: 2017-09-25 Impact factor: 3.710
Authors: Nada Hammouda; Christopher R Carpenter; William W Hung; Adriane Lesser; Sylviah Nyamu; Shan Liu; Cameron J Gettel; Aaron Malsch; Edward M Castillo; Savannah Forrester; Kimberly Souffront; Samuel Vargas; Elizabeth M Goldberg Journal: Acad Emerg Med Date: 2021-06-15 Impact factor: 3.451
Authors: Farhad Pazan; Mirko Petrovic; Antonio Cherubini; Graziano Onder; Alfonso J Cruz-Jentoft; Michael Denkinger; Tischa J M van der Cammen; Jennifer M Stevenson; Kinda Ibrahim; Chakravarthi Rajkumar; Marit Stordal Bakken; Jean-Pierre Baeyens; Peter Crome; Thomas Frühwald; Paul Gallaghar; Adalsteinn Guðmundsson; Wilma Knol; Denis O'Mahony; Alberto Pilotto; Elina Rönnemaa; José Antonio Serra-Rexach; George Soulis; Rob J van Marum; Gijsbertus Ziere; Alpana Mair; Heinrich Burkhardt; Agnieszka Neumann-Podczaska; Katarzyna Wieczorowska-Tobis; Marilia Andreia Fernandes; Heidi Gruner; Dhayana Dallmeier; Jean-Baptiste Beuscart; Nathalie van der Velde; Martin Wehling Journal: Eur J Clin Pharmacol Date: 2020-08-07 Impact factor: 2.953