Randomized Controlled Trial of Screening, Risk Modification, and Physical Therapy to Prevent Falls Among the Elderly Recently Discharged From the Emergency Department to the Community: The Steps to Avoid Falls in the Elderly Study.
Abstract
<h4>Objective</h4>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).<h4>Design</h4>Randomized controlled trial.<h4>Setting</h4>Communities.<h4>Participants</h4>Adults
(N=354) aged ≥65 years who were seen in the ED for a fall or fall-related injuries
and discharged home.<h4>Interventions</h4>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.<h4>Main outcome measures</h4>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.<h4>Results</h4>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).<h4>Conclusions</h4>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.
Type
Journal articleSubject
HumansWounds and Injuries
Vision Tests
Polypharmacy
Patient Discharge
Environment
Accidental Falls
Accidents, Home
Age Factors
Comorbidity
Aged
Aged, 80 and over
Emergency Service, Hospital
Female
Male
Physical Therapy Modalities
Patient Education as Topic
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https://hdl.handle.net/10161/22808Published Version (Please cite this version)
10.1016/j.apmr.2017.01.014Publication Info
Matchar, David B; Duncan, Pamela W; Lien, Christopher T; Ong, Marcus Eng Hock; Lee,
Mina; Gao, Fei; ... Eom, Kirsten (2017). Randomized Controlled Trial of Screening, Risk Modification, and Physical Therapy
to Prevent Falls Among the Elderly Recently Discharged From the Emergency Department
to the Community: The Steps to Avoid Falls in the Elderly Study. Archives of physical medicine and rehabilitation, 98(6). pp. 1086-1096. 10.1016/j.apmr.2017.01.014. Retrieved from https://hdl.handle.net/10161/22808.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
David Bruce Matchar
Professor of Medicine
My research relates to clinical practice improvement - from the development of clinical
policies to their implementation in real world clinical settings. Most recently my
major content focus has been cerebrovascular disease. Other major clinical areas in
which I work include the range of disabling neurological conditions, cardiovascular
disease, and cancer prevention. Notable features of my work are: (1) reliance on
analytic strategies such as meta-analysis, simulation, decision analy

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