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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.

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Date
2017-06
Authors
Matchar, David B
Duncan, Pamela W
Lien, Christopher T
Ong, Marcus Eng Hock
Lee, Mina
Gao, Fei
Sim, Rita
Eom, Kirsten
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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 article
Subject
Humans
Wounds 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
Permalink
https://hdl.handle.net/10161/22808
Published Version (Please cite this version)
10.1016/j.apmr.2017.01.014
Publication 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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Scholars@Duke

Matchar

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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