A 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

Publication date: Available online 12 February 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): David B. Matchar, Pamela W. Duncan, Christopher T.C. Lien, Marcus Eng Hock Ong, Mina Lee, Fei Gao, Rita Sim, Kirsten Eom
ObjectiveTo 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).DesignRandomized controlled trial.SettingCommunities in Central and East regions in Singapore.Participants354 adults aged at least 65 years who were seen at ED for a fall or fall-related injuries and discharged home.InterventionsThe intervention primarily consisted of a tailored program of physical therapy focused on progressive training in strength, balance, and gait for a period of three 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 measuresThe primary outcome measure was experiencing at least one fall during the nine-month study period (a three-month active intervention phase and a six-month maintenance phase). Secondary outcome measures were the occurrence of at least one injurious fall during the study period and a change in the Short Physical Performance Battery (SPPB) score. Participants were assessed both after three and nine months.ResultsDuring the nine-month study period, 37.9% of the control group and 30.5% of the intervention group fell at least once, which was not statistically significantly different (odds ratio 0.72 [0.46, 1.12], p=0.146). The intervention group had statistically significantly fewer individuals with injurious falls (odds ratio 0.56 [0.32, 0.98], p=0.041) and less deterioration in physical performance, reflected by a mean difference of 0.6 in SPPB scores (p=0.029). Multivariate analyses indicated a strong interaction effect between the intervention and the presence of two or more major comorbidities; after accounting for this effect, the intervention program reduced the number of people experiencing at least one fall (odds ratio 0.34 [0.17 – 0.67], p=0.002).ConclusionWe observed that, in this heterogeneous population, the proportion of participants experiencing at least one fall during the study period was not statistically significantly lower in the intervention group compared to the control group. Secondary analyses strongly suggest that individuals with two or more major comorbidities do not benefit from a tailored physical therapy program; however, individuals with less comorbidity may substantially benefit.



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