The effect of fall prevention exercise programmes on fall induced injuries in community dwelling older adults: systematic review and meta-analysis of randomised controlled trials

Fabienne El-Khoury, Bernard Cassou, Marie-Aline Charles, Patricia Dargent-Molina, Fabienne El-Khoury, Bernard Cassou, Marie-Aline Charles, Patricia Dargent-Molina

Abstract

Objective: To determine whether, and to what extent, fall prevention exercise interventions for older community dwelling people are effective in preventing different types of fall related injuries.

Data sources: Electronic databases (PubMed, the Cochrane Library, Embase, and CINAHL) and reference lists of included studies and relevant reviews from inception to July 2013.

Study selection: Randomised controlled trials of fall prevention exercise interventions, targeting older (>60 years) community dwelling people and providing quantitative data on injurious falls, serious falls, or fall related fractures.

Data synthesis: Based on a systematic review of the case definitions used in the selected studies, we grouped the definitions of injurious falls into more homogeneous categories to allow comparisons of results across studies and the pooling of data. For each study we extracted or calculated the rate ratio of injurious falls. Depending on the available data, a given study could contribute data relevant to one or more categories of injurious falls. A pooled rate ratio was estimated for each category of injurious falls based on random effects models.

Results: 17 trials involving 4305 participants were eligible for meta-analysis. Four categories of falls were identified: all injurious falls, falls resulting in medical care, severe injurious falls, and falls resulting in fractures. Exercise had a significant effect in all categories, with pooled estimates of the rate ratios of 0.63 (95% confidence interval 0.51 to 0.77, 10 trials) for all injurious falls, 0.70 (0.54 to 0.92, 8 trials) for falls resulting in medical care, 0.57 (0.36 to 0.90, 7 trials) for severe injurious falls, and 0.39 (0.22 to 0.66, 6 trials) for falls resulting in fractures, but significant heterogeneity was observed between studies of all injurious falls (I(2)=50%, P=0.04).

Conclusions: Exercise programmes designed to prevent falls in older adults also seem to prevent injuries caused by falls, including the most severe ones. Such programmes also reduce the rate of falls leading to medical care.

Conflict of interest statement

Competing interests: The authors declare no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years, and no other relationships or activities that could appear to have influenced the submitted work. All authors, external and internal, had full access to all of the data (including statistical reports and tables) in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis.

Figures

https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4793358/bin/elkf011972.f1_default.jpg
Fig 1 Flow chart of study identification process
https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4793358/bin/elkf011972.f2_default.jpg
Fig 2 Forest plots of studies for four injurious fall categories: A, all injurious falls; B, falls resulting in medical care; C, falls resulting in serious injuries; and D, falls resulting in fractures
https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4793358/bin/elkf011972.f3_default.jpg
Fig 3 Funnel plot of studies included in analysis of all injurious falls

References

    1. Rubenstein LZ. Falls in older people: epidemiology, risk factors and strategies for prevention. Age Ageing 2006;35(suppl 2):ii37-41.
    1. Stevens JA, Mack KA, Paulozzi LJ, Ballesteros MF. Self-reported falls and fall-related injuries among persons aged ≥65 years—United States, 2006. J Safety Res 2008;39:345-9.
    1. Morrison A, Fan T, Sen SS, et al. Epidemiology of falls and osteoporotic fractures: a systematic review. Clin Outcomes Res 2013;5:9-18.
    1. Hartholt KA, van Beeck EF, Polinder S, van der Velde N, van Lieshout EMM, Panneman MJM, et al. Societal consequences of falls in the older population: injuries, healthcare costs, and long-term reduced quality of life. J Trauma 2011;71:748-53.
    1. Gill TM, Murphy TE, Gahbauer EA, Allore HG. Association of injurious falls with disability outcomes and nursing home admissions in community-living older persons. Am J Epidemiol 2013;178:418-25.
    1. Davis JC, Robertson MC, Ashe MC, Liu-Ambrose T, Khan KM, Marra CA. International comparison of cost of falls in older adults living in the community: a systematic review. Osteoporos Int 2010;21:1295-306.
    1. Gillespie LD, Robertson MC, Gillespie WJ, Sherrington C, Gates S, Clemson LM, et al. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev 2012;(9):CD007146.
    1. Sherrington C, Tiedemann A, Fairhall N, Close JCT, Lord SR. Exercise to prevent falls in older adults: an updated meta-analysis and best practice recommendations. N S W Public Health Bull 2011;22:78-83.
    1. Shumway-Cook A, Ciol M, Hoffman J, Dudgeon B, Yorkston K, Chan L. The bottom line. Falls in the Medicare population: incidence, associated factors, and impact on health care. Phys Ther 2009;89:324-32.
    1. Schwenk M, Lauenroth A, Stock C, Rodriguez Moreno R, Oster P, McHugh G, et al. Definitions and methods of measuring and reporting on injurious falls in randomised controlled fall prevention trials: a systematic review. BMC Med Res Methodol 2012;12:501-14.
    1. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JPA, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 2009;339:b2700.
    1. Lamb SE, Becker C, Gillespie LD, Smith JL, Finnegan S, Potter R, et al. Reporting of complex interventions in clinical trials: development of a taxonomy to classify and describe fall-prevention interventions. Trials 2011;12:125-33.
    1. Campbell AJ, Robertson MC, Gardner MM, Norton RN, Tilyard MW, Buchner DM. Randomised controlled trial of a general practice programme of home based exercise to prevent falls in elderly women. BMJ 1997;315:1065-9.
    1. Robertson MC, Campbell AJ, Gardner MM, Devlin N. Preventing injuries in older people by preventing falls: a meta-analysis of individual-level data. J Am Geriatr Soc 2002;50:905-11.
    1. Higgins JPT, Altman DG, Gotzsche PC, Juni P, Moher D, Oxman AD, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ 2011;343:d5928.
    1. Hannan MT, Gagnon MM, Aneja J, Jones RN, Cupples LA, Lipsitz LA, et al. Optimizing the tracking of falls in studies of older participants: comparison of quarterly telephone recall with monthly falls calendars in the MOBILIZE Boston Study. Am J Epidemiol 2010;171:1031-6.
    1. Higgins JP, Green S, Collaboration C. Cochrane handbook for systematic reviews of interventions. Wiley Online Library; 2008.
    1. Higgins JPT, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med 2002;21:1539-58.
    1. Barnett A, Smith B, Lord SR, Williams M, Baumand A. Community-based group exercise improves balance and reduces falls in at-risk older people: a randomised controlled trial. Age Ageing 2003;32:407-14.
    1. Freiberger E, Häberle L, Spirduso WW, Rixt Zijlstra GA. Long-term effects of three multicomponent exercise interventions on physical performance and fall-related psychological outcomes in community-dwelling older adults: a randomized controlled trial. J Am Geriatr Soc 2012;60:437-46.
    1. Haines TP, Russell T, Brauer SG, Erwin S, Lane P, Urry S, et al. Effectiveness of a video-based exercise programme to reduce falls and improve health-related quality of life among older adults discharged from hospital: a pilot randomized controlled trial. Clin Rehabil 2009;23:973-85.
    1. Luukinen H, Lehtola S, Jokelainen J, Väänänen-Sainio R, Lotvonen S, Koistinen P. Prevention of disability by exercise among the elderly: a population-based, randomized, controlled trial. Scand J Prim Health Care 2006;24:199-205.
    1. Skelton D, Dinan S, Campbell M, Rutherford O. Tailored group exercise (Falls Management Exercise—FaME) reduces falls in community-dwelling older frequent fallers (an RCT). Age Ageing 2005;34:636-9.
    1. Smulders E, Weerdesteyn V, Groen BE, Duysens J, Eijsbouts A, Laan R, et al. Efficacy of a short multidisciplinary falls prevention program for elderly persons with osteoporosis and a fall history: a randomized controlled trial. Arch Phys Med Rehabil 2010;91:1705-11.
    1. Robertson MC, Devlin N, Gardner MM, Campbell AJ. Effectiveness and economic evaluation of a nurse delivered home exercise programme to prevent falls. 1: randomised controlled trial. BMJ 2001;322:697-701.
    1. Li F, Harmer P, Fisher KJ, McAuley E, Chaumeton N, Eckstrom E, et al. Tai Chi and fall reductions in older adults: a randomized controlled trial. J Gerontol A Biol Sci Med Sci 2005;60:187-94.
    1. Wolf SL, Barnhart HX, Kutner NG, McNeely E, Coogler C, Xu T. Reducing frailty and falls in older persons: an investigation of Tai Chi and computerized balance training. Atlanta FICSIT Group. Frailty and Injuries: Cooperative Studies of Intervention Techniques. J Am Geriatr Soc 1996;44:489-97.
    1. Fitzharris MP, Day L, Lord SR, Gordon I, Fildes B. The Whitehorse NoFalls trial: effects on fall rates and injurious fall rates. Age Ageing 2010;39:728-33.
    1. Kemmler W, von Stengel S, Engelke K, Haberle L, Kalender WA. Exercise effects on bone mineral density, falls, coronary risk factors, and health care costs in older women: The Randomized Controlled Senior Fitness and Prevention (SEFIP) Study. Arch Intern Med 2010;170:179-85.
    1. Means KM, Rodell DE, O’Sullivan PS. Balance, mobility, and falls among community-dwelling elderly persons: effects of a rehabilitation exercise program. Am J Phys Med Rehabil Assoc Acad Physiatr 2005;84:238-50.
    1. Cornillon E, Blanchon MA, Ramboatsisetraina P, Braize C, Beauchet O, Dubost V, et al. Impact d’un programme de prévention multidisciplinaire de la chute chez le sujet âgé autonome vivant à domicile, avec analyse avant-après des performances physiques. Ann Readapt Med Phys 2002;45:493-504.
    1. MacRae PG, Feltner ME, Reinsch SA. 1-year exercise program for older women: effects on falls, injuries, and physical performance. J Aging Phys Act 1994;2:127-42.
    1. Korpelainen R, Keinänen-Kiukaanniemi S, Heikkinen J, Väänänen K, Korpelainen J. Effect of impact exercise on bone mineral density in elderly women with low BMD: a population-based randomized controlled 30-month intervention. Osteoporos Int 2005;17:109-18.
    1. McMurdo MET, Mole PA, Paterson CR. Controlled trial of weight bearing exercise in older women in relation to bone density and falls. BMJ 1997;314:569.
    1. Tinetti ME. Preventing falls in elderly persons. N Engl J Med. 2003;348:42-9.
    1. Iwamoto J, Suzuki H, Tanaka K, Kumakubo T, Hirabayashi H, Miyazaki Y, et al. Preventative effect of exercise against falls in the elderly: a randomized controlled trial. Osteoporos Int 2009;20:1233-40.
    1. Lord SR, Ward JA, Williams P, Strudwick M. The effect of a 12-month exercise trial on balance, strength, and falls in older women: a randomized controlled trial. J Am Geriatr Soc 1995;43:1198-206.
    1. Howe TE, Rochester L, Jackson A, Banks PMH, Blair VA. Exercise for improving balance in older people. Cochrane Database Syst Rev 2007;(4):CD004963.
    1. Liu-Ambrose T, Nagamatsu LS, Graf P, Beattie BL, Ashe MC, Handy TC. Resistance training and executive functions: a 12-month randomized controlled trial. Arch Intern Med 2010;170:170-8.
    1. Nevitt MC, Cummings SR. Type of fall and risk of hip and wrist fractures: the study of osteoporotic fractures. J Am Geriatr Soc 1993;41:1226-34.
    1. Quant S, Maki BE, Verrier MC, McIlroy WE. Passive and active lower-limb movements delay upper-limb balance reactions. Neuroreport 2001;12:2821-5.
    1. Cummings P, Koepsell TD, Mueller BA. Methodological challenges in injury epidemiology and injury prevention research. Annu Rev Public Health 1995;16:381-400.
    1. Babitsch B, Gohl D, von Lengerke T. Re-revisiting Andersen’s behavioral model of health services use: a systematic review of studies from 1998-2011. Psycho-Soc Med 2012;9:Doc11.
    1. Kam D, Smulders E, Weerdesteyn V, Smits-Engelsman BCM. Exercise interventions to reduce fall-related fractures and their risk factors in individuals with low bone density: a systematic review of randomized controlled trials. Osteoporos Int 2009;20:2111-25.
    1. Kannus P, Parkkari J, Niemi S, Palvanen M. Fall-induced deaths among elderly people. Am J Public Health 2005;95:422-4.
    1. Jarvinen TLN, Sievanen H, Khan KM, Heinonen A, Kannus P. Shifting the focus in fracture prevention from osteoporosis to falls. BMJ 2008;336:124-6.
    1. Martin FC. Next steps for falls and fracture reduction. Age Ageing 2009;38:640-3.
    1. Skelton DA, Beyer N. Exercise and injury prevention in older people. Scand J Med Sci Sports 2003;13:77-85.
    1. Stone KL, Seeley DG, Lui L-Y, Cauley JA, Ensrud K, Browner WS, et al. BMD at multiple sites and risk of fracture of multiple types: long-term results from the study of osteoporotic fractures. J Bone Miner Res 2003;18:1947-54.
    1. Dargent-Molina P, Favier F, Grandjean H, Baun C, Schott AM, Hausherr E, et al. Fall-related factors and risk of hip fracture the EPIDOS prospective study. Lancet 1996;348:145-9.
    1. Cheung AM, Detsky AS. Osteoporosis and fractures: missing the bridge? JAMA 2008;299:1468-70.
    1. Thomas S, Mackintosh S, Halbert J. Does the ‘Otago exercise programme’ reduce mortality and falls in older adults?: a systematic review and meta-analysis. Age Ageing 2010;39:681-7.
    1. Bischoff-Ferrari HA, Dawson-Hughes B, Platz A, Orav EJ, Stähelin HB, Willett WC, et al. Effect of high-dosage cholecalciferol and extended physiotherapy on complications after hip fracture: a randomized controlled trial. Arch Intern Med 2010;170:813-20.
    1. Sherrington C, Whitney JC, Lord SR, Herbert RD, Cumming RG, Close JCT. Effective exercise for the prevention of falls: a systematic review and meta-analysis. J Am Geriatr Soc 2008;56:2234-43.
    1. Province MA, Hadley EC, Hornbrook MC, Lipsitz LA, Miller JP, Mulrow CD, et al. The effects of exercise on falls in elderly patients. A preplanned meta-analysis of the FICSIT Trials. Frailty and Injuries: Cooperative Studies of Intervention Techniques. JAMA 1995;273:1341-7.
    1. Laybourne AH, Biggs S, Martin FC. Falls exercise interventions and reduced falls rate: always in the patient’s interest? Age Ageing 2008;37:10-3.
    1. Sjösten N, Vaapio S, Kivelä S-L. The effects of fall prevention trials on depressive symptoms and fear of falling among the aged: a systematic review. Aging Ment Health 2008;12:30-46.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe