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Abstract
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of: Delbaere K, Valenzuela T, Lord SR, Clemson L, Zijlstra GAR, Close JCT, et al. E-health StandingTall balance exercise for fall prevention in older people: results of a two year randomised controlled trial. BMJ. 2021;373:n740.
Question: Does a home-based e-health balance exercise program (StandingTall) reduce falls in older people? Design: Randomised controlled trial with concealed allocation. Setting: Home-based program in Australia. Participants: Community-dwelling adults aged ≥ 70 years, independent in activities of daily living and able to walk household distances without an assistive device. Key exclusion criteria were unstable or acute medical conditions precluding exercise, progressive neurological condition, and cognitive impairment. Randomisation of 503 participants allocated 254 to intervention and 249 to the control group. Interventions: Both groups received a tablet computer with a health promotion education program consisting of 104 weekly fact sheets. In addition, the intervention group received the StandingTall program and exercise equipment. The tablet-delivered program included tailored and progressive balance exercises (2 hours/week), behavioural change techniques, goal setting, additional fact sheets, and two home visits (to initiate and monitor the StandingTall program). Control participants received two phone calls about the health promotion education program. Outcome measures: The primary outcomes were the rate of falls and proportion of people who fell in the first 12 months. Secondary outcomes were rate of falls and number of injurious falls over 24 months, and common fall risk factors measured at baseline, 6, 12, 18 and 24 months.
RESULTS: A total of 413 participants completed the study. At 12 months, there were no clear differences between groups in fall rate (incidence rate ratio for intervention compared with control: 0.82, 95% CI 0.66 to 1.02) or the proportion who fell (relative risk in intervention compared with control 0.90, 95% CI 0.72 to 1.12). At 24 months, the intervention group had a lower fall rate (incidence rate ratio compared with control 0.84, 95% CI 0.72 to 0.98) and lower rate of injurious falls (incidence rate ratio 0.80, 95% CI 0.66 to 0.98). The intervention group also had small improvements in quality of life and standing balance compared with control.
CONCLUSION: A fall prevention program delivered electronically can reduce fall rates and injurious fall rates over 24 months in community-dwelling older adults.
Language: en |