Citation

Lee HC, Chang KC, Tsauo JY, Hung JW, Huang YC, Lin SI. Arch. Phys. Med. Rehabil. 2013; 94(4): 606-15, 615.e1.

Affiliation

Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan; Exercise and Health Science Research Center, National Yang-Ming University, Taipei, Taiwan.

Copyright

(Copyright © 2013, Elsevier Publishing)

DOI

10.1016/j.apmr.2012.11.037

PMID

23220343

Abstract

OBJECTIVE: To evaluate effects of a multifactorial fall prevention program on fall incidence and physical function in community-dwelling older people. DESIGN: Multi-center randomized controlled clinical trial SETTING: Three medical centers and adjacent community health centers in Taiwan. PARTICIPANTS: Community-dwelling elderly who had fallen in the previous year or with risk of fall INTERVENTIONS: After baseline assessment, eligible subjects were randomly allocated into the intervention group (IG) or control group (CG) stratified by Physiological Profile Assessment (PPA) fall-risk level. IG received a 3-month multifactorial intervention program including 8-week exercise training, health education, home hazards evaluation/ modification, along with medication review and ophthalmology/other specialty consult. CG got health education brochures, referrals and recommendations without direct exercise intervention. MAIN OUTCOME MEASURES: Primary outcome was fall incidence within 1-year. Secondary outcomes were PPA battery (overall fall-risk index, vision, muscular strength, reaction time, balance and proprioception), timed up-and-go (TUG), Taiwanese-International Physical Activity Questionnaire, EuroQoL-5D, Geriatric Depression Scale (GDS), and Fall Efficacy Scale at 3 month after randomization. RESULTS: There were 616 participants with 76±7 years, including low risk 25.6%, moderate risk 25.6% and marked risk 48.7%. The cumulative 1-year fall incidence was 25.2% in IG and 27.6% in CG (HR=0.90, 95% CI 0.66-1.23). IG improved more favorably than CG on overall PPA fall-risk index, reaction time, postural sway with eyes open, TUG, and GDS, especially for those with marked fall-risk. CONCLUSIONS: The multifaceted fall prevention program with exercise intervention improved functional performance at 3-months for community-dwelling elders with risk of fall, but did not reduce falls over 1-year follow-up. Fall incidence might have been decreased simultaneously in both groups by heightened awareness engendered during assessments, education, referrals, and recommendations.

Language: en