Randomised controlled trial of prevention of falls in people aged > or =75 with severe visual impairment: the VIP trial.
OBJECTIVE
To assess the efficacy and cost effectiveness of a home safety programme and a home exercise programme to reduce falls and injuries in older people with low vision.


METHODS
Randomised controlled trial.


METHODS
Dunedin and Auckland, New Zealand.


METHODS
391 women and men aged > or =75 with visual acuity of 6/24 or worse who were living in the community; 92% (361 of 391) completed one year of follow-up.


METHODS
Participants received a home safety assessment and modification programme delivered by an occupational therapist (n = 100), an exercise programme prescribed at home by a physiotherapist plus vitamin D supplementation (n = 97), both interventions (n = 98), or social visits (n = 96).


METHODS
Numbers of falls and injuries resulting from falls, costs of implementing the home safety programme.


RESULTS
Fewer falls occurred in the group randomised to the home safety programme but not in the exercise programme (incidence rate ratios 0.59 (95% confidence interval 0.42 to 0.83) and 1.15 (0.82 to 1.61), respectively). However, within the exercise programme, stricter adherence was associated with fewer falls (P = 0.001). A conservative analysis showed neither intervention was effective in reducing injuries from falls. Delivering the home safety programme cost NZ650 dollars (234 pounds sterling, 344 euros, US432 dollars) (at 2004 prices) per fall prevented.


CONCLUSIONS
The home safety programme reduced falls and was more cost effective than an exercise programme in this group of elderly people with poor vision. The Otago exercise programme with vitamin D supplementation was not effective in reducing falls or injuries in this group, possibly due to low levels of adherence. Trial registration number ISRCTN15342873.
Campbell
A John
AJ
Department of Medical and Surgical Sciences, Otago Medical School, Dunedin, New Zealand. john.campbell@stonebow.otago.ac.nz
Robertson
M Clare
MC
La Grow
Steven J
SJ
Kerse
Ngaire M
NM
Sanderson
Gordon F
GF
Jacobs
Robert J
RJ
Sharp
Dianne M
DM
Hale
Leigh A
LA
D000058:Accidental Falls / Q000191:economics / Q000517:prevention & control*; D000061:Accidents, Home / Q000517:prevention & control*; D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006699:Home Care Services / Q000191:economics; D006801:Humans; D008297:Male; D009520:New Zealand; D009788:Occupational Therapy / Q000379:methods*; D012449:Safety; D014786:Vision Disorders / Q000503:physiopathology / Q000534:rehabilitation*; D014792:Visual Acuity; D019987:Persons with Visual Disabilities