Lack of effectiveness of a multidisciplinary fall-prevention program in elderly people at risk: a randomized, controlled trial.
OBJECTIVE
To assess whether a pragmatic multidisciplinary fall-prevention program was more effective than usual care in preventing new falls and functional decline in elderly people.


METHODS
A two-group, randomized, controlled trial with 12 months of follow-up.


METHODS
University hospital and home-based intervention, the Netherlands.


METHODS
Three hundred thirty-three community-dwelling Dutch people aged 65 and over who were seen in an emergency department after a fall.


METHODS
Participants in the intervention group underwent a detailed medical and occupational-therapy assessment to evaluate and address risk factors for recurrent falls, followed by recommendations and referral if indicated. People in the control group received usual care.


METHODS
Number of people sustaining a fall (fall calendar) and daily functioning (Frenchay Activity Index).


RESULTS
Results showed no statistically significantly favorable effects on falls (odds ratio=0.86, 95% confidence interval (CI)=0.50-1.49) or daily functioning (regression coefficient=0.37, CI=-0.90 to 1.63) after 12 months of follow-up.


CONCLUSIONS
The multidisciplinary fall-prevention program was not effective in preventing falls and functional decline in this Dutch healthcare setting. Implementing the program in its present form in the Netherlands is not recommended. This trial shows that there can be considerable discrepancy between the "ideal" (experimental) version of a program and the implemented version of the same program. The importance of implementation research in assessing feasibility and effectiveness of such a program in a specific healthcare setting is therefore stressed.
Hendriks
Marike R C
MR
Department of Social Medicine, School for Public Health and Primary Care, Caphri, the Netherlands. Marike.Hendriks@beoz.unimaas.nl
Bleijlevens
Michel H C
MH
van Haastregt
Jolanda C M
JC
Crebolder
Harry F J M
HF
Diederiks
Joseph P M
JP
Evers
Silvia M A A
SM
Mulder
Wubbo J
WJ
Kempen
Gertrudis I J M
GI
van Rossum
Erik
E
Ruijgrok
Joop M
JM
Stalenhoef
Paul A
PA
van Eijk
Jacques Th M
JT
D000058:Accidental Falls / Q000517:prevention & control*; D000203:Activities of Daily Living / Q000145:classification; D000368:Aged; D000369:Aged, 80 and over; D015444:Exercise; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000517:prevention & control*; D015577:Geriatric Assessment; D006801:Humans; D004204:Joint Dislocations / Q000517:prevention & control*; D008297:Male; D051346:Mobility Limitation; D009426:Netherlands; D010348:Patient Care Team; D010865:Pilot Projects; D018570:Risk Assessment; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000517:prevention & control*