title: Lack of effectiveness of a multidisciplinary fall-prevention program in elderly people at risk: a randomized, controlled trial.
abstract: 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.
authors.affiliation: Department of Social Medicine, School for Public Health and Primary Care, Caphri, the Netherlands. Marike.Hendriks@beoz.unimaas.nl
authors.forename: Marike R C
authors.initials: MR
authors.lastname: Hendriks
authors.forename: Michel H C
authors.initials: MH
authors.lastname: Bleijlevens
authors.forename: Jolanda C M
authors.initials: JC
authors.lastname: van Haastregt
authors.forename: Harry F J M
authors.initials: HF
authors.lastname: Crebolder
authors.forename: Joseph P M
authors.initials: JP
authors.lastname: Diederiks
authors.forename: Silvia M A A
authors.initials: SM
authors.lastname: Evers
authors.forename: Wubbo J
authors.initials: WJ
authors.lastname: Mulder
authors.forename: Gertrudis I J M
authors.initials: GI
authors.lastname: Kempen
authors.forename: Erik
authors.initials: E
authors.lastname: van Rossum
authors.forename: Joop M
authors.initials: JM
authors.lastname: Ruijgrok
authors.forename: Paul A
authors.initials: PA
authors.lastname: Stalenhoef
authors.forename: Jacques Th M
authors.initials: JT
authors.lastname: van Eijk
mesh_terms: 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*