title: Efficacy of falls prevention interventions: protocol for a systematic review and network meta-analysis.
abstract: BACKGROUND
  Falls are a leading cause of morbidity and mortality in older adults. Although numerous trials of falls prevention interventions have been completed, there is extensive variation in their intervention components and clinical context, such that the key elements of an effective falls prevention program remain unclear to patients, clinicians, and policy-makers. Our objective is to identify the most effective interventions and combinations of interventions that prevent falls though a systematic review and meta-analysis, including a network meta-analysis.
  
  
  METHODS
  We will search for published (e.g., MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Ageline) and unpublished (e.g., trial registries, dissertations) randomised clinical trials (RCTs) in all languages examining interventions to prevent falls compared to usual care or other falls prevention interventions among adults aged ≥65 years from all settings (e.g., community, acute care, long-term care, and rehabilitation). The primary outcomes are number of injurious falls and number of hospitalizations due to falls. Secondary outcomes include falls rate, number of fallers, number of emergency room visits due to falls, number of physician visits due to falls, number of fractures, costs, and number of intervention-related harms (e.g., muscle soreness related to exercise).We will calibrate our eligibility criteria amongst the team and two independent team members will screen the literature search results in duplicate. Conflicts will be resolved through team discussion. A similar process will be used for data abstraction and quality appraisal with the Cochrane risk of bias tool.Our results will be synthesized descriptively and a random effects meta-analysis will be conducted if the studies are deemed methodologically, clinically, and statistically (e.g., I²<60%) similar. If appropriate, a network meta-analysis will be conducted, which will allow the comparison of interventions that have not been compared in head-to-head RCTs, as well as the effectiveness of interventions.
  
  
  CONCLUSIONS
  We will identify the most effective interventions and combinations of interventions that prevent falls in older people. Our results will be used to optimize falls prevention strategies, and our goal is to ultimately improve the health of seniors internationally.
  
  
  BACKGROUND
  PROSPERO registry number: CRD42013004151.
authors.affiliation: Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, ON M5B 1T8, Canada.
authors.forename: Andrea C
authors.initials: AC
authors.lastname: Tricco
authors.forename: Elise
authors.initials: E
authors.lastname: Cogo
authors.forename: Jayna
authors.initials: J
authors.lastname: Holroyd-Leduc
authors.forename: Kathryn M
authors.initials: KM
authors.lastname: Sibley
authors.forename: Fabio
authors.initials: F
authors.lastname: Feldman
authors.forename: Gillian
authors.initials: G
authors.lastname: Kerr
authors.forename: Sumit R
authors.initials: SR
authors.lastname: Majumdar
authors.forename: Susan
authors.initials: S
authors.lastname: Jaglal
authors.forename: Sharon E
authors.initials: SE
authors.lastname: Straus
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control*; D006760:Hospitalization; D006801:Humans; D015201:Meta-Analysis as Topic; D017063:Outcome Assessment, Health Care; D012107:Research Design; D000078202:Systematic Reviews as Topic; D014947:Wounds and Injuries / Q000209:etiology / Q000517:prevention & control*