title: Action seniors! - secondary falls prevention in community-dwelling senior fallers: study protocol for a randomized controlled trial.
abstract: BACKGROUND
  Falls are a 'geriatric giant' and are the third leading cause of chronic disability worldwide. About 30% of community-dwellers over the age of 65 experience one or more falls every year leading to significant risk for hospitalization, institutionalization, and even death. As the proportion of older adults increases, falls will place an increasing demand and cost on the health care system. Exercise can effectively and efficiently reduce falls. Specifically, the Otago Exercise Program has demonstrated benefit and cost-effectiveness for the primary prevention of falls in four randomized trials of community-dwelling seniors. Although evidence is mounting, few studies have evaluated exercise for secondary falls prevention (that is, preventing falls among those with a significant history of falls). Hence, we propose a randomized controlled trial powered for falls that will, for the first time, assess the efficacy and efficiency of the Otago Exercise Program for secondary falls prevention.
  
  
  METHODS
  A randomized controlled trial among 344 community-dwelling seniors aged 70 years and older who attend a falls prevention clinic to assess the efficacy and the cost-effectiveness of a 12-month Otago Exercise Program intervention as a secondary falls prevention strategy. Participants randomized to the control group will continue to behave as they did prior to study enrolment. The economic evaluation will examine the incremental costs and benefits generated by using the Otago Exercise Program intervention versus the control.
  
  
  CONCLUSIONS
  The burden of falls is significant. The challenge is to make a difference - to discover effective, ideally cost-effective, interventions that prevent injurious falls that can be readily translated to the population. Our proposal is very practical - the exercise program requires minimal equipment, the physical therapist expertise is widely available, and seniors in Canada and elsewhere have adopted the program and complied with it. Our innovation includes applying the intervention to a targeted high-risk population, aiming to provide the best value for money. Given society's limited financial resources and the known and increasing burden of falls, there is an urgent need to test this feasible intervention which would be eminently ready for roll out.
  
  
  BACKGROUND
  ClinicalTrials.gov Protocol Registration System: NCT01029171; registered 7 December 2009.
authors: Aging, Mobility, and Cognitive Neuroscience Laboratory, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, 212-2177 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada. Teresa.ambrose@ubc.ca.
authors: Teresa
authors: T
authors: Liu-Ambrose
authors: Aging, Mobility, and Cognitive Neuroscience Laboratory, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, 212-2177 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada. Jennifer.davis@ubc.ca.|Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute & University of British Columbia, 7th Floor, 828 West 10th Avenue, Research Pavilion, Vancouver, BC, V5Z 1M9, Canada. Jennifer.davis@ubc.ca.
authors: Jennifer C
authors: JC
authors: Davis
authors: Aging, Mobility, and Cognitive Neuroscience Laboratory, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, 212-2177 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada. liang.hsu@hiphealth.ca.
authors: Chun Liang
authors: CL
authors: Hsu
authors: Aging, Mobility, and Cognitive Neuroscience Laboratory, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, 212-2177 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada. caitlin.gomez@hiphealth.ca.
authors: Caitlin
authors: C
authors: Gomez
authors: Aging, Mobility, and Cognitive Neuroscience Laboratory, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, 212-2177 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada. kelly.vertes@hiphealth.ca.
authors: Kelly
authors: K
authors: Vertes
authors: School of Pharmacy, Memorial University of Newfoundland, Health Sciences Centre, St. John's, NL, A1B 3V6, Canada. cmarra@mun.ca.
authors: Carlo
authors: C
authors: Marra
authors: Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute & University of British Columbia, 7th Floor, 828 West 10th Avenue, Research Pavilion, Vancouver, BC, V5Z 1M9, Canada. penny.brasher@ubc.ca.
authors: Penelope M
authors: PM
authors: Brasher
authors: Aging, Mobility, and Cognitive Neuroscience Laboratory, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, 212-2177 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada. lizdao@mail.ubc.ca.
authors: Elizabeth
authors: E
authors: Dao
authors: Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute & University of British Columbia, 2635 Laurel St, Vancouver, BC, V5Z 1M9, Canada. karim.khan@ubc.ca.
authors: Karim M
authors: KM
authors: Khan
authors: St Paul's Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. WCook@providencehealth.bc.ca.
authors: Wendy
authors: W
authors: Cook
authors: Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute & University of British Columbia, 7th Floor, 828 West 10th Avenue, Research Pavilion, Vancouver, BC, V5Z 1M9, Canada. meghan.donaldson@ubc.ca.
authors: Meghan G
authors: MG
authors: Donaldson
authors: Behavioural Medicine (BMED) Lab, School of Exercise Science, Physical and Health Education, University of Victoria, 3800 Finnerty Road, Victoria, BC, V8P 5C2, Canada. rhodes@uvic.ca.
authors: Ryan
authors: R
authors: Rhodes
authors: Vancouver Coastal Health Research Institute, Room 3665, 910 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada. larrydian@gmail.com.
authors: Larry
authors: L
authors: Dian
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control*; D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D000375:Aging / Q000523:psychology; D001696:Biomechanical Phenomena; D001955:British Columbia; D003071:Cognition; D003153:Community Health Services; D056344:Executive Function; D005260:Female; D015577:Geriatric Assessment; D006299:Health Services for the Aged; D006801:Humans; D057187:Independent Living; D008297:Male; D009483:Neuropsychological Tests; D004856:Postural Balance; D011788:Quality of Life; D012107:Research Design; D055070:Resistance Training; D012307:Risk Factors; D055502:Secondary Prevention / Q000379:methods*; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome