A Randomized Controlled Trial of Screening, Risk Modification and Physical Therapy to Prevent Falls among the Elderly Recently Discharged from the Emergency Department to the Community: the Steps to Avoid Falls in the Elderly Study

• Published in: Archives of physical medicine and rehabilitation Vol. 98; no. 6; pp. 1086 - 1096
• Main Authors: Matchar, David B., MD, Duncan, Pamela W., PhD, PT, Lien, Christopher T.C., MBBS, MPA, Hock Ong, Marcus Eng, MBBS, MPH, Lee, Mina, MASc, Gao, Fei, PhD, Sim, Rita, BSc, Eom, Kirsten, MPH
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.06.2017
• Subjects: Accidental falls; Accidental Falls - prevention & control; Accidents, Home - prevention & control; Age Factors; Aged; Aged, 80 and over; Comorbidity; Emergency Service, Hospital; Environment; Female; Frail elderly; Humans; Male; Patient Discharge; Patient Education as Topic - organization & administration; Physical Medicine and Rehabilitation; Physical Therapy Modalities; Polypharmacy; Randomized controlled trial; Rehabilitation; Vision Tests; Wounds and Injuries - prevention & control; Ministry of Health, Singapore; RCT; Falls prevention interventions; CDC; MoCA; Montreal Cognitive Assessment; PT; Emergency Department; Modified Falls Efficacy Scale; Falls among the elderly; Tailored physical therapy program; Physiotherapist; Centers for Disease Control and Prevention; AIC; 2-Minute Walk Test; Odds Ratio; ED; Steps to Avoid Falls in the Elderly; MFES; OR; EuroQol Visual Analogue Scale; Community-based physiotherapy; MOH; SPPB; EQ-5D-5L; SAFE; Randomized controlled trial; EQ-VAS; 2MWT; The Agency for Integrated Care; EuroQol-5D-5L; Short Physical Performance Battery; Frail elderly; CI; Rehabilitation; Accidental falls
• ISSN: 0003-9993; 1532-821X
• DOI: 10.1016/j.apmr.2017.01.014

Abstract Objective To evaluate the effectiveness of a multifactorial, tailored program of physical therapy to reduce the occurrence of falls among a heterogeneous group of high-risk elderly Singaporeans recently discharged from the Emergency Department (ED). Design Randomized controlled trial. Setting Communities in Central and East regions in Singapore. Participants 354 adults aged at least 65 years who were seen at ED for a fall or fall-related injuries and discharged home. Interventions The intervention primarily consisted of a tailored program of physical therapy focused on progressive training in strength, balance, and gait for a period of three months. Participants in the intervention group also received screening and follow up for vision, polypharmacy, and environmental hazards. Participants in the control group received usual care prescribed by a physician and educational materials on falls prevention. Main outcome measures The primary outcome measure was experiencing at least one fall during the nine-month study period (a three-month active intervention phase and a six-month maintenance phase). Secondary outcome measures were the occurrence of at least one injurious fall during the study period and a change in the Short Physical Performance Battery (SPPB) score. Participants were assessed both after three and nine months. Results During the nine-month study period, 37.9% of the control group and 30.5% of the intervention group fell at least once, which was not statistically significantly different (odds ratio 0.72 [0.46, 1.12], p=0.146). The intervention group had statistically significantly fewer individuals with injurious falls (odds ratio 0.56 [0.32, 0.98], p=0.041) and less deterioration in physical performance, reflected by a mean difference of 0.6 in SPPB scores (p=0.029). Multivariate analyses indicated a strong interaction effect between the intervention and the presence of two or more major comorbidities; after accounting for this effect, the intervention program reduced the number of people experiencing at least one fall (odds ratio 0.34 [0.17 – 0.67], p=0.002). Conclusion We observed that, in this heterogeneous population, the proportion of participants experiencing at least one fall during the study period was not statistically significantly lower in the intervention group compared to the control group. Secondary analyses strongly suggest that individuals with two or more major comorbidities do not benefit from a tailored physical therapy program; however, individuals with less comorbidity may substantially benefit.