Definitions and methods of measuring and reporting on injurious falls in randomised controlled fall prevention trials: a systematic review

BMC Medical Research Methodology

Klaus Hauer¹  Chris Todd²  Gretl McHugh²  Peter Oster¹  Raquel Rodriguez Moreno¹  Christian Stock³  Andreas Lauenroth⁴  Michael Schwenk¹ 

[1] Department of Geriatric Research, AGAPLESION Bethanien-Hospital/Geriatric Center at the University of Heidelberg, Rohrbacherstr.149, Heidelberg 69126, Germany;School of Nursing, Midwifery and Social Work and Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK;Division of Clinical Epidemiology and Aging Research, German Cancer Research Center Heidelberg, Heidelberg, Germany;Network Aging Research, University of Heidelberg, Heidelberg, Germany

关键词: Fall prevention trials;    Fall-related outcomes;    Elderly;    Injurious falls;    Systematic review;   

Others  :  1136705
DOI  :  10.1186/1471-2288-12-50

 received in 2011-09-22, accepted in 2012-04-17,  发布年份 2012

【 摘 要 】

Background

The standardisation of the assessment methodology and case definition represents a major precondition for the comparison of study results and the conduction of meta-analyses. International guidelines provide recommendations for the standardisation of falls methodology; however, injurious falls have not been targeted. The aim of the present article was to review systematically the range of case definitions and methods used to measure and report on injurious falls in randomised controlled trials (RCTs) on fall prevention.

Methods

An electronic literature search of selected comprehensive databases was performed to identify injurious falls definitions in published trials. Inclusion criteria were: RCTs on falls prevention published in English, study population ≥ 65 years, definition of injurious falls as a study endpoint by using the terms "injuries" and "falls".

Results

The search yielded 2089 articles, 2048 were excluded according to defined inclusion criteria. Forty-one articles were included. The systematic analysis of the methodology applied in RCTs disclosed substantial variations in the definition and methods used to measure and document injurious falls. The limited standardisation hampered comparability of study results. Our results also highlight that studies which used a similar, standardised definition of injurious falls showed comparable outcomes.

Conclusions

No standard for defining, measuring, and documenting injurious falls could be identified among published RCTs. A standardised injurious falls definition enhances the comparability of study results as demonstrated by a subgroup of RCTs used a similar definition. Recommendations for standardising the methodology are given in the present review.

【 授权许可】

   
2012 Schwenk et al; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Hausdorff JM, Rios DA, Edelberg HK: Gait variability and fall risk in community-living older adults: a 1-year prospective study. Arch Phys Med Rehabil 2001, 82(8):1050-1056.
• [2]Tinetti ME, Speechley M, Ginter SF: Risk factors for falls among elderly persons living in the community. N Engl J Med 1988, 319(26):1701-1707.
• [3]Tinetti ME, Williams CS: The effect of falls and fall injuries on functioning in community-dwelling older persons. J Gerontol A Biol Sci Med Sci 1998, 53(2):M112-M119.
• [4]Oakley A, Dawson MF, Holland J, Arnold S, Cryer C, Doyle Y, Rice J, Hodgson CR, Sowden A, Sheldon T, et al.: Preventing falls and subsequent injury in older people. Qual Health Care 1996, 5(4):243-249.
• [5]van Weel C, Vermeulen H, van den Bosch W: Falls, a community care perspective. Lancet 1995, 345(8964):1549-1551.
• [6]Alexander BH, Rivara FP, Wolf ME: The cost and frequency of hospitalization for fall-related injuries in older adults. Am J Public Health 1992, 82(7):1020-1023.
• [7]Gillespie LD, Robertson MC, Gillespie WJ, Lamb SE, Gates S, Cumming RG, Rowe BH: Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev 2009, 2:CD007146.
• [8]Kannus P, Sievanen H, Palvanen M, Jarvinen T, Parkkari J: Prevention of falls and consequent injuries in elderly people. Lancet 2005, 366(9500):1885-1893.
• [9]Rubenstein LZ: Falls in older people: epidemiology, risk factors and strategies for prevention. Age Ageing 2006, 35(Suppl 2):ii37-ii41.
• [10]Sattin RW, Lambert Huber DA, DeVito CA, Rodriguez JG, Ros A, Bacchelli S, Stevens JA, Waxweiler RJ: The incidence of fall injury events among the elderly in a defined population. Am J Epidemiol 1990, 131(6):1028-1037.
• [11]Tinetti ME, Doucette J, Claus E, Marottoli R: Risk factors for serious injury during falls by older persons in the community. J Am Geriatr Soc 1995, 43(11):1214-1221.
• [12]Davis JC, Robertson MC, Ashe MC, Liu-Ambrose T, Khan KM, Marra CA: International comparison of cost of falls in older adults living in the community: a systematic review. Osteoporos Int 2010, 21(8):1295-1306.
• [13]Lamb SE, Jorstad-Stein EC, Hauer K, Becker C: Development of a common outcome data set for fall injury prevention trials: the Prevention of Falls Network Europe consensus. J Am Geriatr Soc 2005, 53(9):1618-1622.
• [14]Todd C, Skelton D: What are the main risk factors for falls among older people and what are the most effective interventions to prevent these falls?. Copenhagen: WHO Regional Office for Europe (Health Evidence Network report); 2004.
• [15]Chang JT, Morton SC, Rubenstein LZ, Mojica WA, Maglione M, Suttorp MJ, Roth EA, Shekelle PG: Interventions for the prevention of falls in older adults: systematic review and meta-analysis of randomised clinical trials. BMJ 2004, 328(7441):680.
• [16]Costello E, Edelstein JE: Update on falls prevention for community-dwelling older adults: review of single and multifactorial intervention programs. J Rehabil Res Dev 2008, 45(8):1135-1152.
• [17]Cusimano MD, Kwok J, Spadafora K: Effectiveness of multifaceted fall-prevention programs for the elderly in residential care. Inj Prev 2008, 14(2):113-122.
• [18]Sherrington C, Whitney JC, Lord SR, Herbert RD, Cumming RG, Close JC: Effective exercise for the prevention of falls: a systematic review and meta-analysis. J Am Geriatr Soc 2008, 56(12):2234-2243.
• [19]Gardner MM, Robertson MC, Campbell AJ: Exercise in preventing falls and fall related injuries in older people: a review of randomised controlled trials. Br J Sports Med 2000, 34(1):7-17.
• [20]Lin MR, Hwang HF, Wang YW, Chang SH, Wolf SL: Community-based tai chi and its effect on injurious falls, balance, gait, and fear of falling in older people. Phys Ther 2006, 86(9):1189-1201.
• [21]McClure R, Turner C, Peel N, Spinks A, Eakin E, Hughes K: Population-based interventions for the prevention of fall-related injuries in older people. Cochrane Database Syst Rev 2005, 1:CD004441.
• [22]Province MA, Hadley EC, Hornbrook MC, Lipsitz LA, Miller JP, Mulrow CD, Ory MG, Sattin RW, Tinetti ME, Wolf SL: The effects of exercise on falls in elderly patients. A preplanned meta-analysis of the FICSIT Trials. Frailty and Injuries: Cooperative Studies of Intervention Techniques. JAMA 1995, 273(17):1341-1347.
• [23]Sydenham E: Systematic reviews on preventing fall-related injuries in older people. Inj Prev 2008, 14(4):274.
• [24]Robertson MC, Campbell AJ, Gardner MM, Devlin N: Preventing injuries in older people by preventing falls: a meta-analysis of individual-level data. J Am Geriatr Soc 2002, 50(5):905-911.
• [25]Lyons RA, John A, Brophy S, Jones SJ, Johansen A, Kemp A, Lannon S, Patterson J, Rolfe B, Sander LV, et al.: Modification of the home environment for the reduction of injuries. Cochrane Database Syst Rev 2006, 4:CD003600.
• [26]Rapp K, Lamb SE, Erhardt-Beer L, Lindemann U, Rissmann U, Klenk J, Becker C: Effect of a statewide fall prevention program on incidence of femoral fractures in residents of long-term care facilities. J Am Geriatr Soc 2010, 58(1):70-75.
• [27]Rubenstein LZ, Josephson KR, Robbins AS: Falls in the nursing home. Ann Intern Med 1994, 121(6):442-451.
• [28]Stevens JA, Corso PS, Finkelstein EA, Miller TR: The costs of fatal and non-fatal falls among older adults. Inj Prev 2006, 12(5):290-295.
• [29]Karlsson M: Does exercise reduce the burden of fractures? A review. Acta Orthop Scand 2002, 73(6):691-705.
• [30]Crowther M, Lim W, Crowther MA: Systematic review and meta-analysis methodology. Blood 2010, 116(17):3140-3146.
• [31]Hauer K, Lamb SE, Jorstad EC, Todd C, Becker C: Systematic review of definitions and methods of measuring falls in randomised controlled fall prevention trials. Age Ageing 2006, 35(1):5-10.
• [32]Cummings P, Koepsell TD, Mueller BA: Methodological challenges in injury epidemiology and injury prevention research. Annu Rev Public Health 1995, 16:381-400.
• [33]Butler M, Kerse N, Todd M: Circumstances and consequences of falls in residential care: the New Zealand story. N Z Med J 2004, 117(1202):U1076.
• [34]Haywood KL, Hargreaves J, White R, Lamb SE: Reviewing measures of outcome: reliability of data extraction. J Eval Clin Pract 2004, 10(2):329-337.
• [35]Bland JM: An Introduction to Medical Statistics. 3rd edition. Oxford: Oxford University Press; 1995.
• [36]Campbell AJ, Robertson MC, Gardner MM, Norton RN, Tilyard MW, Buchner DM: Randomised controlled trial of a general practice programme of home based exercise to prevent falls in elderly women. BMJ 1997, 315(7115):1065-1069.
• [37]Elley CR, Robertson MC, Garrett S, Kerse NM, McKinlay E, Lawton B, Moriarty H, Moyes SA, Campbell AJ: Effectiveness of a falls-and-fracture nurse coordinator to reduce falls: a randomized, controlled trial of at-risk older adults. J Am Geriatr Soc 2008, 56(8):1383-1389.
• [38]Campbell AJ, Robertson MC, La Grow SJ, Kerse NM, Sanderson GF, Jacobs RJ, Sharp DM, Hale LA: Randomised controlled trial of prevention of falls in people aged > or = 75 with severe visual impairment: the VIP trial. BMJ 2005, 331(7520):817.
• [39]Robertson MC, Devlin N, Scuffham P, Gardner MM, Buchner DM, Campbell AJ: Economic evaluation of a community based exercise programme to prevent falls. J Epidemiol Community Health 2001, 55(8):600-606.
• [40]Becker C, Kron M, Lindemann U, Sturm E, Eichner B, Walter-Jung B, Nikolaus T: Effectiveness of a multifaceted intervention on falls in nursing home residents. J Am Geriatr Soc 2003, 51(3):306-313.
• [41]Dyer CA, Taylor GJ, Reed M, Robertson DR, Harrington R: Falls prevention in residential care homes: a randomised controlled trial. Age Ageing 2004, 33(6):596-602.
• [42]Pfeifer M, Begerow B, Minne HW, Suppan K, Fahrleitner-Pammer A, Dobnig H: Effects of a long-term vitamin D and calcium supplementation on falls and parameters of muscle function in community-dwelling older individuals. Osteoporos Int 2009, 20(2):315-322.
• [43]Sanders KM, Stuart AL, Williamson EJ, Simpson JA, Kotowicz MA, Young D, Nicholson GC: Annual high-dose oral vitamin D and falls and fractures in older women: a randomized controlled trial. JAMA 2010, 303(18):1815-1822.
• [44]De Vries OJ, Peeters GMEE, Elders PJM, Muller M, Knol DL, Danner SA, Bouter LM, Lips P: Multifactorial intervention to reduce falls in older people at high risk of recurrent falls: A randomized controlled trial. Arch Intern Med 2010, 170(13):1110-1117.
• [45]Kemmler W, Von Stengel S, Engelke K, Haberle L, Kalender WA: Exercise effects on bone mineral density, falls, coronary risk factors, and health care costs in older women: The randomized controlled senior fitness and prevention (SEFIP) study. Arch Intern Med 2010, 170(2):179-185.
• [46]Jensen J, Lundin-Olsson L, Nyberg L, Gustafson Y: Fall and injury prevention in older people living in residential care facilities. A cluster randomized trial. Ann Intern Med 2002, 136(10):733-741.
• [47]Stenvall M, Olofsson B, Lundstrom M, Englund U, Borssen B, Svensson O, Nyberg L, Gustafson Y: A multidisciplinary, multifactorial intervention program reduces postoperative falls and injuries after femoral neck fracture. Osteoporos Int 2007, 18(2):167-175.
• [48]Reinsch S, MacRae P, Lachenbruch PA, Tobis JS: Attempts to prevent falls and injury: a prospective community study. Gerontologist 1992, 32(4):450-456.
• [49]Lord SR, Tiedemann A, Chapman K, Munro B, Murray SM, Gerontology M, Ther GR, Sherrington C: The effect of an individualized fall prevention program on fall risk and falls in older people: a randomized, controlled trial. J Am Geriatr Soc 2005, 53(8):1296-1304.
• [50]Barnett A, Smith B, Lord SR, Williams M, Baumand A: Community-based group exercise improves balance and reduces falls in at-risk older people: a randomised controlled trial. Age Ageing 2003, 32(4):407-414.
• [51]Means KM, Rodell DE, O'Sullivan PS: Balance, mobility, and falls among community-dwelling elderly persons: effects of a rehabilitation exercise program. Am J Phys Med Rehabil 2005, 84(4):238-250.
• [52]Ray WA, Taylor JA, Brown AK, Gideon P, Hall K, Arbogast P, Meredith S: Prevention of fall-related injuries in long-term care: a randomized controlled trial of staff education. Arch Intern Med 2005, 165(19):2293-2298.
• [53]Ashburn A, Fazakarley L, Ballinger C, Pickering R, McLellan LD, Fitton C: A randomised controlled trial of a home based exercise programme to reduce the risk of falling among people with Parkinson's disease. J Neurol Neurosurg Psychiatry 2007, 78(7):678-684.
• [54]Blalock SJ, Casteel C, Roth MT, Ferreri S, Demby KB, Shankar V: Impact of enhanced pharmacologic care on the prevention of falls: A randomized controlled trial. Am J Geriatr Pharmacother 2010, 8(5):428-440.
• [55]Haran MJ, Cameron ID, Ivers RQ, Simpson JM, Lee BB, Tanzer M, Porwal M, Kwan MM, Severino C, Lord SR: Effect on falls of providing single lens distance vision glasses to multifocal glasses wearers: VISIBLE randomised controlled trial. BMJ (Clin Res Ed) 2010, 340:c2265.
• [56]Rizzo JA, Baker DI, McAvay G, Tinetti ME: The cost-effectiveness of a multifactorial targeted prevention program for falls among community elderly persons. Med Care 1996, 34(9):954-969.
• [57]Wolf SL, Barnhart HX, Kutner NG, McNeely E, Coogler C, Xu T: Reducing frailty and falls in older persons: an investigation of Tai Chi and computerized balance training. Atlanta FICSIT Group. Frailty and Injuries: Cooperative Studies of Intervention Techniques. J Am Geriatr Soc 1996, 44(5):489-497.
• [58]Ray WA, Taylor JA, Meador KG, Thapa PB, Brown AK, Kajihara HK, Davis C, Gideon P, Griffin MR: A randomized trial of a consultation service to reduce falls in nursing homes. JAMA 1997, 278(7):557-562.
• [59]Tinetti ME, Baker DI, McAvay G, Claus EB, Garrett P, Gottschalk M, Koch ML, Trainor K, Horwitz RI: A multifactorial intervention to reduce the risk of falling among elderly people living in the community. N Engl J Med 1994, 331(13):821-827.
• [60]Campbell AJ, Robertson MC, Gardner MM, Norton RN, Buchner DM: Falls prevention over 2 years: a randomized controlled trial in women 80 years and older. Age Ageing 1999, 28(6):513-518.
• [61]Robertson MC, Devlin N, Gardner MM, Campbell AJ: Effectiveness and economic evaluation of a nurse delivered home exercise programme to prevent falls. 1: Randomised controlled trial. BMJ 2001, 322(7288):697-701.
• [62]Nikolaus T, Bach M: Preventing falls in community-dwelling frail older people using a home intervention team (HIT): results from the randomized Falls-HIT trial. J Am Geriatr Soc 2003, 51(3):300-305.
• [63]Kerse N, Butler M, Robinson E, Todd M: Fall prevention in residential care: a cluster, randomized, controlled trial. J Am Geriatr Soc 2004, 52(4):524-531.
• [64]Hornbrook MC, Stevens VJ, Wingfield DJ, Hollis JF, Greenlick MR, Ory MG: Preventing falls among community-dwelling older persons: results from a randomized trial. Gerontologist 1994, 34(1):16-23.
• [65]Luukinen H, Lehtola S, Jokelainen J, Vaananen-Sainio R, Lotvonen S, Koistinen P: Pragmatic exercise-oriented prevention of falls among the elderly: a population-based, randomized, controlled trial. Prev Med 2007, 44(3):265-271.
• [66]Li F, Harmer P, Fisher KJ, McAuley E, Chaumeton N, Eckstrom E, Wilson NL: Tai Chi and fall reductions in older adults: a randomized controlled trial. J Gerontol A Biol Sci Med Sci 2005, 60(2):187-194.
• [67]Skelton D, Dinan S, Campbell M, Rutherford O: Tailored group exercise (Falls Management Exercise - FaME) reduces falls in community-dwelling older frequent fallers (an RCT). Age Ageing 2005, 34(6):636-639.
• [68]Fitzharris MP, Day L, Lord SR, Gordon I, Fildes B: The Whitehorse NoFalls trial: Effects on fall rates and injurious fall rates. Age and Ageing 2010, 39(6):pp 728-pp 733.afq109.
• [69]Spice CL, Morotti W, George S, Dent THS, Rose J, Harris S, Gordon CJ: The Winchester falls project: A randomised controlled trial of secondary prevention of falls in older people. Age and Ageing 2009, 38(1):33-40.
• [70]Sihvonen S, Sipila S, Taskinen S, Era P: Fall incidence in frail older women after individualized visual feedback-based balance training. Gerontology 2004, 50(6):411-416.
• [71]Salminen M, Vahlberg T, Kivela SL: The long-term effect of a multifactorial fall prevention programme on the incidence of falls requiring medical treatment. Publ Health 2009, 123(12):809-813.
• [72]Wolf SL, Sattin RW, Kutner M, O'Grady M, Greenspan AI, Gregor RJ: Intense tai chi exercise training and fall occurrences in older, transitionally frail adults: a randomized, controlled trial. J Am Geriatr Soc 2003, 51(12):1693-1701.
• [73]Hendriks MR, Bleijlevens MH, van Haastregt JC, Crebolder HF, Diederiks JP, Evers SM, Mulder WJ, Kempen GI, van Rossum E, Ruijgrok JM, et al.: Lack of effectiveness of a multidisciplinary fall-prevention program in elderly people at risk: a randomized, controlled trial. J Am Geriatr Soc 2008, 56(8):1390-1397.
• [74]Karkkainen MK, Tuppurainen M, Salovaara K, Sandini L, Rikkonen T, Sirola J, Honkanen R, Arokoski J, Alhava E, Kroger H: Does daily vitamin D 800 IU and calcium 1000 mg supplementation decrease the risk of falling in ambulatory women aged 65-71 years? A 3-year randomized population-based trial (OSTPRE-FPS). Maturitas 2010, 65(4):359-365.
• [75]Suman S, Myint PK, Clark A, Das P, Ring L, Trepte NJB: Community-based fall assessment compared with hospital-based assessment in community-dwelling older people over 65 at high risk of falling: A randomized study. Aging - Clin Exp Res 2011, 23(1):35-41.
• [76]Vind AB, Andersen HE, Pedersen KD, Jorgensen T, Schwarz P: An outpatient multifactorial falls prevention intervention does not reduce falls in High-risk elderly danes. J Am Geriatr Soc 2009, 57(6):971-977.
• [77]Association for the Advancement of Automotive Medicine, Committee on Injury Scaling: The Abbreviated Injury Scale-1990 Revision (AIS-90). Des Plains, IL: Association for the Advancement of Automotive Medicine; 1990.
• [78]Buchner DM, Hornbrook MC, Kutner NG, Tinetti ME, Ory MG, Mulrow CD, Schechtman KB, Gerety MB, Fiatarone MA, Wolf SL, et al.: Development of the common data base for the FICSIT trials. J Am Geriatr Soc 1993, 41(3):297-308.
• [79]Cummings SR, Nevitt MC, Kidd S: Forgetting falls. The limited accuracy of recall of falls in the elderly. J Am Geriatr Soc 1988, 36(7):613-616.
• [80]Nevitt MC, Cummings SR, Browner WS, Seeley DG, Cauley JA, Vogt TM, Black DM: The accuracy of self-report of fractures in elderly women: evidence from a prospective study. Am J Epidemiol 1992, 135(5):490-499.
• [81]Alexandrescu R, O'Brien SJ, Lecky FE: A review of injury epidemiology in the UK and Europe: some methodological considerations in constructing rates. BMC Publ Health 2009, 9:226. BioMed Central Full Text
• [82]Gregg EW, Cauley JA, Seeley DG, Ensrud KE, Bauer DC: Physical activity and osteoporotic fracture risk in older women. Study of Osteoporotic Fractures Research Group. Ann Intern Med 1998, 129(2):81-88.
• [83]Cumming RG, Nevitt MC, Cummings SR: Epidemiology of hip fractures. Epidemiol Rev 1997, 19(2):244-257.
• [84]MacKenzie EJ, Shapiro S, Eastham JN: The Abbreviated Injury Scale and Injury Severity Score. Levels of inter- and intrarater reliability. Med Care 1985, 23(6):823-835.