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Finnegan S1, Bruce J1, Withers EJ1, Lall R1, Underwood M1, Lamb SE2
1University of Warwick, Warwick Clinical Trials Unit, Coventry, United Kingdom, 2University of Oxford, Oxford Clinical Trials Research Unit, Oxford, United Kingdom
Background: Falls are the leading cause of accident-related mortality in older adults. Injurious falls, including fractures, are associated with functional decline, disability, loss of independence and healthcare costs. Although there is encouraging evidence that exercise and other interventions can reduce falls, more research is needed to determine the effectiveness in everyday settings, comparative effectiveness of different interventions and cost effectiveness.
Purpose: To compare three primary care fall prevention interventions (including screening and treatment) in community-dwelling adults aged 70 years and older.
Methods: PreFIT is a cluster randomised controlled trial conducted within primary care across England, UK. Participants were randomised from 63 general practices. Practices were randomised to deliver either: (1) advice only; (2) advice with exercise; (3) advice with multifactorial falls prevention (MFFP). All participants received an advice leaflet published by Age UK. Participants randomised to exercise or MFFP were mailed a postal screener to assess risk of falling. The PreFIT exercise intervention was based on the Otago Exercise Programme and was a progressive, individualised six-month programme delivered by trained therapists. The PreFIT MFFP intervention was an individual assessment of seven falls risk factors with onward referral to specialist services (including exercise) where indicated.
Outcomes included falls, fractures, mortality, frailty, health-related quality of life and resource use. These outcomes were collected by postal questionnaires administered at baseline, 4, 8, 12 and 18 months, falls diaries and routine health records.
Results: We randomised 9803 community-dwelling adults to advice only (n=3223; 33%); advice with exercise (n=3279; 34%); or advice with MFFP (n=3301; 34%). Participant mean age was 78 years (SD 5.7) and over half (52%) of the sample were female.
Response to postal screening of falls risk was excellent. Of the 5791 (88%) participants who returned the screener, 3626 (63%) were at low risk of falling and 2153 (37%) were at intermediate or high risk of falling and referred to treatment.
Of 1079 participants referred to exercise, 697 (65%) attended at least one assessment and 455 (65%) completed the six-month intervention. Strength and balance improved for the participants who completed the intervention; mean (se) changes in chair stand test and 4-test balance scale scores were 0.22 (0.38), 95% CI 0.14 to 0.29 and 0.56 (0.39), 95% CI 0.49 to 0.64, respectively.
Of 1074 participants referred for MFFP, 762 (71%) attended assessment and 971 onward referrals were made to services including GP, physiotherapy, podiatry and occupational therapy.
Participants randomised to exercise had a lower rate of falls at eight months compared to those receiving advice only or MFFP; but there were no statistically significant differences in the rate of falling between treatment groups at 12 or 18 months. However, health economic analysis suggests that exercise is a cost effective intervention.
Conclusion(s): Screening participants worked well in the primary care setting and uptake to exercise and MFFP interventions was good. Exercise was found to reduce rate of falls in the short term but no sustained effects were observed over time.
Implications: The findings from PreFIT will inform clinical practice and shape future falls prevention policy.
Keywords: Falls prevention, exercise, multifactorial assessment
Funding acknowledgements: The PreFIT study is funded by the National Institute of Health Research Technology Assessment Programme (NiHR HTA), project number 08/14/41.
Purpose: To compare three primary care fall prevention interventions (including screening and treatment) in community-dwelling adults aged 70 years and older.
Methods: PreFIT is a cluster randomised controlled trial conducted within primary care across England, UK. Participants were randomised from 63 general practices. Practices were randomised to deliver either: (1) advice only; (2) advice with exercise; (3) advice with multifactorial falls prevention (MFFP). All participants received an advice leaflet published by Age UK. Participants randomised to exercise or MFFP were mailed a postal screener to assess risk of falling. The PreFIT exercise intervention was based on the Otago Exercise Programme and was a progressive, individualised six-month programme delivered by trained therapists. The PreFIT MFFP intervention was an individual assessment of seven falls risk factors with onward referral to specialist services (including exercise) where indicated.
Outcomes included falls, fractures, mortality, frailty, health-related quality of life and resource use. These outcomes were collected by postal questionnaires administered at baseline, 4, 8, 12 and 18 months, falls diaries and routine health records.
Results: We randomised 9803 community-dwelling adults to advice only (n=3223; 33%); advice with exercise (n=3279; 34%); or advice with MFFP (n=3301; 34%). Participant mean age was 78 years (SD 5.7) and over half (52%) of the sample were female.
Response to postal screening of falls risk was excellent. Of the 5791 (88%) participants who returned the screener, 3626 (63%) were at low risk of falling and 2153 (37%) were at intermediate or high risk of falling and referred to treatment.
Of 1079 participants referred to exercise, 697 (65%) attended at least one assessment and 455 (65%) completed the six-month intervention. Strength and balance improved for the participants who completed the intervention; mean (se) changes in chair stand test and 4-test balance scale scores were 0.22 (0.38), 95% CI 0.14 to 0.29 and 0.56 (0.39), 95% CI 0.49 to 0.64, respectively.
Of 1074 participants referred for MFFP, 762 (71%) attended assessment and 971 onward referrals were made to services including GP, physiotherapy, podiatry and occupational therapy.
Participants randomised to exercise had a lower rate of falls at eight months compared to those receiving advice only or MFFP; but there were no statistically significant differences in the rate of falling between treatment groups at 12 or 18 months. However, health economic analysis suggests that exercise is a cost effective intervention.
Conclusion(s): Screening participants worked well in the primary care setting and uptake to exercise and MFFP interventions was good. Exercise was found to reduce rate of falls in the short term but no sustained effects were observed over time.
Implications: The findings from PreFIT will inform clinical practice and shape future falls prevention policy.
Keywords: Falls prevention, exercise, multifactorial assessment
Funding acknowledgements: The PreFIT study is funded by the National Institute of Health Research Technology Assessment Programme (NiHR HTA), project number 08/14/41.
Topic: Older people; Primary health care
Ethics approval required: Yes
Institution: National Research Ethics Service
Ethics committee: Derbyshire Research Ethics Committee
Ethics number: 10/H0401/36
All authors, affiliations and abstracts have been published as submitted.
