Effectiveness and economic evaluation of a nurse delivered home exercise programme to prevent falls. 1: Randomised controlled trial

doi:10.1136/bmj.322.7288.697

BMJ 2001;322:697 ( 24 March )

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Effectiveness and economic evaluation of a nurse delivered home exercise programme to prevent falls. 1: Randomised controlled trial

M Clare Robertson, research fellow, ^a Nancy Devlin, senior lecturer, ^b Melinda M Gardner, research physiotherapist, ^a A John Campbell, professor of geriatric medicine. ^a

^a Department of Medical and Surgical Sciences, Otago Medical School, PO Box 913, Dunedin, New Zealand, ^b Department of Economics, University of Otago

Correspondence to: M C Robertson clare.robertson{at}stonebow.otago.ac.nz

Objectives: To assess the effectiveness of a trained districtnurse individually prescribing a home based exercise programmeto reduce falls and injuries in elderly people and to estimatethe cost effectiveness of theprogramme.
Design: Randomised controlled trial with one year'sfollowup.
Setting: Community health service at a New Zealandhospital.
Participants: 240 women and men aged 75 years andolder.
Intervention: 121 participants received the exercise programme(exercise group) and 119 received usual care (control group);90% (211 of 233) completed thetrial.
Main outcome measures: Number of falls, number of injuries resultingfrom falls, costs of implementing the programme, and hospitalcosts as a result offalls.
Results: Falls were reduced by 46% (incidence rateratio 0.54, 95% confidence interval 0.32 to 0.90). Five hospitaladmissions were due to injuries caused by falls in the controlgroup and none in the exercise group. The programme cost $NZ1803(£523) (at 1998 prices) per fall prevented for delivering theprogramme and $NZ155 per fall prevented when hospital costs avertedwereconsidered.
Conclusion: A home exercise programme, previously shownto be successful when delivered by a physiotherapist, was alsoeffective in reducing falls when delivered by a trained nursefrom within a home health service. Serious injuries and hospitaladmissions due to falls were also reduced. The programme was costeffective in participants aged 80 years and older compared withyoungerparticipants.

What is already known on this topic
Falls are the costliest type of injury among elderly people, and the healthcare costs increase with frequency of falls and severity of injuries

An exercise programme delivered by a physiotherapist was successful in reducing falls and moderate injuries in elderly people

What this study adds
An exercise programme to prevent falls in elderly people worked well when delivered by a district nurse from a home health service in the suburbs of a large city

Researchers, public health administrators, and health practitioners can work together to benefit elderly people in the community

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Randomised controlled trial of prevention of falls in people aged $≥$ 75 with severe visual impairment: the VIP trial: A John Campbell, M Clare Robertson, Steven J La Grow, Ngaire M Kerse, Gordon F Sanderson, Robert J Jacobs, Dianne M Sharp, and Leigh A Hale
BMJ 2005 331: 817. [Abstract] [Full Text] [PDF]

Exercise programmes prevent falls in elderly people
BMJ 2001 322: 0. [Full Text]

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