BMJ 2001;322:701 ( 24 March )

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Effectiveness and economic evaluation of a nurse delivered home exercise programme to prevent falls. 2: Controlled trial in multiple centres

M Clare Robertson, research fellow, ^a Melinda M Gardner, research physiotherapist, ^a Nancy Devlin, senior lecturer, ^b Rob McGee, senior lecturer, ^c 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, ^c Department of Preventive and Social Medicine, Otago Medical School

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

Objectives: To assess the effectiveness of trained nurses based in general practices individually prescribing a home exercise programme to reduce falls and injuries in elderly people and to estimate the cost effectiveness of the programme.
Design: Controlled trial with one year's follow up.
Setting: 32 general practices in seven southern New Zealand centres.
Participants: 450 women and men aged 80 years and older.
Intervention: 330 participants received the exercise programme (exercise centres) and 120 received usual care (control centres); 87% (371 of 426) completed the trial.
Main outcome measures: Number of falls, number of injuries resulting from falls, costs of implementing the programme, and hospital costs as a result of falls.
Results: Falls were reduced by 30% in the exercise centres (incidence rate ratio 0.70, 95% confidence interval 0.59 to 0.84). The programme was equally effective in men and women. The programme cost $NZ418 (£121) (at 1998 prices) per person to deliver for one year or $NZ1519 (£441) per fall prevented. Fewer participants had falls resulting in injuries, but there was no difference in the number who had serious injuries and no difference in hospital costs resulting from falls in exercise centres compared with control centres.
Conclusions: An individually tailored exercise programme, delivered by trained nurses from within general practices, was effective in reducing falls in three different centres. This strategy should be combined with other successful interventions to form part of home programmes to prevent falls in elderly people.

What is already known on this topic One half of those aged 80 years and older will fall in any one year, often with serious health and social consequences An exercise programme delivered by a physiotherapist or trained district nurse was successful in reducing falls and moderate injuries in elderly people What this study adds An exercise programme to prevent falls in elderly people can be delivered safely and effectively by trained nurses in general practices The nurses obtained results that were consistent with the physiotherapist in the research setting and the district nurse in the accompanying paper

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