Randomised controlled trial of prevention of falls in people aged >=75 with severe visual impairment: the VIP trial

doi:10.1136/bmj.38601.447731.55

BMJ 2005;331:817 (8 October), doi:10.1136/bmj.38601.447731.55 (published 23 September 2005)

Primary care

Randomised controlled trial of prevention of falls in people aged $≥$ 75 with severe visual impairment: the VIP trial

A John Campbell, professor of geriatric medicine¹, M Clare Robertson, senior research fellow¹, Steven J La Grow, professor of rehabilitation², Ngaire M Kerse, general practice and primary health care³, Gordon F Sanderson, optometrist and senior lecturer¹, Robert J Jacobs, optometrist and associate professor of optometry⁴, Dianne M Sharp, consultant ophthalmologist⁵, Leigh A Hale, senior lecturer⁶

¹ Department of Medical and Surgical Sciences, Otago Medical School, Dunedin, New Zealand, ² School of Health Sciences, University of Massey, New Zealand, ³ School of Population Health, University of Auckland, New Zealand, ⁴ Department of Optometry and Vision Science, University of Auckland, New Zealand, ⁵ Auckland Hospital, Auckland, New Zealand, ⁶ School of Physiotherapy, University of Otago, Dunedin, New Zealand

Correspondence to: A John Campbell john.campbell{at}stonebow.otago.ac.nz

Objectives To assess the efficacy and cost effectiveness ofa home safety programme and a home exercise programme to reducefalls and injuries in older people with low vision.

Design Randomised controlled trial.

Setting Dunedin and Auckland, New Zealand.

Participants 391 women and men aged $≥$ 75 with visual acuity of6/24 or worse who were living in the community; 92% (361 of391) completed one year of follow-up.

Interventions Participants received a home safety assessmentand modification programme delivered by an occupational therapist(n = 100), an exercise programme prescribed at home by a physiotherapistplus vitamin D supplementation (n = 97), both interventions(n = 98), or social visits (n = 96).

Main outcome measures Numbers of falls and injuries resultingfrom falls, costs of implementing the home safety programme.

Results Fewer falls occurred in the group randomised to thehome safety programme but not in the exercise programme (incidencerate ratios 0.59 (95% confidence interval 0.42 to 0.83) and1.15 (0.82 to 1.61), respectively). However, within the exerciseprogramme, stricter adherence was associated with fewer falls(P = 0.001). A conservative analysis showed neither interventionwas effective in reducing injuries from falls. Delivering thehome safety programme cost $NZ650 (£234, 344 euros, $US432)(at 2004 prices) per fall prevented.

Conclusion The home safety programme reduced falls and was morecost effective than an exercise programme in this group of elderlypeople with poor vision. The Otago exercise programme with vitaminD supplementation was not effective in reducing falls or injuriesin this group, possibly due to low levels of adherence.

Trial registration number ISRCTN15342873.

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