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 of a home safety programme and a home exercise programme to reduce falls 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 of 6/24 or worse who were living in the community; 92% (361 of 391) completed one year of follow-up.

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

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

Results Fewer falls occurred in the group randomised to the home safety programme but not in the exercise programme (incidence rate ratios 0.59 (95% confidence interval 0.42 to 0.83) and 1.15 (0.82 to 1.61), respectively). However, within the exercise programme, stricter adherence was associated with fewer falls (P = 0.001). A conservative analysis showed neither intervention was effective in reducing injuries from falls. Delivering the home safety programme cost $NZ650 (£234, 344 euros, $US432) (at 2004 prices) per fall prevented.

Conclusion The home safety programme reduced falls and was more cost effective than an exercise programme in this group of elderly people with poor vision. The Otago exercise programme with vitamin D supplementation was not effective in reducing falls or injuries in this group, possibly due to low levels of adherence.

Trial registration number ISRCTN15342873.


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