Cluster randomised trial of a targeted multifactorial intervention to prevent falls among older people in hospital

doi:10.1136/bmj.39499.546030.BE

BMJ 2008;336:758-760 (5 April), doi:10.1136/bmj.39499.546030.BE (published 10 March 2008)

Research

Cluster randomised trial of a targeted multifactorial intervention to prevent falls among older people in hospital

Robert G Cumming, professor of epidemiology and geriatric medicine¹^,2, Catherine Sherrington, research fellow¹^,3^,4, Stephen R Lord, senior principal research fellow⁴, Judy M Simpson, professor (biostatistics)¹, Constance Vogler, staff specialist geriatrician⁵, Ian D Cameron, professor of rehabilitation medicine⁶, Vasi Naganathan, senior lecturer geriatric medicine², for the Prevention of Older People’s Injury Falls Prevention in Hospitals Research Group

¹ School of Public Health, University of Sydney, Sydney, Australia, ² Centre for Education and Research on Ageing, Concord Hospital, Australia, ³ Faculty of Health Sciences, University of Sydney, Lidcombe, Australia, ⁴ Prince of Wales Medical Research Institute, University of New South Wales, Kensington, Australia, ⁵ Department of Aged Care and Rehabilitation, Royal North Shore Hospital, St Leonards, Australia, ⁶ Rehabilitation Studies Unit, University of Sydney, Ryde, Australia

Correspondence to: R G Cumming, Centre for Education and Research on Ageing, Concord Hospital, Concord, NSW 2139, Australia bobc{at}health.usyd.edu.au

Objective To determine the efficacy of a targeted multifactorialfalls prevention programme in elderly care wards with relativelyshort lengths of stay.

Design Cluster randomised trial.

Setting 24 elderly care wards in 12 hospitals in Sydney, Australia.

Participants 3999 patients, mean age 79 years, with a medianhospital stay of seven days.

Interventions A nurse and physiotherapist each worked for 25hours a week for three months in all intervention wards. Theyprovided a targeted multifactorial intervention that includeda risk assessment of falls, staff and patient education, drugreview, modification of bedside and ward environments, an exerciseprogramme, and alarms for selected patients.

Main outcome measure Falls during hospital stay.

Results Intervention and control wards were similar at baselinefor previous rates of falls and individual patient characteristics.Overall, 381 falls occurred during the study. No differencewas found in fall rates during follow-up between interventionand control wards: respectively, 9.26 falls per 1000 bed daysand 9.20 falls per 1000 bed days (P=0.96). The incidence rateratio adjusted for individual lengths of stay and previous fallrates in the ward was 0.96 (95% confidence interval 0.72 to1.28).

Conclusion A targeted multifactorial falls prevention programmewas not effective among older people in hospital wards withrelatively short lengths of stay.

Trial registration Australian New Zealand Clinical Trials RegistryACTRNO 12605000467639.

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Interpreting the null result: Frances Healey
BMJ 2008 336: 847. [Extract] [Full Text] [PDF]

Results are not surprising: Alan Walmsley
BMJ 2008 336: 847. [Extract] [Full Text] [PDF]

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This article has been cited by other articles:

Healey, F. (2008). Interpreting the null result. BMJ 336: 847-847 [Full text]
Walmsley, A. (2008). Results are not surprising. BMJ 336: 847-847 [Full text]

Rapid Responses:

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bmj.com, 11 Mar 2008 [Full text]
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