BMJ  2008;336:847 (19 April), doi:10.1136/bmj.39549.430162.3A

Letters

Preventing falls among older people in hospital

Interpreting the null result

The first 150 words of the full text of this article appear below.

Evidence that multifaceted interventions in acute hospitals are ineffective is limited,¹ with most studies based on rehabilitation units² and only one other large cluster randomised controlled trial in an acute setting.³ This showed a significant reduction in falls after the introduction of multifaceted interventions, as did other large acute hospital studies of before and after design.⁴ So what explains the disparity in the results? It is hard to fault the quality of design in this study, so unpacking the "black box" of the intervention is crucial in understanding the null result.

Firstly, as the authors point out, control wards in their study may have introduced some or all of the interventions too—hopefully control ward patients were also provided with "appropriate walking aids." Osmosis is particularly likely, given the study duration of three years and interventions based on guidance issued in 1998.⁵ It is harder to effect a difference if good . . . [Full text of this article]

¹ School of Health and Social Care, University of Reading, Reading RG1 5AQ, ² National Patient Safety Agency, Leeds LS2 7UE

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

Robert G Cumming, Catherine Sherrington, Stephen R Lord, Judy M Simpson, Constance Vogler, Ian D Cameron, Vasi Naganathan for the Prevention of Older People’s Injury Falls Prevention in Hospitals Research Group
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