Community falls prevention for people who call an emergency ambulance after a fall: randomised controlled trialBMJ 2010; 340 doi: https://doi.org/10.1136/bmj.c2102 (Published 11 May 2010) Cite this as: BMJ 2010;340:c2102
- Philippa A Logan, postdoctoral researcher and occupational therapist1,
- C A C Coupland, associate professor in medical statistics1,
- J R F Gladman, professor of older persons medicine and community geriatrician1,
- O Sahota, professor of orthogeriatric medicine and consultant physician2,
- V Stoner-Hobbs, triage nurse3,
- K Robertson, community occupational therapist4,
- V Tomlinson, data analyst3,
- M Ward, community nurse5,
- T Sach, senior lecturer in health economics6,
- A J Avery, professor of primary care and general practitioner1
- 1School of Community Health Sciences, University of Nottingham
- 2Nottingham University Hospital, Nottingham
- 3East Midlands Ambulance Service Headquarters, Nottingham
- 4Community Rehabilitation, Lings Bar Hospital, Nottinghamshire Community Health, Nottingham
- 5Community Rehabilitation, Nottingham City Primary Care Trust, Nottingham
- 6Health Economics Group, School of Medicine, Health Policy and Practice, University of East Anglia, Norwich
- Correspondence to: PA Logan, Division of Rehabilitation and Ageing, University of Nottingham, Queen’s Medical Centre, Nottingham NG7 2UH
- Accepted 29 March 2010
Objective To evaluate whether a service to prevent falls in the community would help reduce the rate of falls in older people who call an emergency ambulance when they fall but are not taken to hospital.
Design Randomised controlled trial.
Setting Community covered by four primary care trusts, England.
Participants 204 adults aged more than 60 living at home or in residential care who had fallen and called an emergency ambulance but were not taken to hospital.
Interventions Referral to community fall prevention services or standard medical and social care.
Main outcome measures The primary outcome was the rate of falls over 12 months, ascertained from monthly diaries. Secondary outcomes were scores on the Barthel index, Nottingham extended activities of daily living scale, and falls efficacy scale at baseline and by postal questionnaire at 12 months. Analysis was by intention to treat.
Results 102 people were allocated to each group. 99 (97%) participants in the intervention group received the intervention. Falls diaries were analysed for 88.6 person years in the intervention group and 84.5 person years in the control group. The incidence rates of falls per year were 3.46 in the intervention group and 7.68 in the control group (incidence rate ratio 0.45, 95% confidence interval 0.35 to 0.58, P<0.001). The intervention group achieved higher scores on the Barthel index and Nottingham extended activities of daily living and lower scores on the falls efficacy scale (all P<0.05) at the 12 month follow-up. The number of times an emergency ambulance was called because of a fall was significantly different during follow-up (incidence rate ratio 0.60, 95% confidence interval 0.40 to 0.92, P=0.018).
Conclusion A service to prevent falls in the community reduced the fall rate and improved clinical outcome in the high risk group of older people who call an emergency ambulance after a fall but are not taken to hospital.
Trial registration Current Controlled Trials ISRCTN67535605.
We thank CL Fellows (clinical audit manager, East Midlands Ambulance Service), who initially contacted participants through the ambulance service, and C Simms-Jones (clinical audit office), who helped collect data from the ambulance service.
Contributors: PAL (principal investigator) designed the protocol, secured funding, recruited participants, collected and analysed data, and wrote the paper. She is guarantor. CACC analysed the data, interpreted the results, and drafted sections of the paper. JRFG designed and wrote the protocol and grant application, interpreted and analysed the results, and wrote the paper. OS designed and wrote the protocol and grant application, interpreted the results, and wrote the paper. VS-H designed and wrote the protocol and grant application, collected data, and wrote the paper. KR designed and wrote the protocol and grant application, collected and checked the data, and wrote the paper. VT designed and wrote the protocol and grant application; collected, checked, and input the data; and wrote the paper. MW designed and wrote the protocol and grant application, collected and checked the data, interpreted the results, and wrote the paper. TS designed and wrote the protocol and grant application, interpreted the results, and wrote the paper. AJA designed and wrote the protocol and grant application, interpreted the results, and wrote the paper. All authors, external and internal, had full access to all of the data (including statistical reports and tables) in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis
Funding: This study was funded by a postdoctoral training scholarship awarded to PAL from the UK NHS National Institute of Health Research. The funding source provided an external peer review of the study protocol but did not have any role in the data collection, analysis, report writing, or decision to publish this paper.
Competing interests: All authors have completed the unified competing interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare (1) no financial support for the submitted work from anyone other than their employer; (2) no financial relationships with commercial entities that might have an interest in the submitted work; (3) no spouses, partners, or children with relationships with commercial entities that might have an interest in the submitted work; and (4) no non-financial interests that may be relevant to the submitted work.
Ethical approval: This study was approved by the North Nottinghamshire local research ethics committee and the Nottinghamshire primary care trusts for NHS research and development committee (05/Q2402/53).
Data sharing: The technical appendix, statistical code, and dataset are available from the corresponding author at.
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