Robertson M C, Devlin N, Gardner M M, Campbell A J
Department of Medical and Surgical Sciences, Otago Medical School, Dunedin, New Zealand.
BMJ. 2001 Mar 24;322(7288):697-701. doi: 10.1136/bmj.322.7288.697.
To assess the effectiveness of a trained district nurse individually prescribing a home based exercise programme to reduce falls and injuries in elderly people and to estimate the cost effectiveness of the programme.
Randomised controlled trial with one year's follow up.
Community health service at a New Zealand hospital.
240 women and men aged 75 years and older.
121 participants received the exercise programme (exercise group) and 119 received usual care (control group); 90% (211 of 233) completed the trial.
Number of falls, number of injuries resulting from falls, costs of implementing the programme, and hospital costs as a result of falls.
Falls were reduced by 46% (incidence rate ratio 0.54, 95% confidence interval 0.32 to 0.90). Five hospital admissions were due to injuries caused by falls in the control group and none in the exercise group. The programme cost $NZ1803 (523 pound sterling) (at 1998 prices) per fall prevented for delivering the programme and $NZ155 per fall prevented when hospital costs averted were considered.
A home exercise programme, previously shown to be successful when delivered by a physiotherapist, was also effective in reducing falls when delivered by a trained nurse from within a home health service. Serious injuries and hospital admissions due to falls were also reduced. The programme was cost effective in participants aged 80 years and older compared with younger participants.
评估经过培训的社区护士单独开具家庭锻炼计划以减少老年人跌倒及受伤的有效性，并估算该计划的成本效益。
为期一年随访的随机对照试验。
新西兰一家医院的社区卫生服务中心。
240名75岁及以上的男性和女性。
121名参与者接受锻炼计划（锻炼组），119名接受常规护理（对照组）；90%（233名中的211名）完成试验。
跌倒次数、跌倒导致的受伤次数、实施该计划的成本以及跌倒导致的住院费用。
跌倒次数减少了46%（发生率比为0.54，95%置信区间为0.32至0.90）。对照组有5例因跌倒受伤住院，锻炼组无。该计划每预防一次跌倒的实施成本为1803新西兰元（523英镑）（按1998年价格），若考虑避免的住院费用，则每预防一次跌倒成本为155新西兰元。
一项先前由物理治疗师实施时已证明成功的家庭锻炼计划，由家庭健康服务机构中经过培训的护士实施时，在减少跌倒方面也有效。跌倒导致的严重伤害和住院情况也有所减少。与年轻参与者相比，该计划对80岁及以上的参与者具有成本效益。
