Rucker Diana, Rowe Brian H, Johnson Jeffrey A, Steiner Ivan P, Russell Anthony S, Hanley David A, Maksymowych Walter P, Holroyd Brian R, Harley Charles H, Morrish Donald W, Wirzba Brian J, Majumdar Sumit R
Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
Prev Med. 2006 Apr;42(4):316-9. doi: 10.1016/j.ypmed.2006.01.008. Epub 2006 Feb 20.
Falls and fear of falling are a major health problem. We sought to determine the effectiveness of an educational intervention in reducing fear of falling and preventing recurrent falls in community-dwelling patients after a fragility fracture.
One hundred two community-dwelling patients aged 50 years or older who fell and sustained a wrist fracture and were treated at Emergency Departments in Edmonton, Alberta, Canada (2001-2002) were allocated to either standardized educational leaflets and post-discharge telephone counseling regarding fall prevention strategies ("intervention") or attention-controls ("controls"). Main outcomes were fear of falling and recurrent falls 3 months after fracture.
Mean age was 67 years and most patients were female (80%). The majority of falls (76%) leading to fracture occurred outdoors. Three months post-fracture, almost half of patients (48%) reported increased fear of falling and 11 of 102 (11%) reported falling again. The intervention did not reduce the fear of falling (43% had increased fear vs. 53% of controls, adjusted P value=0.55) or decrease recurrent falls (17% fell vs. 5% of controls, adjusted P value=0.059) within 3 months of fracture.
An educational intervention undertaken in the Emergency Department was no more effective than usual care in reducing fear of falling or recurrent falls in community-dwelling patients. Future strategies must address a number of dimensions beyond simple education.
跌倒及跌倒恐惧是一个主要的健康问题。我们试图确定一项教育干预措施在降低社区居住的脆性骨折患者跌倒恐惧及预防再次跌倒方面的有效性。
2001年至2002年在加拿大艾伯塔省埃德蒙顿市急诊科接受治疗的102名年龄在50岁及以上、因跌倒导致手腕骨折的社区居住患者，被分配至接受关于预防跌倒策略的标准化教育传单及出院后电话咨询（“干预组”）或注意力控制组（“对照组”）。主要结局指标为骨折后3个月的跌倒恐惧及再次跌倒情况。
平均年龄为67岁，大多数患者为女性（80%）。导致骨折的跌倒多数（76%）发生在户外。骨折后3个月，近一半患者（48%）报告跌倒恐惧增加，102名患者中有11名（11%）报告再次跌倒。干预措施在骨折后3个月内未降低跌倒恐惧（43%恐惧增加，对照组为53%，校正P值 = 0.55），也未减少再次跌倒情况（17%再次跌倒，对照组为5%，校正P值 = 0.059）。
在急诊科开展的教育干预措施在降低社区居住患者跌倒恐惧或再次跌倒方面并不比常规护理更有效。未来的策略必须在简单教育之外解决多个方面的问题。
