Gates S, Fisher J D, Cooke M W, Carter Y H, Lamb S E
Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry CV4 7AL.
BMJ. 2008 Jan 19;336(7636):130-3. doi: 10.1136/bmj.39412.525243.BE. Epub 2007 Dec 18.
To evaluate the effectiveness of multifactorial assessment and intervention programmes to prevent falls and injuries among older adults recruited to trials in primary care, community, or emergency care settings.
Systematic review of randomised and quasi-randomised controlled trials, and meta-analysis.
Six electronic databases (Medline, Embase, CENTRAL, CINAHL, PsycINFO, Social Science Citation Index) to 22 March 2007, reference lists of included studies, and previous reviews.
Eligible studies were randomised or quasi-randomised trials that evaluated interventions to prevent falls that were based in emergency departments, primary care, or the community that assessed multiple risk factors for falling and provided or arranged for treatments to address these risk factors.
Outcomes were number of fallers, fall related injuries, fall rate, death, admission to hospital, contacts with health services, move to institutional care, physical activity, and quality of life. Methodological quality assessment included allocation concealment, blinding, losses and exclusions, intention to treat analysis, and reliability of outcome measurement.
19 studies, of variable methodological quality, were included. The combined risk ratio for the number of fallers during follow-up among 18 trials was 0.91 (95% confidence interval 0.82 to 1.02) and for fall related injuries (eight trials) was 0.90 (0.68 to 1.20). No differences were found in admissions to hospital, emergency department attendance, death, or move to institutional care. Subgroup analyses found no evidence of different effects between interventions in different locations, populations selected for high risk of falls or unselected, and multidisciplinary teams including a doctor, but interventions that actively provide treatments may be more effective than those that provide only knowledge and referral.
Evidence that multifactorial fall prevention programmes in primary care, community, or emergency care settings are effective in reducing the number of fallers or fall related injuries is limited. Data were insufficient to assess fall and injury rates.
评估多因素评估与干预计划在预防初级保健、社区或急诊护理环境中招募参加试验的老年人跌倒及受伤方面的有效性。
对随机和半随机对照试验进行系统评价及荟萃分析。
截至2007年3月22日的六个电子数据库（医学索引数据库、荷兰医学文摘数据库、循证医学图书馆、护理学与健康领域数据库、心理学文摘数据库、社会科学引文索引）、纳入研究的参考文献列表以及先前的综述。
符合条件的研究为随机或半随机试验，这些试验评估了在急诊科、初级保健机构或社区开展的预防跌倒干预措施，这些干预措施评估了多种跌倒风险因素，并提供或安排针对这些风险因素的治疗。
结局指标包括跌倒者数量、与跌倒相关的损伤、跌倒率、死亡、住院、与医疗服务机构的接触、转入机构护理、身体活动及生活质量。方法学质量评估包括分配隐藏、盲法、失访和排除、意向性分析以及结局测量的可靠性。
纳入了19项方法学质量各异的研究。18项试验中随访期间跌倒者数量的合并风险比为0.91（95%置信区间0.82至1.02），与跌倒相关损伤（8项试验）的合并风险比为0.90（0.68至1.20）。在住院、急诊科就诊、死亡或转入机构护理方面未发现差异。亚组分析未发现不同地点的干预措施、因跌倒高风险或非特定风险而选择的人群以及包括医生在内的多学科团队之间存在不同效果的证据，但积极提供治疗的干预措施可能比仅提供知识和转诊的干预措施更有效。
在初级保健、社区或急诊护理环境中，多因素预防跌倒计划在减少跌倒者数量或与跌倒相关损伤方面有效的证据有限。数据不足以评估跌倒率和损伤率。
