Cusimano M D, Kwok J, Spadafora K
Injury Prevention Research Office, Li Ka Shing Knowledge Institute, Keenan Research Centre, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
Inj Prev. 2008 Apr;14(2):113-22. doi: 10.1136/ip.2007.017533.
Unintentional falls are particularly prevalent among older people and constitute a public health concern. Not much is known about the implications of multifaceted intervention programs implemented in residential care settings.
To evaluate the effectiveness of multifaceted intervention programs in reducing the number of falls, fallers, recurrent fallers, and injurious falls among older people living in residential care facilities.
Comprehensive searches of Medline, PubMed, and EMBASE up to July 2007, the cited literature lists of each included study, and the internet engines Google Scholar, Yahoo, and Dogpile were performed to identify eligible studies.
Eligible studies for this review were those that had randomized, controlled trials with adequate follow-up study components in their design. Studies that included elderly people in residential care who participated in multifaceted falls-prevention programs were included.
Two authors independently extracted the necessary data. Studies were assessed for quality by the criteria of Downs and Black. The results of the included studies have been reviewed narratively.
From 21 articles potentially relevant to the topic, five studies met the inclusion criteria and all were reasonably well conducted. Three reported significant reductions in the number of recurrent fallers, two reported significant reductions in the number of falls, and one reported significant reductions in the number of fallers. One other reported a reduction in the number of injurious falls in those who received the multifaceted prevention program compared with the control group. However, the analyses of this specific study were not based on intent-to-treat, so the effect of intervention on the number of injurious falls remains inconclusive. No study reported on adverse events, costs, or sustainability of the interventions.
Multifaceted programs that encompass a wide range of intervention strategies have shown some evidence of efficacy. However, more well-designed research is required that assesses effects on injurious falls, quality of life, cost-effectiveness, and sustainability.
意外跌倒在老年人中尤为普遍，是一个公共卫生问题。对于在寄宿护理机构实施的多方面干预项目的影响了解不多。
评估多方面干预项目在减少居住在寄宿护理机构的老年人跌倒次数、跌倒者数量、反复跌倒者数量和伤害性跌倒方面的有效性。
对截至2007年7月的Medline、PubMed和EMBASE进行全面检索，查阅每项纳入研究的参考文献列表，并利用谷歌学术、雅虎和Dogpile等互联网搜索引擎来识别符合条件的研究。
本综述的符合条件的研究是那些在设计中有随机对照试验且有充分随访研究部分的研究。纳入那些包括参与多方面预防跌倒项目的寄宿护理老年人的研究。
两位作者独立提取必要数据。根据唐斯和布莱克的标准对研究进行质量评估。对纳入研究的结果进行了叙述性综述。
从21篇可能与该主题相关的文章中，有5项研究符合纳入标准，且所有研究开展得都较为合理。3项研究报告反复跌倒者数量显著减少，2项研究报告跌倒次数显著减少，1项研究报告跌倒者数量显著减少。另一项研究报告称，与对照组相比，接受多方面预防项目的人伤害性跌倒次数减少。然而，这项具体研究的分析并非基于意向性治疗，因此干预对伤害性跌倒次数的影响仍不确定。没有研究报告干预的不良事件、成本或可持续性。
包含广泛干预策略的多方面项目已显示出一些有效性证据。然而，需要更多设计良好的研究来评估对伤害性跌倒、生活质量、成本效益和可持续性的影响。
