Turner Samantha, Arthur Geri, Lyons Ronan A, Weightman Alison L, Mann Mala K, Jones Sarah J, John Ann, Lannon Simon
School of Medicine, Swansea University, Grove Building, Singleton Park, Swansea, UK, SA2 8PP.
Cochrane Database Syst Rev. 2011 Feb 16;2011(2):CD003600. doi: 10.1002/14651858.CD003600.pub3.
Injury in the home is common, accounting for approximately a third of all injuries. The majority of injuries to children under five and people aged 75 and older occur at home. Multifactorial injury prevention interventions have been shown to reduce injuries in the home. However, few studies have focused specifically on the impact of physical adaptations to the home environment and the effectiveness of such interventions needs to be ascertained.
To determine the effect of modifications to the home environment on the reduction of injuries due to environmental hazards.
We searched The Cochrane Library, MEDLINE, EMBASE and other specialised databases. We also scanned conference proceedings and reference lists. We contacted the first author of all included randomised controlled trials. The searches were last updated to the end of December 2009, and were not restricted by language or publication status.
Randomised controlled trials.
Two authors screened all abstracts for relevance, outcome and design. Two authors independently assessed methodological quality and extracted data from each eligible study. We performed meta-analysis to combine effect measures, using a random-effects model. We assessed heterogeneity using an I(2) statistic and a Chi(2) test.
We found 28 published studies and one unpublished study. Only two studies were sufficiently similar to allow pooling of data for statistical analyses. Studies were divided into three groups; children, older people and the general population/mixed age group. None of the studies focusing on children or older people demonstrated a reduction in injuries that were a direct result of environmental modification in the home. One study in older people demonstrated a reduction in falls and one a reduction in falls and injurious falls that may have been due to hazard reduction. One meta-analysis was performed which examined the effects on falls of multifactorial interventions consisting of home hazard assessment and modification, medication review, health and bone assessment and exercise (RR 1.09, 95% CI 0.97 to 1.23).
AUTHORS' CONCLUSIONS: There is insufficient evidence to determine whether interventions focused on modifying environmental home hazards reduce injuries. Further interventions to reduce hazards in the home should be evaluated by adequately designed randomised controlled trials measuring injury outcomes. Recruitment of large study samples to measure effect must be a major consideration for future trials. Researchers should also consider using factorial designs to allow the evaluation of individual components of multifactorial interventions.
家庭伤害很常见，约占所有伤害的三分之一。五岁以下儿童和75岁及以上老年人的大多数伤害发生在家中。多因素伤害预防干预措施已被证明可减少家庭伤害。然而，很少有研究专门关注家庭环境的物理改造的影响，此类干预措施的有效性有待确定。
确定家庭环境改造对减少环境危害导致的伤害的效果。
我们检索了考克兰图书馆、MEDLINE、EMBASE和其他专业数据库。我们还浏览了会议论文集和参考文献列表。我们联系了所有纳入的随机对照试验的第一作者。检索截至2009年12月底，不受语言或出版状态限制。
随机对照试验。
两位作者筛选所有摘要的相关性、结果和设计。两位作者独立评估方法学质量并从每项符合条件的研究中提取数据。我们使用随机效应模型进行荟萃分析以合并效应量。我们使用I²统计量和卡方检验评估异质性。
我们找到了28项已发表研究和1项未发表研究。只有两项研究足够相似，能够合并数据进行统计分析。研究分为三组：儿童、老年人和一般人群/混合年龄组。没有一项针对儿童或老年人的研究表明，家庭环境改造直接导致的伤害有所减少。一项针对老年人的研究表明跌倒次数减少，另一项研究表明跌倒和伤害性跌倒次数减少，这可能是由于危害减少所致。进行了一项荟萃分析，研究了由家庭危害评估与改造、药物审查、健康和骨骼评估以及锻炼组成的多因素干预措施对跌倒的影响（风险比1.09，95%置信区间0.97至1.23）。
没有足够的证据来确定专注于改造家庭环境危害的干预措施是否能减少伤害。应通过设计充分的随机对照试验来评估进一步减少家庭危害的干预措施，这些试验需测量伤害结果。未来试验必须主要考虑招募大型研究样本以测量效果。研究人员还应考虑使用析因设计，以便评估多因素干预措施的各个组成部分。
