College of Nursing & Health Innovation, Arizona State University, Phoenix, AZ 85004, USA.
J Am Med Dir Assoc. 2012 Feb;13(2):188.e13-21. doi: 10.1016/j.jamda.2011.04.022. Epub 2011 Jun 15.
To examine the reported effectiveness of fall-prevention programs for older adults by reviewing randomized controlled trials from 2000 to 2009.
Systematic review and meta-analysis of randomized controlled trials.
A systematic literature search of articles was conducted using 5 electronic databases (Medline, PubMed, PsycINFO, CINAHL, and RefWorks), including articles describing interventions designed to prevent falls, in English with full text availability, from 2000 through 2009.
Of a potential 227 studies, we identified 17 randomized controlled trials with a duration of intervention of at least 5 months of follow-up. Inclusion and exclusion criteria were used to assess the methodological qualities of the studies. We excluded unidentified study design, quasi-experimental studies, and/or studies that were nonspecific regarding inclusion criteria.
Primary outcome measures were number of falls and fall rate. Methodological quality assessment included internal and external validity, reporting, and power. Data were extracted independently by 2 investigators and analyzed using a random-effects model. We analyzed the effectiveness of these fall intervention programs using their risk ratios (RR) in 2 single-intervention versus 15 multifactorial intervention trials, 3 nursing homes versus 14 community randomized controlled trials, and 8 Model 1 (initial intervention with subsequent follow up) versus 9 Model II (ongoing intervention throughout the follow-up) studies.
The combined RR for the number of falls among 17 studies was 0.855 (z = -2.168; p = .030; 95% CI = 0.742-0.985; Q = 196.204, df = 16, P = .000, I(2) = 91.845), demonstrating that fall-prevention programs across the studies were effective by reducing fall rates by 14%, but with substantial heterogeneity. Subgroup analysis indicated that there was a significant fall reduction of 14% in multifactorial intervention (RR = 0.856, z = -2.039, P = .041) with no variation between multifactorial and single-intervention groups (Q = 0.002, P = .961), 55% in the nursing home setting (RR = 0.453, z = -9.366, P = .000) with significant variation between nursing home and community groups (Q = 62.788, P = .000), and no significant effect was gained by dividing studies into either in Model I or II. Sensitivity analysis found homogeneity (Q = 18.582, df = 12, P = .099, I(2) = 35.423) across studies with a 9% overall fall reduction (RR = 0.906, 95% CI = 0.853-0.963, z = -3.179, P = .001), including a fall-reduction rate of 10% in multifactorial intervention (RR = 0.904, z = -3.036, P = .002), 9% in community (RR = 0.909, z = -3.179, P = .001), and 12% in Model I (RR = 0.876, z = -3.534, P = .000) with no variations among all the groups. Meta regression suggested that the model fit explained 68.6% of the relevant variance.
The meta-sensitivity analysis indicates that randomized controlled trials of fall-prevention programs conducted within the past 10 years (2000-2009) are effective in overall reduction of fall rates of 9% with a reduction of fall rates of 10% in multifactorial interventions, 9% in community settings, and 12% in Model I interventions (initial intervention efforts and then subsequent follow-up).
通过对 2000 年至 2009 年的随机对照试验进行系统性回顾和荟萃分析，研究老年人防跌倒计划的报告效果。
随机对照试验的系统性回顾和荟萃分析。
使用 5 个电子数据库（Medline、PubMed、PsycINFO、CINAHL 和 RefWorks）对文章进行了系统性文献检索，包括描述旨在预防跌倒的干预措施的文章，这些文章为英文且全文可用，研究时间为 2000 年至 2009 年。
在潜在的 227 项研究中，我们确定了 17 项具有至少 5 个月随访时间的干预措施的随机对照试验。使用纳入和排除标准来评估研究的方法学质量。我们排除了未识别的研究设计、准实验研究以及/或者关于纳入标准不具体的研究。
主要结局测量是跌倒的数量和跌倒率。方法学质量评估包括内部和外部有效性、报告和功效。数据由两名独立的研究者提取，并使用随机效应模型进行分析。我们使用其风险比（RR）分析了这些跌倒干预计划的有效性，这些 RR 来自 2 项单一干预与 15 项多因素干预试验、3 家疗养院与 14 项社区随机对照试验以及 8 项模型 1（初始干预后进行后续随访）与 9 项模型 2（整个随访期间持续干预）研究。
17 项研究中跌倒数量的合并 RR 为 0.855（z=-2.168；p=0.030；95%CI=0.742-0.985；Q=196.204，df=16，P=0.000，I(2)=91.845），表明这些研究中的跌倒预防计划通过降低 14%的跌倒率有效，但存在很大的异质性。亚组分析表明，多因素干预的跌倒减少率显著为 14%（RR=0.856，z=-2.039，P=0.041），且多因素干预组和单一干预组之间没有差异（Q=0.002，P=0.961），疗养院环境中的跌倒减少率为 55%（RR=0.453，z=-9.366，P=0.000），且疗养院组和社区组之间存在显著差异（Q=62.788，P=0.000），而将研究分为模型 I 或 II 并没有显著效果。敏感性分析发现，整体跌倒减少率为 9%（RR=0.906，95%CI=0.853-0.963，z=-3.179，P=0.001），包括多因素干预的跌倒减少率为 10%（RR=0.904，z=-3.036，P=0.002）、社区的跌倒减少率为 9%（RR=0.909，z=-3.179，P=0.001）和模型 I 的跌倒减少率为 12%（RR=0.876，z=-3.534，P=0.000），所有组之间均无差异。元回归表明，模型拟合解释了 68.6%的相关方差。
元敏感性分析表明，在过去 10 年（2000-2009 年）内进行的防跌倒计划的随机对照试验总体上有效，可降低 9%的跌倒率，其中多因素干预降低 10%、社区环境降低 9%、模型 I 干预（初始干预和随后的后续随访）降低 12%。
