Univ Paris-Sud, UMRS 1018, F-94807, Villejuif, France.
BMJ. 2013 Oct 29;347:f6234. doi: 10.1136/bmj.f6234.
To determine whether, and to what extent, fall prevention exercise interventions for older community dwelling people are effective in preventing different types of fall related injuries.
Electronic databases (PubMed, the Cochrane Library, Embase, and CINAHL) and reference lists of included studies and relevant reviews from inception to July 2013.
Randomised controlled trials of fall prevention exercise interventions, targeting older (>60 years) community dwelling people and providing quantitative data on injurious falls, serious falls, or fall related fractures.
Based on a systematic review of the case definitions used in the selected studies, we grouped the definitions of injurious falls into more homogeneous categories to allow comparisons of results across studies and the pooling of data. For each study we extracted or calculated the rate ratio of injurious falls. Depending on the available data, a given study could contribute data relevant to one or more categories of injurious falls. A pooled rate ratio was estimated for each category of injurious falls based on random effects models.
17 trials involving 4305 participants were eligible for meta-analysis. Four categories of falls were identified: all injurious falls, falls resulting in medical care, severe injurious falls, and falls resulting in fractures. Exercise had a significant effect in all categories, with pooled estimates of the rate ratios of 0.63 (95% confidence interval 0.51 to 0.77, 10 trials) for all injurious falls, 0.70 (0.54 to 0.92, 8 trials) for falls resulting in medical care, 0.57 (0.36 to 0.90, 7 trials) for severe injurious falls, and 0.39 (0.22 to 0.66, 6 trials) for falls resulting in fractures, but significant heterogeneity was observed between studies of all injurious falls (I(2)=50%, P=0.04).
Exercise programmes designed to prevent falls in older adults also seem to prevent injuries caused by falls, including the most severe ones. Such programmes also reduce the rate of falls leading to medical care.
确定针对老年社区居住人群的防跌倒运动干预措施在预防不同类型跌倒相关伤害方面的效果，以及效果的大小。
电子数据库（PubMed、Cochrane 图书馆、Embase 和 CINAHL），以及纳入研究的参考文献列表和相关综述，检索时间截至 2013 年 7 月。
针对老年（>60 岁）社区居住人群的防跌倒运动干预措施的随机对照试验，提供关于伤害性跌倒、严重跌倒或跌倒相关骨折的定量数据。
基于对纳入研究中使用的病例定义的系统回顾，我们将伤害性跌倒的定义分为更同质的类别，以便对研究结果进行比较，并对数据进行合并。对于每项研究，我们提取或计算伤害性跌倒的率比值。根据可用数据，一项研究可能为一个或多个伤害性跌倒类别提供数据。基于随机效应模型，为每个伤害性跌倒类别估算合并率比值。
有 17 项涉及 4305 名参与者的试验符合荟萃分析的纳入标准。确定了 4 种跌倒类型：所有伤害性跌倒、导致医疗护理的跌倒、严重伤害性跌倒和导致骨折的跌倒。运动在所有类别中均有显著效果，合并率比值的估计值分别为：所有伤害性跌倒（10 项研究）0.63（95%置信区间 0.51 至 0.77），导致医疗护理的跌倒（8 项研究）0.70（0.54 至 0.92），严重伤害性跌倒（7 项研究）0.57（0.36 至 0.90），导致骨折的跌倒（6 项研究）0.39（0.22 至 0.66），但所有伤害性跌倒的研究之间存在显著的异质性（I(2)=50%，P=0.04）。
旨在预防老年人跌倒的运动方案似乎也能预防跌倒相关伤害，包括最严重的伤害。此类方案还能降低导致医疗护理的跌倒发生率。
