STRIDE 跌倒伤害预防干预对跌倒、跌倒伤害和健康相关生活质量的影响。
Effect of the STRIDE fall injury prevention intervention on falls, fall injuries, and health-related quality of life.
机构信息
Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
Geriatric Research, Education and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA.
出版信息
J Am Geriatr Soc. 2022 Nov;70(11):3221-3229. doi: 10.1111/jgs.17964. Epub 2022 Aug 6.
BACKGROUND
Falls are common in older adults and can lead to severe injuries. The Strategies to Reduce Injuries and Develop Confidence in Elders (STRIDE) trial cluster-randomized 86 primary care practices across 10 health systems to a multifactorial intervention to prevent fall injuries, delivered by registered nurses trained as falls care managers, or enhanced usual care. STRIDE enrolled 5451 community-dwelling older adults age ≥70 at increased fall injury risk.
METHODS
We assessed fall-related outcomes via telephone interviews of participants (or proxies) every 4 months. At baseline, 12 and 24 months, we assessed health-related quality of life (HRQOL) using the EQ-5D-5L and EQ-VAS. We used Poisson models to assess intervention effects on falls, fall-related fractures, fall injuries leading to hospital admission, and fall injuries leading to medical attention. We used hierarchical longitudinal linear models to assess HRQOL.
RESULTS
For recurrent event models, intervention versus control incidence rate ratios were 0.97 (95% confidence interval [CI], 0.93-1.00; p = 0.048) for falls, 0.93 (95% CI, 0.80-1.08; p = 0.337) for self-reported fractures, 0.89 (95% CI, 0.73-1.07; p = 0.205) for adjudicated fractures, 0.91 (95% CI, 0.77-1.07; p = 0.263) for falls leading to hospital admission, and 0.97 (95% CI, 0.89-1.06; p = 0.477) for falls leading to medical attention. Similar effect sizes (non-significant) were obtained for dichotomous outcomes (e.g., participants with ≥1 events). The difference in least square mean change over time in EQ-5D-5L (intervention minus control) was 0.009 (95% CI, -0.002 to 0.019; p = 0.106) at 12 months and 0.005 (95% CI, -0.006 to 0.015; p = 0.384) at 24 months.
CONCLUSIONS
Across a standard set of outcomes typically reported in fall prevention studies, we observed modest improvements, one of which was statistically significant. Future work should focus on patient-, practice-, and organization-level operational strategies to increase the real-world effectiveness of interventions, and improving the ability to detect small but potentially meaningful clinical effects.
CLINICALTRIALS
gov identifier: NCT02475850.
背景
老年人经常会跌倒，这可能导致严重的伤害。减少伤害和增强老年人信心的策略（STRIDE）试验以群组为单位，将 86 个初级保健机构随机分配到 10 个卫生系统中，以接受多因素干预，预防跌倒伤害，该干预由经过培训的注册护士担任跌倒护理经理来实施，或者提供增强的常规护理。STRIDE 招募了 5451 名居住在社区、年龄在 70 岁以上且有较高跌倒伤害风险的老年人。
方法
我们通过每 4 个月对参与者（或代理人）进行电话访谈，评估与跌倒相关的结果。在基线、12 个月和 24 个月时，我们使用 EQ-5D-5L 和 EQ-VAS 评估健康相关生活质量（HRQOL）。我们使用泊松模型评估干预对跌倒、与跌倒相关的骨折、导致住院的跌倒伤害和导致医疗关注的跌倒伤害的影响。我们使用分层纵向线性模型评估 HRQOL。
结果
对于复发性事件模型，与对照组相比，干预组的跌倒发生率的比率为 0.97（95%置信区间 [CI]，0.93-1.00；p=0.048），自我报告的骨折发生率的比率为 0.93（95% CI，0.80-1.08；p=0.337），经裁决的骨折发生率的比率为 0.89（95% CI，0.73-1.07；p=0.205），导致住院的跌倒发生率的比率为 0.91（95% CI，0.77-1.07；p=0.263），导致医疗关注的跌倒发生率的比率为 0.97（95% CI，0.89-1.06；p=0.477）。对于二分结局（例如，有≥1 次事件的参与者），也得到了类似的效应大小（无统计学意义）。在 EQ-5D-5L 中，干预组与对照组的最小平方均值变化差异为 0.009（95% CI，-0.002 至 0.019；p=0.106），在 12 个月时为 0.005（95% CI，-0.006 至 0.015；p=0.384）。
结论
在一组通常在预防跌倒研究中报告的标准结局中，我们观察到适度的改善，其中一项改善具有统计学意义。未来的工作应侧重于患者、实践和组织层面的运营策略，以提高干预措施在现实世界中的有效性，并提高检测潜在有意义的临床效果的能力。
临床试验
gov 标识符：NCT02475850。
Zotero 插件