Jansen Carl-Philipp, Gottschalk Sophie, Nerz Corinna, Labudek Sarah, Kramer-Gmeiner Franziska, Klenk Jochen, Clemson Lindy, Todd Chris, Dams Judith, König Hans-Helmut, Becker Clemens, Schwenk Michael
Department of Clinical Gerontology and Geriatric Rehabilitation, Robert Bosch Hospital, Stuttgart, Germany.
Institute of Sports and Sports Sciences, Heidelberg University, Heidelberg, Germany.
Age Ageing. 2023 Jan 8;52(1). doi: 10.1093/ageing/afac331.
the individually delivered Lifestyle-integrated Functional Exercise (LiFE) was shown to improve physical activity (PA) and reduce fall incidence, however being rather resource-consuming due to one-to-one delivery. A potentially less resource-intensive group format (gLiFE) was developed and compared against the original program, considering higher risk of falling due to possible PA enhancement.
to investigate non-inferiority in terms of PA-adjusted fall risk and cost-effectiveness of gLiFE at 12-month follow-up.
single-blinded, randomised, multi-centre non-inferiority trial.
community.
in total, 309 adults aged 70+ years at risk of or with history of falling; n = 153 in gLiFE, n = 156 in LiFE.
LiFE was delivered one-to-one at the participants' homes, gLiFE in a group. PA-adjusted fall risk was analysed using negative binomial regression to compare incidence rate ratios (IRR). Cost-effectiveness was presented by incremental cost-effectiveness ratios and cost-effectiveness acceptability curves, considering quality-adjusted life years, PA and falls as effect measures. Secondary analyses included PA (steps/day) and fall outcomes.
non-inferiority was inconclusive (IRR 0.96; 95% confidence interval, CI 0.67; 1.37); intervention costs were lower for gLiFE, but cost-effectiveness was uncertain. gLiFE participants significantly increased PA (+1,090 steps/day; 95% CI 345 and 1.835) versus insignificant increase in LiFE (+569, 95% CI -31; 1,168). Number of falls and fallers were reduced in both formats.
non-inferiority of gLiFE compared with LiFE was inconclusive after 12 months. Increases in PA were clinically relevant in both groups, although nearly twice as high in gLiFE. Despite lower intervention costs of gLiFE, it was not clearly superior in terms of cost-effectiveness.
个体化的生活方式整合功能锻炼（LiFE）已被证明可提高身体活动水平（PA）并降低跌倒发生率，但由于一对一指导，资源消耗较大。考虑到PA增强可能导致跌倒风险增加，开发了一种资源消耗可能较低的小组形式（gLiFE）并与原始方案进行比较。
在12个月随访时，研究gLiFE在PA调整后的跌倒风险和成本效益方面的非劣效性。
单盲、随机、多中心非劣效性试验。
社区。
共有309名70岁及以上有跌倒风险或有跌倒史的成年人；gLiFE组n = 153，LiFE组n = 156。
LiFE在参与者家中一对一进行指导，gLiFE以小组形式进行。使用负二项回归分析PA调整后的跌倒风险，以比较发病率比（IRR）。考虑质量调整生命年、PA和跌倒作为效果指标，通过增量成本效益比和成本效益可接受性曲线呈现成本效益。次要分析包括PA（每天步数）和跌倒结果。
非劣效性尚无定论（IRR 0.96；95%置信区间，CI 0.67；1.37）；gLiFE的干预成本较低，但成本效益不确定。与LiFE组增加不显著（+569，95% CI -31；1,168）相比，gLiFE组参与者的PA显著增加（+1,090步/天；95% CI 345和1,835）。两种形式的跌倒次数和跌倒者数量均减少。
12个月后，gLiFE与LiFE相比的非劣效性尚无定论。两组的PA增加均具有临床意义，尽管gLiFE组的增加几乎是LiFE组的两倍。尽管gLiFE的干预成本较低，但其在成本效益方面并不明显优于LiFE。
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