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- Title
Effect of a Home-Based Exercise Program on Subsequent Falls Among Community-Dwelling High-Risk Older Adults After a Fall: A Randomized Clinical Trial.
- Authors
Liu-Ambrose, Teresa; Davis, Jennifer C.; Best, John R.; Dian, Larry; Madden, Kenneth; Cook, Wendy; Hsu, Chun Liang; Khan, Karim M.
- Abstract
<bold>Importance: </bold>Whether exercise reduces subsequent falls in high-risk older adults who have already experienced a fall is unknown.<bold>Objective: </bold>To assess the effect of a home-based exercise program as a fall prevention strategy in older adults who were referred to a fall prevention clinic after an index fall.<bold>Design, Setting, and Participants: </bold>A 12-month, single-blind, randomized clinical trial conducted from April 22, 2009, to June 5, 2018, among adults aged at least 70 years who had a fall within the past 12 months and were recruited from a fall prevention clinic.<bold>Interventions: </bold>Participants were randomized to receive usual care plus a home-based strength and balance retraining exercise program delivered by a physical therapist (intervention group; n = 173) or usual care, consisting of fall prevention care provided by a geriatrician (usual care group; n = 172). Both were provided for 12 months.<bold>Main Outcomes and Measures: </bold>The primary outcome was self-reported number of falls over 12 months. Adverse event data were collected in the exercise group only and consisted of falls, injuries, or muscle soreness related to the exercise intervention.<bold>Results: </bold>Among 345 randomized patients (mean age, 81.6 [SD, 6.1] years; 67% women), 296 (86%) completed the trial. During a mean follow-up of 338 (SD, 81) days, a total of 236 falls occurred among 172 participants in the exercise group vs 366 falls among 172 participants in the usual care group. Estimated incidence rates of falls per person-year were 1.4 (95% CI, 0.1-2.0) vs 2.1 (95% CI, 0.1-3.2), respectively. The absolute difference in fall incidence was 0.74 (95% CI, 0.04-1.78; P = .006) falls per person-year and the incident rate ratio was 0.64 (95% CI, 0.46-0.90; P = .009). No adverse events related to the intervention were reported.<bold>Conclusions and Relevance: </bold>Among older adults receiving care at a fall prevention clinic after a fall, a home-based strength and balance retraining exercise program significantly reduced the rate of subsequent falls compared with usual care provided by a geriatrician. These findings support the use of this home-based exercise program for secondary fall prevention but require replication in other clinical settings.<bold>Trial Registration: </bold>ClinicalTrials.gov Identifiers: NCT01029171; NCT00323596.
- Subjects
GERIATRICIANS; PHYSICAL therapists; CLINICAL trials; PHYSICAL training &; conditioning; ACCIDENTAL fall prevention; OLDER people; MYALGIA; DISEASE relapse prevention; COMPARATIVE studies; POSTURAL balance; EXERCISE therapy; ACCIDENTAL falls; LONGITUDINAL method; RESEARCH methodology; MEDICAL cooperation; RESEARCH; RESEARCH funding; EVALUATION research; INDEPENDENT living; BLIND experiment; RESISTANCE training
- Publication
JAMA: Journal of the American Medical Association, 2019, Vol 321, Issue 21, p2092
- ISSN
0098-7484
- Publication type
journal article
- DOI
10.1001/jama.2019.5795