BACKGROUND:Annually, about 30% of the persons of 65 years and older falls at least once and 15% falls at least twice. Falls often result in serious injuries, such as fractures. Therefore, the prevention of accidental falls is necessary. The aim is to describe the design of a study that evaluates the efficacy and cost-effectiveness of a multidisciplinary assessment and treatment of multiple fall risk factors in independently living older persons with a high risk of falling. METHODS/DESIGN:The study is designed as a randomised controlled trial (RCT) with an economic evaluation. Independently living persons of 65 years and older who recently experienced a fall are interviewed in their homes and screened for risk of recurrent falling using a validated fall risk profile. Persons at low risk of recurrent falling are excluded from the RCT. Persons who have a high risk of recurrent falling are blindly randomised into an intervention (n = 100) or usual care (n = 100) group. The intervention consists of a multidisciplinary assessment and treatment of multifactorial fall risk factors. The transmural multidisciplinary approach entails close cooperation between geriatrician, primary care physician, physical therapist and occupational therapist and can be extended with other specialists if relevant. A fall calendar is used to record falls during one year of follow-up. Primary outcomes are time to first and second falls. Three, six and twelve months after the home visit, questionnaires for economic evaluation are completed. After one year, during a second home visit, the secondary outcome measures are reassessed and the adherence to the interventions is evaluated. Data will be analysed according to the intention-to-treat principle and also an on-treatment analysis will be performed. DISCUSSION:Strengths of this study are the selection of persons at high risk of recurrent falling followed by a multidisciplinary intervention, its transmural character and the evaluation of adherence. If proven effective, implementation of our multidisciplinary assessment followed by treatment of fall risk factors will reduce the incidence of falls. TRIAL REGISTRATION:Current Controlled Trials ISRCTN11546541.

译文

背景:每年,年龄在65岁以上的人中至少有30%跌倒一次,而15%的人跌倒至少两次。跌倒通常会导致严重的伤害,例如骨折。因此,防止意外跌倒是必要的。目的是描述一项研究的设计,该研究评估多学科评估和多种跌倒危险因素的治疗的多学科评估和治疗的有效性和成本效益,这些老人独立生活在有跌倒高风险的老年人中。
方法/设计:本研究设计为具有经济评估的随机对照试验(RCT)。最近经历过跌倒的65岁及65岁以上的独立生活者在他们的家中接受采访,并使用经过验证的跌倒风险图来筛查反复跌倒的风险。反复跌倒风险低的人不包括在RCT中。反复跌倒风险高的人被盲目随机分为干预组(n = 100)或常规护理组(n = 100)。干预措施包括多学科评估和多因素跌倒危险因素的治疗。跨壁的多学科方法需要老年医生,初级保健医师,物理治疗师和职业治疗师之间的密切合作,并且可以在相关专家的陪同下进行扩展。秋季日历用于记录随访一年中的秋季。主要结果是第一次和第二次跌倒的时间。进行家访后的三个,六个和十二个月,完成了经济评估问卷。一年后,在第二次家庭访视期间,将重新评估次要结局指标,并评估对干预措施的依从性。将根据意向性治疗原则对数据进行分析,并进行治疗中分析。
讨论:本研究的优势在于选择高风险反复跌倒的人,然后进行多学科干预,其透壁性和依从性评估。如果证明有效,实施我们的多学科评估再治疗跌倒危险因素,将减少跌倒的发生率。
试用注册:电流控制试验ISRCTN11546541。

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