Abstract
Smulders E, Weerdesteyn V, Groen BE, Duysens J, Eijsbouts A, Laan R, van Lankveld
W. Efficacy of a short multidisciplinary falls prevention program for elderly persons
with osteoporosis and a fall history: a randomized controlled trial.
Objective
To evaluate the efficacy of the Nijmegen Falls Prevention Program (NFPP) for persons
with osteoporosis and a fall history in a randomized controlled trial. Persons with
osteoporosis are at risk for fall-related fractures because of decreased bone strength.
A decrease in the number of falls therefore is expected to be particularly beneficial
for these persons.
Design
Randomized controlled trial.
Setting
Hospital.
Participants
Persons with osteoporosis and a fall history (N=96; mean ± SD age, 71.0±4.7y; 90 women).
Intervention
After baseline assessment, participants were randomly assigned to the exercise (n=50;
participated in the NFPP for persons with osteoporosis [5.5wk]) or control group (n=46;
usual care).
Main Outcome Measures
Primary outcome measure was fall rate, measured by using monthly fall calendars for
1 year. Secondary outcomes were balance confidence (Activity-specific Balance Confidence
Scale), quality of life (QOL; Quality of Life Questionnaire of the European Foundation
for Osteoporosis), and activity level (LASA Physical Activity Questionnaire, pedometer),
assessed posttreatment subsequent to the program and after 1 year of follow-up.
Results
The fall rate in the exercise group was 39% lower than for the control group (.72
vs 1.18 falls/person-year; risk ratio, .61; 95% confidence interval, .40–.94). Balance
confidence in the exercise group increased by 13.9% (P=.001). No group differences were observed in QOL and activity levels.
Conclusion
The NFPP for persons with osteoporosis was effective in decreasing the number of falls
and improving balance confidence. Therefore, it is a valuable new tool to improve
mobility and independence of persons with osteoporosis.
Key Words
List of Abbreviations:
ABC (Activity-specific Balance Confidence), ANOVA (analysis of variance), BMD (bone mineral density), CI (confidence interval), DXA (dual-energy x-ray absorptiometry), IRR (incidence rate ratio), LAPAQ (LASA Physical Activity Questionnaire), M1 (baseline), M2 (postintervention), M3 (1-year follow-up), NFPP (Nijmegen Falls Prevention Program), QOL (quality of life), QUALEFFO-41 (Quality of Life Questionnaire of the European Foundation for Osteoporosis)To read this article in full you will need to make a payment
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References
- What is the role of falls?.Best Pract Res Clin Rheumatol. 2005; 19: 913-935
- Incidence of and risk factors for falls and injurious falls among the community-dwelling elderly.Am J Epidemiol. 1993; 137: 342-354
- Risk factors for serious injury during falls by older persons in the community.J Am Geriatr Soc. 1995; 43: 1214-1221
- Consequences of falling in older men and women and risk factors for health service use and functional decline.Age Ageing. 2004; 33: 58-65
- Fall-induced deaths among elderly people.Am J Public Health. 2005; 95: 422-424
- Socio-demographic, health-related and psychosocial correlates of fear of falling and avoidance of activity in community-living older persons who avoid activity due to fear of falling.BMC Public Health. 2009; 9: 170
- Falls, injuries due to falls, and the risk of admission to a nursing home.N Engl J Med. 1997; 337: 1279-1284
- Shifting the focus in fracture prevention from osteoporosis to falls.BMJ. 2008; 336: 124-126
- Exercise interventions to reduce fall-related fractures and their risk factors in individuals with low bone density: a systematic review of randomized controlled trials.Osteoporosis Int. 2009; 20: 2111-2125
- Both resistance and agility training reduce back pain and improve health-related quality of life in older women with low bone mass.Osteoporos Int. 2005; 16: 1321-1329
- Balance training program is highly effective in improving functional status and reducing the risk of falls in elderly women with osteoporosis: a randomized controlled trial.Osteoporos Int. 2007; 18: 419-425
- Effect of impact exercise on bone mineral density in elderly women with low BMD: a population-based randomized controlled 30-month intervention.Osteoporos Int. 2006; 17: 109-118
- Randomised factorial trial of falls prevention among older people living in their own homes.BMJ. 2002; 325: 128
- Interventions for preventing falls in older people living in the community.Cochrane Database Syst Rev. 2009; 2 (CD007146)
- The effects of exercise on falls in elderly patients. A preplanned meta-analysis of the FICSIT Trials. Frailty and Injuries: Cooperative Studies of Intervention Techniques.JAMA. 1995; 273: 1341-1347
- Preventing injuries in older people by preventing falls: a meta-analysis of individual-level data.J Am Geriatr Soc. 2002; 50: 905-911
- A five-week exercise program can reduce falls and improve obstacle avoidance in the elderly.Gerontology. 2006; 52: 131-141
- The development of a multi-modal fall prevention program for persons with osteoporosis.in: Vincent M.L. Moreau T.M. Accidental falls: causes, preventions and interventions. Nova Publisher Inc, New York2008: 185-201
- Risk factors for injurious falls: a prospective study.J Gerontol. 1991; 46: M164-M170
- Risk factors for falls among elderly persons living in the community.N Engl J Med. 1988; 319: 1701-1707
- Could martial arts fall training be safe for persons with osteoporosis?.BMC Res Notes. 2010; 3: 111
- Development of a common outcome data set for fall injury prevention trials: the Prevention of Falls Network Europe consensus.J Am Geriatr Soc. 2005; 53: 1618-1622
- Assessing fear of falling: can a short version of the Activities-specific Balance Confidence Scale be useful?.Mov Disord. 2006; 21: 2101-2105
- The Activities-specific Balance Confidence (ABC) Scale.J Gerontol A Biol Sci Med Sci. 1995; 50A: M28-M34
- The short version of the Activities-specific Balance Confidence (ABC) Scale: its validity, reliability, and relationship to balance impairment and falls in older adults.Arch Gerontol Geriatr. 2009; 51: 9-12
- [Is the Activities-specific Balance Confidence Scale suitable for Dutch older persons living in the community?].Tijdschr Gerontol Geriatr. 2005; 36: 146-154
- Comparison of the LASA Physical Activity Questionnaire with a 7-day diary and pedometer.J Clin Epidemiol. 2004; 57: 252-258
- Quality of life in patients with vertebral fractures: validation of the Quality of Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO).Osteoporos Int. 1999; 10: 150-160
- Quality of life in patients with osteoporosis.Osteoporos Int. 2005; 16: 447-455
- Poisson regression model in epidemiology—an introduction.Ann Fac Medic Vet di Parma. 2006; XXVI: 25-44
- Patients with recurrent falls attending Accident & Emergency benefit from multifactorial intervention—a randomised controlled trial.Age Ageing. 2005; 34: 162-168
- Fall and injury prevention in older people living in residential care facilities.Ann Intern Med. 2002; 136: 733-741
- A multidisciplinary, multifactorial intervention program reduces postoperative falls and injuries after femoral neck fracture.Osteoporos Int. 2006; 18 (167-165)
- Interventions to reduce fear of falling in community-living older people: a systematic review.J Am Geriatr Soc. 2007; 55: 603-615
- Effects of a multicomponent cognitive behavioral group intervention on fear of falling and activity avoidance in community-dwelling older adults: results of a randomized controlled trial.J Am Geriatr Soc. 2009; 57: 2020-2028
- A randomized, controlled trial of a group intervention to reduce fear of falling and associated activity restriction in older adults.J Gerontol B Psychol Sci Soc Sci. 1998; 53: 384-392
- Falls exercise interventions and reduced falls rate: always in the patient's interest?.Age Ageing. 2008; 37: 10-13
- Prevalence and correlates of fear of falling, and associated avoidance of activity in the general population of community-living older people.Age Ageing. 2007; 36: 304-309
- Number of pedometer-assessed steps taken per day by adults: a descriptive meta-analysis.Phys Ther. 2007; 87: 1642-1650
- The effect of exercise training programs on bone mass: a meta-analysis of published controlled trials in pre- and postmenopausal women.Osteoporos Int. 1999; 9: 1-12
- Regulation of bone mass by mechanical strain magnitude.Calcified Tissue Int. 1985; 37: 411-417
- Effective exercise for the prevention of falls: a systematic review and meta-analysis.J Am Geriatr Soc. 2008; 56: 2234-2243
Article info
Footnotes
Supported by the Organization for Health-care Research in The Netherlands (ZonMW; grant no. 6100.00006).
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.
Trial registry number: NCT 00432692 (clinicaltrials.gov).
Reprints are not available from the author.
Identification
Copyright
© 2010 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
