Effectiveness and economic evaluation of a nurse delivered home exercise programme to prevent falls. 1: Randomised controlled trial

Objectives To assess the effectiveness of a trained district nurse individu ally prescribing a home based exercise programme to reduce falls and injuri es in elderly people and to estimate the cost effectiveness of the programm e. Design Randomised controlled trial with one year's follow up. Setting Community health service at a New Zealand hospital. Participants 240 women and men aged 75 years and older. Intervention 121 participants received the exercise programme (exercise gro up) and 119 received usual care (control group); 90% (211 of 233) completed the trial. Main outcome measures Number of falls, number of injuries resulting from fa lls, costs of implementing the programme, and hospital costs as a result of falls. Results Falls were reduced by 46% (incidence rate ratio 0.54, 95% confidenc e interval 0.32 to 0.90). Five hospital admissions were due to injuries cau sed by falls in the control group and none in the exercise group. The progr amme cost $NZ1803 (pound 523) (at 1998 prices) per fall prevented for deliv ering the programme and $NZ155 per fall prevented when hospital costs avert ed were considered. Conclusion A home exercise programme, previously shown to be successful whe n delivered by a physiotherapist, was also effective in reducing falls when delivered by a trained nurse from within a home health service. Serious in juries and hospital admissions due to falls were also reduced. The programm e was cost effective in participants aged 80 years and older compared with younger participants.