Effectiveness and economic evaluation of a nurse delivered home exercise programme to prevent falls. 2: Controlled trial in multiple centres

Objectives To assess the effectiveness of trained nurses based in general p ractices individually prescribing a home exercise programme to reduce falls and injuries in elderly people and to estimate the cost effectiveness of t he programme. Design Controlled trial with one year's follow up. Setting 32 general practices in seven southern New Zealand centres. Participants 450 women and men aged 80 years and older. Intervention 330 participants received the exercise programme (exercise cen tres) and 120 received usual care (control centres); 87% (371 of 426) compl eted 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 30% in the exercise centres (incidence rate r atio 0.70, 95% confidence interval 0.59 to 0.84). The programme was equally effective in men and women. The programme cost $NZ418 (pound 121) (at 1998 prices) per person to deliver for one year or $NZ1519 (pound 441) per fall prevented. Fewer participants had falls resulting in injuries, but there w as no difference in the number who had serious injuries and no difference i n hospital costs resulting from falls in exercise centres compared with con trol centres. Conclusions An individually tailored exercise programme, delivered by train ed nurses from within general practices, was effective in reducing falls in three different centres, This strategy should be combined with other succe ssful interventions to form part of home programmes to prevent falls in eld erly people.