A randomized controlled trial of a community-based consultation service toprevent falls

Background: Multifaceted programs that combine assessment with intervention s have been shown to reduce subsequent falls in some clinical trials. We te sted this approach to see whether it would be effective if offered as a con sultation service using existing health care resources. Methods: The subjects of this randomized controlled trial had to be aged 65 years or more and had to have fallen within the previous 3 months. They we re randomly assigned to receive either usual care or the intervention, whic h consisted of in-home assessment in conjunction with the development of an individualized treatment plan, including an exercise program for those dee med likely to benefit. The primary outcomes were the proportion of particip ants who fell and the rate of falling during the following year. Visits to the emergency department and admissions to hospital were secondary outcomes . Results: One hundred and sixty-three subjects were randomly assigned,to eit her the control or the intervention group, and 152 provided data about thei r falls. There were no significant differences between the control and inte rvention groups in the cumulative number of falls (311 v. 241, p = 0.34), h aving one or more falls (79.2% v. 72.0%, p = 0.30) or in the mean number of falls (4.0 v. 3.2, p = 0.43). Analysis of secondary outcomes (health care use) also showed no significant differences between the intervention group and the control group. In the Cox regression analysis, there was no signifi cant difference between the groups in the proportion of subjects having one or more falls (p = 0.55), but there was a significantly (p < 0.001) longer time between falls in the intervention group. In a post hoc subgroup analy sis, subjects with more than 2 falls in the 3 months preceding study entry who had been assigned to the intervention group were less likely to fall (p = 0.046) and had a significantly longer time between falls (p <0.001), whe n compared with the group who received usual care. Interpretation: The intervention did not decrease significantly the cumulat ive number of falls, the likelihood of participants having at least one fal l over the next year or the mean number of falls. It did increase significa ntly the time between falls in a survival analysis when age, sex and histor y of falling were used as covariates.