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Am Fam Physician. 2007;76(12):1872

Background: Falls occur in 30 to 50 percent of community-dwelling older persons at least once per year and are the most common cause of injuries, hospital admissions, and fractures in persons 65 years and older. Falls also cause significant psychological distress. Health-related quality of life (QOL) is a useful measure for determining the effect of interventions in older persons, partially because QOL is an important outcome in this group. Lin and colleagues used QOL as an outcome measure to evaluate the effects of fall prevention programs because these programs often affect the various domains of functioning captured by QOL assessments.

The Study: The study included Taiwanese residents 65 years and older who had fallen in the previous four weeks. Of 207 persons identified, 150 were enrolled in the study. Participants were randomly assigned to one of three interventions conducted at home visits every two weeks over four months. The interventions were education, home assessment and modification, and exercise training. The education group received information on exercise, environmental modification, and fall prevention. The home assessment group received home-safety assessments and specific recommendations for removing environmental hazards. The exercise group received 40 to 60 minutes of stretching, muscle strengthening, and balance training. Baseline measures included patient demographics, health and mental status, and fall details. Primary outcomes were scores on a brief, 26-item version of the World Health Organization Quality of Life instrument (WHOQOL-BREF). Secondary outcomes included functional measures such as activities of daily living (ADL), balance, gait, and depression level. Follow-up occurred at two and four months.

Results: After adjustments, the education group's WHOQOL-BREF scores increased significantly in the physical domain (increase of 3.9; 95% confidence interval [CI], 1.6 to 6.2), but the scores did not increase in the other three domains. Compared with the education group, the exercise group's scores in the physical domain did not increase to a statistically significant degree (increase of 2.1; 95% CI, −1.2 to 5.3). Scores increased by 3.8 (95% CI, 0.7 to 7.0) in the psychological domain, by 3.4 (95% CI, 0.7 to 6.1) in the social domain, and by 3.2 (95% CI, 0.6 to 5.7) in the environmental domain. The home assessment group's scores also increased in these domains compared with the education group, but the increases were not statistically significant.

Improvements in secondary outcome measures were significant in ADL and depression in the education group. Compared with the education group, the exercise group's scores increased significantly in functional reach, balance, and gait, and decreased significantly in fear of falling. Compared with the education group, the home assessment group's scores decreased significantly in depression. Differences in fall incidence over the six-month period was not statistically significant among groups.

Conclusion: The authors conclude that QOL outcomes suggest a greater benefit with exercise compared with the other interventions. The main usefulness of this study is that QOL measures are more sensitive than other measures in assessing the effect of fall prevention programs. Exercise programs that simply measure number of fall prevention as outcomes have conflicting results, in part because vigorous exercisers tend to fall more. However, studies of falls using QOL outcomes need to be refined to eliminate confounding factors.

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