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Abstract
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Commentary :: Provenance: Invited. Not peer reviewed.
Cases for public policy to introduce community-based falls prevention programs rely on the belief that preventing falls will prevent the negative sequelae of falls, such as fractures.1 This belief is well grounded in data, with a recent Cochrane review indicating that falls prevention exercise programs reduce the risk of fall-related fracture.2 Therefore, what could explain the null findings reported by Lamb et al for both exercise and multifactorial falls prevention interventions?
The primary outcome for this trial was fractures, captured using multiple data reporting systems. This approach is superior to previous trials included in the Cochrane meta-analysis that relied on self-reported falls and fractures and were vulnerable to obsequious response bias. However, this was a pragmatic trial of a targeted approach to delivering these interventions, so direct inferences should not be drawn from the overall results about the efficacy of these interventions. In this study, 39% of all fractures occurred in people who were not assessed as high risk and were not eligible for intervention, which renders the employed screening approach questionable. Only 22% attended one or more exercise sessions, and 19% attended a multifactorial intervention session. There was also a near 4-month delay from randomisation until the commencement of the intervention. Figure S3 illustrates discrepancies in fracture rate across low-risk subgroups in each cohort, even though they all received advice only, and that exercise may have delayed time to first fracture among high-risk individuals. Despite these issues, it is still clear that this large-scale, very real-life roll-out of these targeted falls-prevention interventions failed to reduce fracture rates. Although clinicians can justifiably still trust in these interventions, it would be fair for policy-makers to question whether falls and fracture prevention in community-dwelling adults observed in efficacy trials can successfully be translated into real-life contexts...
Language: en |