%0 Journal Article %T Effect of the STRIDE fall injury prevention intervention on falls, fall injuries, and health-related quality of life %J Journal of the American Geriatrics Society %D 2022 %A Ganz, David A. %A Yuan, Anita H. %A Greene, Erich J. %A Latham, Nancy K. %A Araujo, Katy %A Siu, Albert L. %A Magaziner, Jay %A Gurwitz, Jerry H. %A Wu, Albert W. %A Alexander, Neil B. %A Wallace, Robert B. %A Greenspan, Susan L. %A Rich, Jeremy %A Volpi, Elena %A Waring, Stephen C. %A Dykes, Patricia C. %A Ko, Fred %A Resnick, Neil M. %A McMahon, Siobhan K. %A Basaria, Shehzad %A Wang, Rixin %A Lu, Charles %A Esserman, Denise %A Dziura, James %A Miller, Michael E. %A Travison, Thomas G. %A Peduzzi, Peter %A Bhasin, Shalender %A Reuben, David B. %A Gill, Thomas M. %V ePub %N ePub %P ePub-ePub %X BACKGROUND: Falls are common in older adults and can lead to severe injuries. The Strategies to Reduce Injuries and Develop Confidence in Elders (STRIDE) trial cluster-randomized 86 primary care practices across 10 health systems to a multifactorial intervention to prevent fall injuries, delivered by registered nurses trained as falls care managers, or enhanced usual care. STRIDE enrolled 5451 community-dwelling older adults age ≥70 at increased fall injury risk.

METHODS: We assessed fall-related outcomes via telephone interviews of participants (or proxies) every 4 months. At baseline, 12 and 24 months, we assessed health-related quality of life (HRQOL) using the EQ-5D-5L and EQ-VAS. We used Poisson models to assess intervention effects on falls, fall-related fractures, fall injuries leading to hospital admission, and fall injuries leading to medical attention. We used hierarchical longitudinal linear models to assess HRQOL.

RESULTS: For recurrent event models, intervention versus control incidence rate ratios were 0.97 (95% confidence interval [CI], 0.93-1.00; p = 0.048) for falls, 0.93 (95% CI, 0.80-1.08; p = 0.337) for self-reported fractures, 0.89 (95% CI, 0.73-1.07; p = 0.205) for adjudicated fractures, 0.91 (95% CI, 0.77-1.07; p = 0.263) for falls leading to hospital admission, and 0.97 (95% CI, 0.89-1.06; p = 0.477) for falls leading to medical attention. Similar effect sizes (non-significant) were obtained for dichotomous outcomes (e.g., participants with ≥1 events). The difference in least square mean change over time in EQ-5D-5L (intervention minus control) was 0.009 (95% CI, -0.002 to 0.019; p = 0.106) at 12 months and 0.005 (95% CI, -0.006 to 0.015; p = 0.384) at 24 months.

CONCLUSIONS: Across a standard set of outcomes typically reported in fall prevention studies, we observed modest improvements, one of which was statistically significant. Future work should focus on patient-, practice-, and organization-level operational strategies to increase the real-world effectiveness of interventions, and improving the ability to detect small but potentially meaningful clinical effects. CLINICALTRIALS: gov identifier: NCT02475850.

Language: en

%G en %I John Wiley and Sons %@ 0002-8614 %U http://dx.doi.org/10.1111/jgs.17964