OBJECTIVE: To evaluate the literature on effectiveness of remote feedback on physical activity and capacity in home-based physical activity interventions for older adults with or without medical conditions. In addition, the effect of remote feedback on adherence was inventoried.
METHODS: A systematic review. Data sources included PubMed, PsycInfo, Cochrane and EMBASE. A best-evidence synthesis was used for qualitative summarizing of results.
RESULTS: Twenty-four studies met the inclusion criteria for systematic effectiveness evaluation and 22 for adherence inventory. Three categories of contact were identified: frequent, non-frequent, and direct remote contact during exercising. Evidence for positive enhancement of physical activity or capacity varied from conflicting in frequent contact strategies (16 studies) to strong in non-frequent (5 studies) and direct contact strategies (3 studies). Adherence rates in intervention groups were similar or higher than treatment-as-usual or exercise control groups.
CONCLUSION: Results imply with varying strength that interventions using frequent, non-frequent or direct remote feedback seem more effective than treatment as usual and equally effective as supervised exercise interventions. Direct remote contact seems a particularly good alternative to supervised onsite exercising.
PRACTICE IMPLICATIONS: Remote feedback is promising in an older population getting increasingly used to new technology.
QUESTIONS: What factors are associated with adherence of older adults to group exercise interventions for the prevention of falls? What is the relationship between adherence and the falls prevention efficacy of the intervention? DESIGN: Systematic review with meta-analysis of randomised trials. PARTICIPANTS: Older adults (60 years and older) undertaking a group exercise intervention for falls prevention. INTERVENTION: Group exercise not in combination with a home program and intended at least in part for falls prevention. OUTCOME MEASURES: Adherence was measured as the mean proportion of sessions attended, including participants who discontinued the intervention. Falls prevention efficacy was measured as the proportion of fallers in the intervention versus the control group at follow-up. Various program-related factors, including intervention duration, session frequency, and components of the exercise regimen were examined for each of the studies. RESULTS: Of the 210 articles identified, 18 studies met the inclusion criteria and were analysed. The pooled estimate of adherence across the studies was 0.74 (95% CI 0.67 to 0.80). Lower levels of adherence were associated with group exercise interventions that had a duration of 20 weeks or more, two or fewer sessions per week, or a flexibility component. No significant relationship was found between adherence and falls prevention efficacy. CONCLUSION: Program-related factors may influence adherence to group exercise interventions for the prevention of falls. Further research is encouraged to more precisely determine the effect of intervention level factors on adherence, and the effect of adherence on intervention efficacy.
OBJECTIVE: To determine whether adherence to home exercise interventions for the prevention of falls in older adults relates to home exercise program characteristics and intervention efficacy.
METHODS: In Australia (2011) a systematic literature search of four databases was conducted. Randomized controlled trials were included. Random-effects meta-analysis of participant adherence rates was performed. Meta-regression analyses were used to determine the relationship between intervention program characteristics, intervention efficacy and adherence.
RESULTS: Twenty-three studies met the inclusion criteria. The pooled estimate of participants who were fully adherent was 21% (95% Confidence Interval: 15%-29%, range: 0%-68%). Higher levels of full adherence were found in interventions containing balance or walking exercise, moderate home visit support, physiotherapist led delivery and no flexibility training. Higher levels of partial adherence were found in interventions containing home visit or telephone support, a participant health service recruitment approach and no group exercise training. Neither full nor partial adherence to prescribed home exercise program dosages was associated with intervention efficacy.
CONCLUSION: Adherence to home exercise for the prevention of falls in older adults is low and may be affected by home exercise program characteristics. There is an absence of evidence to link adherence to intervention efficacy.
BACKGROUND: Approximately 30% of people over 65 years of age living in the community fall each year. This is an update of a Cochrane review first published in 2009.
OBJECTIVES: To assess the effects of interventions designed to reduce the incidence of falls in older people living in the community.
SEARCH METHODS: We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (February 2012), CENTRAL (The Cochrane Library 2012, Issue 3), MEDLINE (1946 to March 2012), EMBASE (1947 to March 2012), CINAHL (1982 to February 2012), and online trial registers.
SELECTION CRITERIA: Randomised trials of interventions to reduce falls in community-dwelling older people.
DATA COLLECTION AND ANALYSIS: Two review authors independently assessed risk of bias and extracted data. We used a rate ratio (RaR) and 95% confidence interval (CI) to compare the rate of falls (e.g. falls per person year) between intervention and control groups. For risk of falling, we used a risk ratio (RR) and 95% CI based on the number of people falling (fallers) in each group. We pooled data where appropriate.
MAIN RESULTS: We included 159 trials with 79,193 participants. Most trials compared a fall prevention intervention with no intervention or an intervention not expected to reduce falls. The most common interventions tested were exercise as a single intervention (59 trials) and multifactorial programmes (40 trials). Sixty-two per cent (99/159) of trials were at low risk of bias for sequence generation, 60% for attrition bias for falls (66/110), 73% for attrition bias for fallers (96/131), and only 38% (60/159) for allocation concealment.Multiple-component group exercise significantly reduced rate of falls (RaR 0.71, 95% CI 0.63 to 0.82; 16 trials; 3622 participants) and risk of falling (RR 0.85, 95% CI 0.76 to 0.96; 22 trials; 5333 participants), as did multiple-component home-based exercise (RaR 0.68, 95% CI 0.58 to 0.80; seven trials; 951 participants and RR 0.78, 95% CI 0.64 to 0.94; six trials; 714 participants). For Tai Chi, the reduction in rate of falls bordered on statistical significance (RaR 0.72, 95% CI 0.52 to 1.00; five trials; 1563 participants) but Tai Chi did significantly reduce risk of falling (RR 0.71, 95% CI 0.57 to 0.87; six trials; 1625 participants).Multifactorial interventions, which include individual risk assessment, reduced rate of falls (RaR 0.76, 95% CI 0.67 to 0.86; 19 trials; 9503 participants), but not risk of falling (RR 0.93, 95% CI 0.86 to 1.02; 34 trials; 13,617 participants).Overall, vitamin D did not reduce rate of falls (RaR 1.00, 95% CI 0.90 to 1.11; seven trials; 9324 participants) or risk of falling (RR 0.96, 95% CI 0.89 to 1.03; 13 trials; 26,747 participants), but may do so in people with lower vitamin D levels before treatment.Home safety assessment and modification interventions were effective in reducing rate of falls (RR 0.81, 95% CI 0.68 to 0.97; six trials; 4208 participants) and risk of falling (RR 0.88, 95% CI 0.80 to 0.96; seven trials; 4051 participants). These interventions were more effective in people at higher risk of falling, including those with severe visual impairment. Home safety interventions appear to be more effective when delivered by an occupational therapist.An intervention to treat vision problems (616 participants) resulted in a significant increase in the rate of falls (RaR 1.57, 95% CI 1.19 to 2.06) and risk of falling (RR 1.54, 95% CI 1.24 to 1.91). When regular wearers of multifocal glasses (597 participants) were given single lens glasses, all falls and outside falls were significantly reduced in the subgroup that regularly took part in outside activities. Conversely, there was a significant increase in outside falls in intervention group participants who took part in little outside activity.Pacemakers reduced rate of falls in people with carotid sinus hypersensitivity (RaR 0.73, 95% CI 0.57 to 0.93; three trials; 349 participants) but not risk of falling. First eye cataract surgery in women reduced rate of falls (RaR 0.66, 95% CI 0.45 to 0.95; one trial; 306 participants), but second eye cataract surgery did not.Gradual withdrawal of psychotropic medication reduced rate of falls (RaR 0.34, 95% CI 0.16 to 0.73; one trial; 93 participants), but not risk of falling. A prescribing modification programme for primary care physicians significantly reduced risk of falling (RR 0.61, 95% CI 0.41 to 0.91; one trial; 659 participants).An anti-slip shoe device reduced rate of falls in icy conditions (RaR 0.42, 95% CI 0.22 to 0.78; one trial; 109 participants). One trial (305 participants) comparing multifaceted podiatry including foot and ankle exercises with standard podiatry in people with disabling foot pain significantly reduced the rate of falls (RaR 0.64, 95% CI 0.45 to 0.91) but not the risk of falling.There is no evidence of effect for cognitive behavioural interventions on rate of falls (RaR 1.00, 95% CI 0.37 to 2.72; one trial; 120 participants) or risk of falling (RR 1.11, 95% CI 0.80 to 1.54; two trials; 350 participants).Trials testing interventions to increase knowledge/educate about fall prevention alone did not significantly reduce the rate of falls (RaR 0.33, 95% CI 0.09 to 1.20; one trial; 45 participants) or risk of falling (RR 0.88, 95% CI 0.75 to 1.03; four trials; 2555 participants).No conclusions can be drawn from the 47 trials reporting fall-related fractures.Thirteen trials provided a comprehensive economic evaluation. Three of these indicated cost savings for their interventions during the trial period: home-based exercise in over 80-year-olds, home safety assessment and modification in those with a previous fall, and one multifactorial programme targeting eight specific risk factors.
AUTHORS' CONCLUSIONS: Group and home-based exercise programmes, and home safety interventions reduce rate of falls and risk of falling.Multifactorial assessment and intervention programmes reduce rate of falls but not risk of falling; Tai Chi reduces risk of falling.Overall, vitamin D supplementation does not appear to reduce falls but may be effective in people who have lower vitamin D levels before treatment.
To evaluate the literature on effectiveness of remote feedback on physical activity and capacity in home-based physical activity interventions for older adults with or without medical conditions. In addition, the effect of remote feedback on adherence was inventoried.
METHODS:
A systematic review. Data sources included PubMed, PsycInfo, Cochrane and EMBASE. A best-evidence synthesis was used for qualitative summarizing of results.
RESULTS:
Twenty-four studies met the inclusion criteria for systematic effectiveness evaluation and 22 for adherence inventory. Three categories of contact were identified: frequent, non-frequent, and direct remote contact during exercising. Evidence for positive enhancement of physical activity or capacity varied from conflicting in frequent contact strategies (16 studies) to strong in non-frequent (5 studies) and direct contact strategies (3 studies). Adherence rates in intervention groups were similar or higher than treatment-as-usual or exercise control groups.
CONCLUSION:
Results imply with varying strength that interventions using frequent, non-frequent or direct remote feedback seem more effective than treatment as usual and equally effective as supervised exercise interventions. Direct remote contact seems a particularly good alternative to supervised onsite exercising.
PRACTICE IMPLICATIONS:
Remote feedback is promising in an older population getting increasingly used to new technology.
