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What works in falls prevention in Asia: a systematic review and meta-analysis of randomized controlled trials

Background There is strong research evidence for falls prevention among older people in the community setting, although most is from Western countries. Differences between countries (eg sunlight exposure, diet, environment, exercise preferences) may influence the success of implementing falls preve...

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Main Authors:	Hill, Keith D., Suttanon, Plaiwan, Lin, Sang-I, Tsang, William W.N., Ashari, Asmidawati, Abd Hamid, Tengku Aizan, Farrier, Kaela, Burton, Elissa
Format:	Article
Language:	English
Published:	BioMed Central 2018
Online Access:	http://psasir.upm.edu.my/id/eprint/74435/1/s12877-017-0683-1.pdf http://psasir.upm.edu.my/id/eprint/74435/ https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-017-0683-1
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spelling	my.upm.eprints.744352024-09-11T01:48:52Z http://psasir.upm.edu.my/id/eprint/74435/ What works in falls prevention in Asia: a systematic review and meta-analysis of randomized controlled trials Hill, Keith D. Suttanon, Plaiwan Lin, Sang-I Tsang, William W.N. Ashari, Asmidawati Abd Hamid, Tengku Aizan Farrier, Kaela Burton, Elissa Background There is strong research evidence for falls prevention among older people in the community setting, although most is from Western countries. Differences between countries (eg sunlight exposure, diet, environment, exercise preferences) may influence the success of implementing falls prevention approaches in Asian countries that have been shown to be effective elsewhere in the world. The aim of this review is to evaluate the scope and effectiveness of falls prevention randomized controlled trials (RCTs) from the Asian region. Method RCTs investigating falls prevention interventions conducted in Asian countries from (i) the most recent (2012) Cochrane community setting falls prevention review, and (ii) subsequent published RCTs meeting the same criteria were identified, classified and grouped according to the ProFANE intervention classification. Characteristics of included trials were extracted from both the Cochrane review and original publications. Where ≥2 studies investigated an intervention type in the Asian region, a meta-analysis was performed. Results Fifteen of 159 RCTs in the Cochrane review were conducted in the Asian region (9%), and a further 11 recent RCTs conducted in Asia were identified (total 26 Asian studies: median 160 participants, mean age:75.1, female:71.9%). Exercise (15 RCTs) and home assessment/modification (n = 2) were the only single interventions with ≥2 RCTs. Intervention types with ≥1 effective RCT in reducing fall outcomes were exercise (6 effective), home modification (1 effective), and medication (vitamin D) (1 effective). One multiple and one multifactorial intervention also had positive falls outcomes. Meta-analysis of exercise interventions identified significant benefit (number of fallers: Odds Ratio 0.43 [0.34,0.53]; number of falls: 0.35 [0.21,0.57]; and number of fallers injured: 0.50 [0.35,0.71]); but multifactorial interventions did not reach significance (number of fallers OR = 0.57 [0.23,1.44]). Conclusion There is a small but growing research base of falls prevention RCTs from Asian countries, with exercise approaches being most researched and effective. For other interventions shown to be effective elsewhere, consideration of local issues is required to ensure that research and programs implemented in these countries are effective, and relevant to the local context, people, and health system. There is also a need for further high quality, appropriately powered falls prevention trials in Asian countries. BioMed Central 2018-01-05 Article PeerReviewed text en http://psasir.upm.edu.my/id/eprint/74435/1/s12877-017-0683-1.pdf Hill, Keith D. and Suttanon, Plaiwan and Lin, Sang-I and Tsang, William W.N. and Ashari, Asmidawati and Abd Hamid, Tengku Aizan and Farrier, Kaela and Burton, Elissa (2018) What works in falls prevention in Asia: a systematic review and meta-analysis of randomized controlled trials. BMC Geriatrics, 18 (1). art. no. 3. pp. 1-21. ISSN 1471-2318 (In Press) https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-017-0683-1 10.1186/s12877-017-0683-1
institution	Universiti Putra Malaysia
building	UPM Library
collection	Institutional Repository
continent	Asia
country	Malaysia
content_provider	Universiti Putra Malaysia
content_source	UPM Institutional Repository
url_provider	http://psasir.upm.edu.my/
language	English
description	Background There is strong research evidence for falls prevention among older people in the community setting, although most is from Western countries. Differences between countries (eg sunlight exposure, diet, environment, exercise preferences) may influence the success of implementing falls prevention approaches in Asian countries that have been shown to be effective elsewhere in the world. The aim of this review is to evaluate the scope and effectiveness of falls prevention randomized controlled trials (RCTs) from the Asian region. Method RCTs investigating falls prevention interventions conducted in Asian countries from (i) the most recent (2012) Cochrane community setting falls prevention review, and (ii) subsequent published RCTs meeting the same criteria were identified, classified and grouped according to the ProFANE intervention classification. Characteristics of included trials were extracted from both the Cochrane review and original publications. Where ≥2 studies investigated an intervention type in the Asian region, a meta-analysis was performed. Results Fifteen of 159 RCTs in the Cochrane review were conducted in the Asian region (9%), and a further 11 recent RCTs conducted in Asia were identified (total 26 Asian studies: median 160 participants, mean age:75.1, female:71.9%). Exercise (15 RCTs) and home assessment/modification (n = 2) were the only single interventions with ≥2 RCTs. Intervention types with ≥1 effective RCT in reducing fall outcomes were exercise (6 effective), home modification (1 effective), and medication (vitamin D) (1 effective). One multiple and one multifactorial intervention also had positive falls outcomes. Meta-analysis of exercise interventions identified significant benefit (number of fallers: Odds Ratio 0.43 [0.34,0.53]; number of falls: 0.35 [0.21,0.57]; and number of fallers injured: 0.50 [0.35,0.71]); but multifactorial interventions did not reach significance (number of fallers OR = 0.57 [0.23,1.44]). Conclusion There is a small but growing research base of falls prevention RCTs from Asian countries, with exercise approaches being most researched and effective. For other interventions shown to be effective elsewhere, consideration of local issues is required to ensure that research and programs implemented in these countries are effective, and relevant to the local context, people, and health system. There is also a need for further high quality, appropriately powered falls prevention trials in Asian countries.
format	Article
author	Hill, Keith D. Suttanon, Plaiwan Lin, Sang-I Tsang, William W.N. Ashari, Asmidawati Abd Hamid, Tengku Aizan Farrier, Kaela Burton, Elissa
spellingShingle	Hill, Keith D. Suttanon, Plaiwan Lin, Sang-I Tsang, William W.N. Ashari, Asmidawati Abd Hamid, Tengku Aizan Farrier, Kaela Burton, Elissa What works in falls prevention in Asia: a systematic review and meta-analysis of randomized controlled trials
author_facet	Hill, Keith D. Suttanon, Plaiwan Lin, Sang-I Tsang, William W.N. Ashari, Asmidawati Abd Hamid, Tengku Aizan Farrier, Kaela Burton, Elissa
author_sort	Hill, Keith D.
title	What works in falls prevention in Asia: a systematic review and meta-analysis of randomized controlled trials
title_short	What works in falls prevention in Asia: a systematic review and meta-analysis of randomized controlled trials
title_full	What works in falls prevention in Asia: a systematic review and meta-analysis of randomized controlled trials
title_fullStr	What works in falls prevention in Asia: a systematic review and meta-analysis of randomized controlled trials
title_full_unstemmed	What works in falls prevention in Asia: a systematic review and meta-analysis of randomized controlled trials
title_sort	what works in falls prevention in asia: a systematic review and meta-analysis of randomized controlled trials
publisher	BioMed Central
publishDate	2018
url	http://psasir.upm.edu.my/id/eprint/74435/1/s12877-017-0683-1.pdf http://psasir.upm.edu.my/id/eprint/74435/ https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-017-0683-1
_version_	1811685939820363776
score	13.211869

What works in falls prevention in Asia: a systematic review and meta-analysis of randomized controlled trials

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