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Randomized Controlled Trial
. 2015 Jul 22:351:h3830.
doi: 10.1136/bmj.h3830.

Effectiveness of two year balance training programme on prevention of fall induced injuries in at risk women aged 75-85 living in community: Ossébo randomised controlled trial

Fabienne El-Khoury  1 , Bernard Cassou  2 , Aurélien Latouche  3 , Philippe Aegerter  4 , Marie-Aline Charles  5 , Patricia Dargent-Molina  6
Affiliations
Randomized Controlled Trial

Effectiveness of two year balance training programme on prevention of fall induced injuries in at risk women aged 75-85 living in community: Ossébo randomised controlled trial

Fabienne El-Khoury et al. BMJ. .

Abstract

Objective: To assess the effectiveness of a two year exercise programme of progressive balance retraining in reducing injurious falls among women aged 75-85 at increased risk of falls and injuries and living in the community.

Design: Pragmatic multicentre, two arm, parallel group, randomised controlled trial.

Setting: 20 study sites in 16 medium to large cities throughout France.

Participants: 706 women aged 75-85, living in their own home, and with diminished balance and gait capacities, randomly allocated to the experimental intervention group (exercise programme, n=352) or the control group (no intervention, n=354).

Intervention: Weekly supervised group sessions of progressive balance training offered in community based premises for two years, supplemented by individually prescribed home exercises.

Outcome measures: A geriatrician blinded to group assignment classified falls into one of three categories (no consequence, moderate, severe) based on physical damage and medical care. The primary outcome was the rate of injurious falls (moderate and severe). The two groups were compared for rates of injurious falls with a "shared frailty" model. Other outcomes included the rates of all falls, physical functional capacities (balance and motor function test results), fear of falling (FES-I), physical activity level, and perceived health related quality of life (SF-36). Analysis was by intention to treat.

Results: There were 305 injurious falls in the intervention group and 397 in the control group (hazard ratio 0.81, 95% confidence interval 0.67 to 0.99). The difference in severe injuries (68 in intervention group v 87 in control group) was of the same order of magnitude (0.83, 0.60 to 1.16). At two years, women in the intervention group performed significantly better on all physical tests and had significantly better perception of their overall physical function than women in the control group. Among women who started the intervention (n=294), the median number of group sessions attended was 53 (interquartile range 16-71). Five injurious falls related to the intervention were recorded.

Conclusion: A two year progressive balance retraining programme combining weekly group and individual sessions was effective in reducing injurious falls and in improving measured and perceived physical function in women aged 75-85 at risk of falling.Trial registration ClinicalTrials.gov (NCT00545350).

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Conflict of interest statement

Competing interests: All authors have completed the Unified Competing Interest form at http://www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

Figures

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Fig 1 Flow through trial of women aged 75-85 who took part in two year balance training programme for prevention of fall induced injuries (intervention) or no such programme (control)
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Fig 2 Details of participation of women aged 75-85 in two year balance training programme for prevention of fall induced injuries. IQR=interquartile range
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Fig 3 Mean cumulative function (MCF) for two comparison groups: mean number of injurious falls in women aged 75-85 in two year balance training programme for prevention of fall induced injuries (intervention) or no such programme (control)
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Fig 4 Difference in mean cumulative function (MCF) between two comparison groups: mean number of injurious falls prevented in women aged 75-85 in two year balance training programme for prevention of fall induced injuries
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