Abstract
BackgroundHome exercise can prevent falls in the general older community but its impact in people recently discharged from hospital is not known. The study aimed to investigate the effects of a home-based exercise program on falls and mobility among people recently discharged from hospital.Methods and FindingsThis randomised controlled trial (ACTRN12607000563460) was conducted among 340 older people. Intervention group participants (n = 171) were asked to exercise at home for 15–20 minutes up to 6 times weekly for 12 months. The control group (n = 169) received usual care. Primary outcomes were rate of falls (assessed over 12 months using monthly calendars), performance-based mobility (Lower Extremity Summary Performance Score, range 0–3, at baseline and 12 months, assessor unaware of group allocation) and self-reported ease of mobility task performance (range 0–40, assessed with 12 monthly questionaries). Participants had an average age of 81.2 years (SD 8.0) and 70% had fallen in the past year. Complete primary outcome data were obtained for at least 92% of randomised participants. Participants in the intervention group reported more falls than the control group (177 falls versus 123 falls) during the 12-month study period and this difference was statistically significant (incidence rate ratio 1.43, 95% CI 1.07 to 1.93, p = 0.017). At 12-months, performance-based mobility had improved significantly more in the intervention group than in the control group (between-group difference adjusted for baseline performance 0.13, 95% CI 0.04 to 0.21, p = 0.004). Self-reported ease in undertaking mobility tasks over the 12-month period was not significantly different between the groups (0.49, 95% CI −0.91 to 1.90, p = 0.488).ConclusionsAn individualised home exercise prescription significantly improved performance-based mobility but significantly increased the rate of falls in older people recently discharged from hospital.Trial RegistrationAustralian New Zealand Clinical Trials Registry ACTRN12607000563460
Highlights
The development and widespread implementation of effective strategies to minimise disability and falls among older people is an urgent public health challenge due to the increasing proportion of older people in the global population
Twelve months of falls data were available for 320 people (94% of those randomised; 159 from the control group and 161 from the intervention group)
The intervention group reported a higher fall rate (177 falls, 1.0 fall per person, SD 1.23) than the control group (123 falls, 0.73 falls per person, SD 1.22) and this difference was statistically significant
Summary
The development and widespread implementation of effective strategies to minimise disability and falls among older people is an urgent public health challenge due to the increasing proportion of older people in the global population. As our previous meta-analysis [11] found greater effects on falls of exercise programs that challenge balance, a home exercise program that targets balance may prevent falls in people who have been in hospital. Home exercise can prevent falls in the general older community but its impact in people recently discharged from hospital is not known. The study aimed to investigate the effects of a home-based exercise program on falls and mobility among people recently discharged from hospital
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