Individually-tailored multifactorial intervention to reduce falls in the Malaysian Falls Assessment and Intervention Trial (MyFAIT): A randomized controlled trial

PLoS One. 2018 Aug 3;13(8):e0199219. doi: 10.1371/journal.pone.0199219. eCollection 2018.

Abstract

Objective: To determine the effectiveness of an individually-tailored multifactorial intervention in reducing falls among at risk older adult fallers in a multi-ethnic, middle-income nation in South-East Asia.

Design: Pragmatic, randomized-controlled trial.

Setting: Emergency room, medical outpatient and primary care clinic in a teaching hospital in Kuala Lumpur, Malaysia.

Participants: Individuals aged 65 years and above with two or more falls or one injurious fall in the past 12 months.

Intervention: Individually-tailored interventions, included a modified Otago exercise programme, HOMEFAST home hazards modification, visual intervention, cardiovascular intervention, medication review and falls education, was compared against a control group involving conventional treatment.

Primary and secondary outcome measures: The primary outcome was any fall recurrence at 12-month follow-up. Secondary outcomes were rate of fall and time to first fall.

Results: Two hundred and sixty-eight participants (mean age 75.3 ±7.2 SD years, 67% women) were randomized to multifactorial intervention (n = 134) or convention treatment (n = 134). All participants in the intervention group received medication review and falls education, 92 (68%) were prescribed Otago exercises, 86 (64%) visual intervention, 64 (47%) home hazards modification and 51 (38%) cardiovascular intervention. Fall recurrence did not differ between intervention and control groups at 12-months [Risk Ratio, RR = 1.037 (95% CI 0.613-1.753)]. Rate of fall [RR = 1.155 (95% CI 0.846-1.576], time to first fall [Hazard Ratio, HR = 0.948 (95% CI 0.782-1.522)] and mortality rate [RR = 0.896 (95% CI 0.335-2.400)] did not differ between groups.

Conclusion: Individually-tailored multifactorial intervention was ineffective as a strategy to reduce falls. Future research efforts are now required to develop culturally-appropriate and affordable methods of addressing this increasingly prominent public health issue in middle-income nations.

Trial registration: ISRCTN Registry no. ISRCTN11674947.

Publication types

  • Pragmatic Clinical Trial
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Accidental Falls / prevention & control*
  • Accidental Falls / statistics & numerical data
  • Accidents, Home / prevention & control
  • Accidents, Home / statistics & numerical data
  • Aged
  • Aged, 80 and over
  • Cardiovascular Diseases / epidemiology
  • Cardiovascular Diseases / therapy
  • Emergency Service, Hospital
  • Environment Design / standards
  • Exercise Therapy
  • Female
  • Humans
  • Malaysia
  • Male
  • Patient Admission / statistics & numerical data
  • Precision Medicine / methods*
  • Primary Prevention / methods*
  • Vision Disorders / diagnosis
  • Vision Disorders / epidemiology
  • Vision Disorders / therapy

Associated data

  • ISRCTN/ISRCTN11674947
  • figshare/10.6084/m9.figshare.5731464

Grants and funding

This work was supported by the University Malaya Research Grant (grant number UMRG-RP-010-2012 to MPT, URL: https://www.um.edu.my/research-and-community/information-for-researchers/research-funding), the University of Malaya Postgraduate Research Fund (grant number PPP-2015B-4805 to PJT, URL: https://www.um.edu.my/research-and-community/information-for-researchers/research-funding), Ministry of Science and Technology Science Fund (grant number SF017-2013 to MPT, http://www.mosti.gov.my/en/), and the University of Malaya Grand Challenge fund (grant number GC002-14HTM to MPT, https://www.um.edu.my/research-and-community/information-for-researchers/research-funding). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.