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Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet].

Hospital fall prevention: a systematic review of implementation, components, adherence, and effectiveness

S Hempel, S Newberry, Z Wang, M Booth, R Shanman, B Johnsen, V Shier, D Saliba, WD Spector, and DA Ganz.

Review published: 2013.

CRD summary

This review concluded that the results from fall prevention interventions in USA acute care hospitals were promising. The authors stated that better reporting of outcomes, intervention components, comparison groups, implementation and adherence was needed. Limitations of the review methodology and reporting suggest that their conclusion regarding the interventions' effectiveness may not be reliable.

Authors' objectives

To examine the implementation, components, adherence and effectiveness of fall prevention interventions in acute care hospitals in USA.

Searching

Six databases (including DARE and PubMed) were searched from 2005 to August 2011 for relevant reviews and/or study articles published in English. Search terms were reported. Further publications of interest were identified through contact with experts and searches of fall prevention toolkits/guidelines and reference lists of included studies.

Study selection

Eligible studies evaluated fall prevention interventions delivered to in-patients of US acute care hospitals. Numerical data on in-hospital falls had to have been reported for intervention groups and concurrent/historical controls. Studies with interventions that focused on the time after hospital stay were excluded. Also excluded were studies of interventions with the sole aims to reduce restraints, risk of injury from falls or the effects of falls.

The included studies were published between 1983 and 2011. Most interventions targeted hospital wards or units; the others targeted an entire hospital or multiple hospitals. Most interventions primarily targeted health professional behaviour; common intervention components for all patient types included fall risk assessment, patient and family education, and structured post-fall evaluations.

Two reviewers independently selected studies for inclusion in the review. Any discrepancies were resolved through discussion.

Assessment of study quality

The authors did not report whether they assessed the quality of studies.

Data extraction

Data on in-hospital falls were extracted to enable calculation of incidence rate ratios and 95% confidence intervals (CI) for individual studies.

Two reviewers extracted data on study characteristics and one reviewer extracted data on the outcomes. Any discrepancies were resolved through discussion.

Methods of synthesis

Incidence rate ratios (IRR) and 95% confidence intervals were pooled using a random-effects model. Heterogeneity was assessed using the Ι² statistic. Meta-regression was performed to explore the influence of study characteristics. Sensitivity analyses were conducted by removing one study at a time from the meta-analysis. Publication bias was assessed using Egger's test and the Begg rank test.

Results of the review

Fifty-nine studies were included in the review (exact number of participants unclear): 11 studies with a concurrent control and 48 studies with a historic control.

Overall, no statistically significant difference in fall rates was found between intervention and control groups (IRR 0.77, 95% CI 0.52 to 1.12; eight studies; substantial heterogeneity Ι²=94%). Similar results were shown when analyses were stratified according to the type of control (concurrent or historic). When one particular study was removed in the sensitivity analyses, the difference between groups became statistically significant (IRR 0.67, 95% CI 0.58 to 0.77; seven studies) and heterogeneity was reduced (Ι²=39%).

Meta-regressions showed no association between the IRR and implementation intensity, intervention complexity, comparator information or adherence levels. No evidence of publication bias was found. Further results were reported.

Authors' conclusions

Results from fall prevention interventions in US acute care hospitals were promising. However, better reporting of outcomes, intervention components, comparison groups, implementation and adherence is needed to strengthen the evidence base.

CRD commentary

The review question and inclusion criteria were defined clearly. Extensive efforts were made to locate relevant studies but the restriction to studies published in English meant that some relevant studies may have been missed. Study selection and data extraction were performed in duplicate, which reduced the risk of reviewer error and bias. The authors did not report any quality assessment so it was difficult to know how reliable the results of the individual studies were. Study details were limited and in particular duration and follow-up times of interventions were not reported. Study articles reportedly provided limited information about interventions, comparison groups and implementation and adherence strategies. Given the heterogeneity across the studies, limited reporting of study details and unknown quality of the included studies, it did not seem appropriate that they were statistically synthesised. The authors acknowledged that the analyses were limited by low statistical power.

The authors' tentative conclusions reflect the evidence presented but limitations of the review methodology and reporting suggest that these conclusions may not be reliable. The authors' recommendations for better reporting of outcomes and other characteristics are warranted.

Implications of the review for practice and research

Practice: None stated.

Research: The authors stated that better reporting of outcomes and other characteristics (such as intervention components, comparison groups, implementation strategy, adherence) was needed in published fall prevention evaluations.

Funding

Agency for Healthcare Research and Quality, USA; US Department of Veterans Affairs.

Bibliographic details

Hempel S, Newberry S, Wang Z, Booth M, Shanman R, Johnsen B, Shier V, Saliba D, Spector WD, Ganz DA. Hospital fall prevention: a systematic review of implementation, components, adherence, and effectiveness. Journal of the American Geriatrics Society 2013; 61(4): 483-494. [PMC free article: PMC3670303] [PubMed: 23527904]

PubMedID

23527904

Indexing Status

Subject indexing assigned by NLM

MeSH

Accidental Falls /prevention & control /statistics & numerical data; Hospital Administration /statistics & numerical data; Humans; Interior Design and Furnishings /statistics & numerical data; Outcome Assessment (Health Care); Risk Assessment; Risk Factors; Risk Management /organization & administration; Safety Management /organization & administration; United States

AccessionNumber

12013026020

Date bibliographic record published

03/06/2013

Date abstract record published

10/06/2014

Record Status

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.

CRD has determined that this article meets the DARE scientific quality criteria for a systematic review.

Copyright © 2014 University of York.

PMID: 23527904

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