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J Gerontol A Biol Sci Med Sci. 2018 Jul 9;73(8):1053-1061. doi: 10.1093/gerona/glx190.

Strategies to Reduce Injuries and Develop Confidence in Elders (STRIDE): A Cluster-Randomized Pragmatic Trial of a Multifactorial Fall Injury Prevention Strategy: Design and Methods.

Author information

1
Pepper Older Americans Independence Center, Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Boston, Massachusetts.
2
Pepper Older Americans Independence Center, Yale University, New Haven, Connecticut.
3
Multicampus Program in Geriatrics Medicine and Gerontology, David Geffen School of Medicine at UCLA, Los Angeles, California.
4
Meyers Primary Care Institute, Reliant Medical Group, Worcester, Massachusetts.
5
Brigham and Women's Hospital, Boston, Massachusetts.
6
School of Nursing, University of Minnesota, Minneapolis.
7
Wake Forest University, Winston-Salem, North Carolina.
8
Hebrew SeniorLife, Harvard Medical School, Boston, Massachusetts.
9
Yale Center for Analytical Sciences, Yale University, New Haven, Connecticut.
10
University of Michigan, Ann Arbor.
11
Pepper Older Americans Independence Center, Division of Geriatrics and Gerontology, University of Pittsburgh, Pennsylvania.
12
Mount Sinai School of Medicine, New York, New York.
13
University of Texas Medical Branch, Galveston.
14
Johns Hopkins University, Baltimore, Maryland.
15
HealthCare Partners, El Segundo, California.
16
Essentia Health, Duluth, Minnesota.
17
University of Iowa, Iowa City.
18
University of Maryland, Baltimore.
19
Patient Centered Outcomes Research Institute, Washington, District of Columbia.
20
National Institute on Aging, Bethesda, Maryland.

Abstract

Background:

Fall injuries are a major cause of morbidity and mortality among older adults. We describe the design of a pragmatic trial to compare the effectiveness of an evidence-based, patient-centered multifactorial fall injury prevention strategy to an enhanced usual care.

Methods:

Strategies to Reduce Injuries and Develop Confidence in Elders (STRIDE) is a 40-month cluster-randomized, parallel-group, superiority, pragmatic trial being conducted at 86 primary care practices in 10 health care systems across United States. The 86 practices were randomized to intervention or control group using covariate-based constrained randomization, stratified by health care system. Participants are community-living persons, ≥70 years, at increased risk for serious fall injuries. The intervention is a comanagement model in which a nurse Falls Care Manager performs multifactorial risk assessments, develops individualized care plans, which include surveillance, follow-up evaluation, and intervention strategies. Control group receives enhanced usual care, with clinicians and patients receiving evidence-based information on falls prevention. Primary outcome is serious fall injuries, operationalized as those leading to medical attention (nonvertebral fractures, joint dislocation, head injury, lacerations, and other major sequelae). Secondary outcomes include all fall injuries, all falls, and well-being (concern for falling; anxiety and depressive symptoms; physical function and disability). Target sample size was 5,322 participants to provide 90% power to detect 20% reduction in primary outcome rate relative to control.

Results:

Trial enrolled 5,451 subjects in 20 months. Intervention and follow-up are ongoing.

Conclusions:

The findings of the STRIDE study will have important clinical and policy implications for the prevention of fall injuries in older adults.

PMID:
29045582
PMCID:
PMC6037050
[Available on 2019-07-09]
DOI:
10.1093/gerona/glx190

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