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Title: What works in falls prevention in Asia : a systematic review and meta-analysis of randomized controlled trials
Authors: Hill, KD
Suttanon, P
Lin, SI
Tsang, WWN 
Ashari, A
Abd Hamid, TA
Farrier, K
Burton, E
Issue Date: 5-Jan-2018
Source: BMC geriatrics, 5 Jan. 2018, , v. 18, 3, p. 1-21
Abstract: Background: There is strong research evidence for falls prevention among older people in the community setting, although most is from Western countries. Differences between countries (eg sunlight exposure, diet, environment, exercise preferences) may influence the success of implementing falls prevention approaches in Asian countries that have been shown to be effective elsewhere in the world. The aim of this review is to evaluate the scope and effectiveness of falls prevention randomized controlled trials (RCTs) from the Asian region.
Method: RCTs investigating falls prevention interventions conducted in Asian countries from (i) the most recent (2012) Cochrane community setting falls prevention review, and (ii) subsequent published RCTs meeting the same criteria were identified, classified and grouped according to the ProFANE intervention classification. Characteristics of included trials were extracted from both the Cochrane review and original publications. Where >= 2 studies investigated an intervention type in the Asian region, a meta-analysis was performed.
Results: Fifteen of 159 RCTs in the Cochrane review were conducted in the Asian region (9%), and a further 11 recent RCTs conducted in Asia were identified (total 26 Asian studies: median 160 participants, mean age: 75.1, female: 71.9%). Exercise (15 RCTs) and home assessment/modification (n = 2) were the only single interventions with = 2 RCTs. Intervention types with >= 1 effective RCT in reducing fall outcomes were exercise (6 effective), home modification (1 effective), and medication (vitamin D) (1 effective). One multiple and one multifactorial intervention also had positive falls outcomes. Meta-analysis of exercise interventions identified significant benefit (number of fallers: Odds Ratio 0.43 [0.34,0.53]; number of falls: 0.35 [0.21,0.57]; and number of fallers injured: 0.50 [0.35,0.71]); but multifactorial interventions did not reach significance (number of fallers OR = 0.57 [0.23,1.44]).
Conclusion: There is a small but growing research base of falls prevention RCTs from Asian countries, with exercise approaches being most researched and effective. For other interventions shown to be effective elsewhere, consideration of local issues is required to ensure that research and programs implemented in these countries are effective, and relevant to the local context, people, and health system. There is also a need for further high quality, appropriately powered falls prevention trials in Asian countries.
Keywords: Falls prevention
Effectiveness
Asia
Elderly
Community
Publisher: BioMed Central
Journal: BMC geriatrics 
EISSN: 1471-2318
DOI: 10.1186/s12877-017-0683-1
Rights: Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
The following publication Hill, K.D., Suttanon, P., Lin, SI. et al. What works in falls prevention in Asia: a systematic review and meta-analysis of randomized controlled trials. BMC Geriatr 18, 3 (2018). is available at https://dx.doi.org/10.1186/s12877-017-0683-1
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