The article critically appraised during #GeriMedJC on February 27th was:
Keall MD, Pierse N, Howden-Chapman P, Cunningham C, Cunningham M, Guria J, Baker MG. Home modifications to reduce injuries from falls in the Home Injury Prevention Intervention (HIPI) study: a cluster-randomised controlled trial. The Lancet, Volume 385, Issue 9964, 17–23 January 2015, Pages 231-238
The live version of #GeriMedJC also featured a short 10 minute primer on propensity-matching given by Dr. Joanne Ho. She is a geriatrician and clinical pharmacologist. Follower her on Twitter @geridrugho. Moving forward, the new format for #GeriMedJC may only include one article rather than two.
This is what Symplur analytics had to say about the February tweet chat:
Missed the discussion? You can get the transcript of the February #GeriMedJC tweet chat here.
Thanks again to all those who participated in the Tweet chat and a special shout out to the physiotherapy and physiatry participants!
The next #GeriMedJC will be on March 27, 2015 08:00 EST / 13:00 GMT. See you then!
#GeriMedJC has its PubMed Commons account up and running.
PubMed Commons Journal Clubs is a new initiative to capture discussions of scientific publications and connect them to citations in PubMed. This initiative is currently open to journal clubs holding regular discussions for research, graduate and postgraduate education, or continuing professional education.
Check it out here.
A recent Cochrane review examined the effectiveness of various interventions to prevent falls among older people living in the community. Home-safety assessment and modification interventions were effective at reducing the rate and risk of falls. This month, we discuss a cluster-randomised controlled trial from New Zealand, in which they assessed the benefits of a basic set of home-safety modifications.
The full text of the article can be found here and the abstract is posted below.
Engage in the discussion on Twitter on February 27, 2015 at 08:00 EST / 13:00 GMT and don't forget to use the hashtag #GeriMedJC.
Did you know that the live version of #GeriMedJC runs for an hour and is broadcast to nine different hospitals in four different cities via the Ontario Telemedicine Network?
- Toronto: Mount Sinai Hospital, Sunnybrook Hospital, St. Michael’s Hospital, Baycrest Hospital, North York General Hospital, St. Joseph’s Hospital
- Mississauga: Trillium Hospital
- Kitchener-Waterloo: St. Mary’s General Hospital
- Oshawa: Lakeridge Health
Keall MD, Pierse N, Howden-Chapman P, Cunningham C, Cunningham M, Guria J, Baker MG. Home modifications to reduce injuries from falls in the Home Injury Prevention Intervention (HIPI) study: a cluster-randomised controlled trial. The Lancet, Volume 385, Issue 9964, 17–23 January 2015, Pages 231-238
BACKGROUND:
Despite the considerable injury burden attributable to falls at home among the general population, few effective safety interventions have been identified. We tested the safety benefits of home modifications, including handrails for outside steps and internal stairs, grab rails for bathrooms, outside lighting, edging for outside steps, and slip-resistant surfacing for outside areas such as decks and porches.
METHODS:
We did a single-blind, cluster-randomised controlled trial of households from the Taranaki region of New Zealand. To be eligible, participants had to live in an owner-occupied dwelling constructed before 1980 and at least one member of every household had to be in receipt of state benefits or subsidies. We randomly assigned households by electronic coin toss to either immediate home modifications (treatment group) or a 3-year wait before modifications (control group). Household members in the treatment group could not be masked to their assigned status because modifications were made to their homes. The primary outcome was the rate of falls at home per person per year that needed medical treatment, which we derived from administrative data for insurance claims. Coders who were unaware of the random allocation analysed text descriptions of injuries and coded injuries as all falls and injuries most likely to be affected by the home modifications tested. To account for clustering at the household level, we analysed all injuries from falls at home per person-year with a negative binomial generalised linear model with generalised estimating equations. Analysis was by intention to treat. This trial is registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12609000779279.
FINDINGS:
Of 842 households recruited, 436 (n=950 individual occupants) were randomly assigned to the treatment group and 406 (n=898 occupants) were allocated to the control group. After a median observation period of 1148 days (IQR 1085-1263), the crude rate of fall injuries per person per year was 0·061 in the treatment group and 0·072 in the control group (relative rate 0·86, 95% CI 0·66-1·12). The crude rate of injuries specific to the intervention per person per year was 0·018 in the treatment group and 0·028 in the control group (0·66, 0·43-1·00). A 26% reduction in the rate of injuries caused by falls at home per year exposed to the intervention was estimated in people allocated to the treatment group compared with those assigned to the control group, after adjustment for age, previous falls, sex, and ethnic origin (relative rate 0·74, 95% CI 0·58-0·94). Injuries specific to the home-modification intervention were cut by 39% per year exposed (0·61, 0·41-0·91).
INTERPRETATION:
Our findings suggest that low-cost home modifications and repairs can be a means to reduce injury in the general population. Further research is needed to identify the effectiveness of particular modifications from the package tested.
