Authors' objectives
To assess the effectiveness of fall-prevention exercise interventions in the prevention of fall-related injuries in older
community dwelling people.
Searching
PubMed, EMBASE, CINAHL and The Cochrane Library were searched up to July 2013 for peer reviewed
publications in English or French. Search terms were reported. Reference lists of relevant reviews were searched
manually.
Study selection
Eligible studies were randomised controlled trials (RCTs) that assessed the effectiveness of fall-prevention exercise
interventions in the prevention of fall-related injuries in older (>60 years) community dwelling people. Eligible
comparators were no intervention or a placebo control (as defined in the review). Trials had to report quantitative data
on injurious falls, serious falls, fall-related injuries or fall-induced fractures. Trials that assessed multifactorial
interventions were excluded from the review. Studies of participants with specific neurodegenerative disease or any
other characteristic that affected the risk of falling (such as severe visual impairment) and was not correctable by
exercise were excluded from the review. Adverse events were reported.
Included trials were conducted between 1994 and 2012. Participant eligibility criteria and fall definitions varied
between trials. Most participants were women. Mean ages ranged between 64.5 and 88 years. Participants at greater
risk of falling and unselected populations were included in the review. Most trials included interventions consisting of
gait, balance and functional training, strengthening exercises, and flexibility. Interventions were delivered at home
and/or in groups at various frequencies for between 5.5 weeks and 18 months. Most trials used prospective daily
calendars to record falls.
Two reviewers independently screened studies for inclusion; discrepancies were resolved through discussion.
Assessment of study quality
Two reviewers independently assessed trial quality according to Cochrane risk of bias methods. Risk of bias for
methods used to confirm serious injurious falls were assessed; self-report methods were considered to be at high risk
of bias and use of medical records or radiography reports were considered to be at low risk of bias.
Any discrepancies between reviewers were resolved through consensus or referral to a third reviewer.
Data extraction
Two reviewers independently extracted data on injurious falls to calculate rate ratios and 95% confidence intervals.
Where rate ratios could not be initially calculated, data were imputed to enable calculation. Primary authors were
contacted for further information where necessary. Any discrepancies between reviewers were resolved through
consensus or referral to a third reviewer.
Methods of synthesis
A random-effects model was used to combine rate ratios and 95% confidence intervals by type of injurious fall