We used a form designed for this review to extract data on study and intervention characteristics, quality assessment, and outcomes (see supplementary file). The taxonomy for fall prevention interventions developed by the Prevention of Falls Network Europe (ProFaNE)12 was used to describe the characteristics of the interventions provided (for example, participants’ selection criteria, type of exercises, and intervention procedures). This tool uses internationally agreed criteria to evaluate systematically the content and format of fall prevention interventions. We also extracted the definitions and methods used to collect falls and to classify fall related injuries, as well as the number, rate, or risk ratio of injurious falls and any available data on the nature of the injuries. We contacted authors of included articles to obtain more detailed data on the outcomes of injurious falls (for example, if authors reported the number of participants with an injurious fall but not the total number of injurious falls, or data on falls resulting in fractures but not data on other injurious falls).
After reviewing the case definitions used in the selected studies, we sought to group definitions of injurious falls into more homogeneous categories to allow results to be compared across studies and the data to be pooled. The ProFaNE group recently proposed a standardised classification of injurious falls to be used in future randomised controlled trials.10 As a foundation for developing a retrospective classification of the definitions of injurious falls found in the studies selected for this review, we used the ProFaNE classification along with the standardised classification of Campbell and Robertson,13 which is the classification most often used in published trials of these interventions.14 We also recorded any reports of adverse effects associated with interventions.
We followed the recommendations of the Cochrane Collaboration15 to assess risk of bias in the following domains: random sequence generation (selection bias), allocation concealment (selection bias), blinding of the assessment of falls and injurious falls (detection bias), and incomplete outcome data (attrition bias). We also assessed bias in the recall of falls owing to unreliable methods of ascertainment,16 using the criteria developed for the Cochrane review of fall prevention trials.7 The methods used to confirm serious injurious falls were also examined: we judged self reports from participants to be at a high risk of bias, whereas we considered the use of medical records or radiography reports (for fractures) to be at low risk. Two authors (FEK, PDM) independently assessed the risks of bias and extracted data. Disagreement was resolved by consensus or adjudication by a third party.