Nine thousand older people across 60 GP practices will be randomly assigned to one of three fall-prevention strategies to find out which works best and costs least. Falls are a major cause of injury and loss of independence in older age, yet GPs lack clear evidence on whether simple advice, structured exercise, or a full multi-factorial programme is most effective. Current practice varies widely, and money may be spent on programmes that are no better than cheaper alternatives. If the trial shows that one strategy clearly outperforms the others, GP surgeries could adopt a single, evidence-based approach as standard care. That would reduce fractures and hospital admissions, and free up NHS resources for other priorities. If the cheapest option—advice—turns out to be as effective as more intensive programmes, the savings could be substantial without harming patient outcomes. The abstract provides no cost figures, so the economic impact cannot be quantified here. The trial will also measure quality of life and falls rates, giving a full picture of what works in everyday community settings.
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Context: Common falls prevention strategies used in primary care settings include advice and information, structured exercise, and multi-factorial risk-reduction programmes. Little is known about the comparative effectiveness and cost-effectiveness of these strategies. Objective: To estimate the comparative effectiveness and cost-effectiveness of advice, structured exercise and a multi-factorial fall prevention programme, for the prevention of fall injuries among older people living in the community. Design: A 3-arm, cluster-randomised controlled trial with economic evaluation. The unit of randomisation will be the General Practice, and minimisation will be used to ensure balance in the allocation of practices by list size and area socio-economic status. Population: 9,000 people (60 practices) aged over 70 years living in the community, including people in sheltered accommodation, but excluding people living in nursing or residential care homes. Interventions: Practices will be randomly allocated to one of the trial interventions, which they will adopt as usual care practice for the duration of the trial. The three trial arms interventions are: Advice: We will utilise evidence that, for older people, advice about the positive aspects of treatment (e.g. regaining or improving balance/mobility) as opposed to negative (e.g. falls) is a more acceptable presentation and likely to result in greater uptake. Exercise: We will use the Otago Exercise Program, delivered either on a group basis or at home. The program has a good evidence base in relation to falls, but has not been tested formally in the UK setting. MFFP. We will base MFFP on an existing programme (Tinetti et al., 1994) that is safe and feasible in the community setting. We will undertake an update and consensus building exercise (with members of the British Geriatrics Society) to ensure that the intervention is fully informed. Outcomes: The trial is powered (80%) to detect (p<0.05) a moderate difference in fracture rate, from 6% to 4% (RR 0.67). Peripheral fracture data, aggregated at the practice level, will be sourced from primary care, HES and self-report. Falls and HRQoL (secondary outcomes) will be assessed in random sub-samples of the trial population by postal questionnaire at 4 month intervals.
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