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Effectiveness and economic evaluation of a nurse delivered home exercise programme to prevent falls. 1: Randomised
M C Robertson1, N Devlin, M M Gardner
1Department of Medical and Surgical Sciences, Otago Medical School, Dunedin, New Zealand. clare.robertson@stonebow.otago.ac.nz
Objectives:
To assess the effectiveness of a trained district nurse individually prescribing a home based exercise programme to reduce falls and injuries in elderly people and to estimate the cost effectiveness of the programme.
Design:
Randomised controlled trial with one year's follow up.
Setting:
Community health service at a New Zealand hospital.
Participants:
240 women and men aged 75 years and older.
Intervention:
121 participants received the exercise programme (exercise group) and 119 received usual care (control group); 90% (211 of 233) completed the trial.
Main Outcome Measures:
Number of falls, number of injuries resulting from falls, costs of implementing the programme, and hospital costs as a result of falls.
Results:
Falls were reduced by 46% (incidence rate ratio 0.54, 95% confidence interval 0.32 to 0.90). Five hospital admissions were due to injuries caused by falls in the control group and none in the exercise group. The programme cost $NZ1803 (523 pound sterling) (at 1998 prices) per fall prevented for delivering the programme and $NZ155 per fall prevented when hospital costs averted were considered.
Conclusion:
A home exercise programme, previously shown to be successful when delivered by a physiotherapist, was also effective in reducing falls when delivered by a trained nurse from within a home health service. Serious injuries and hospital admissions due to falls were also reduced. The programme was cost effective in participants aged 80 years and older compared with younger participants.