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英国诺丁汉大学Pip A Logan团队比较了英国老年人护理院多因素跌倒预防计划与常规护理对跌倒率的影响。相关论文于2021年12月7日发表在《英国医学杂志》上。

为了确定与长期护理院的常规护理相比，多因素跌倒预防计划的临床和成本效益，研究组进行了一项多中心、平行、整群随机对照试验。他们在英国设立长期护理院，招募需要护理的老年人或痴呆症患者。最终共纳入84家护理院，涉及1657名入住的参与者。其中39家护理院被随机分配到干预组，接受多因素防跌倒计划（GtACH），45家被分配到常规护理组。

主要观察指标为随机分组后91-180天的跌倒率。经济评估使用质量调整生命年（QALYs）来衡量健康相关的生活质量，QALYs使用EuroQoL指数的5域5级版本（EQ-5D-5L）或代理版本（EQ-5D-5L- p）和痴呆生活质量效用量表（DEMQOL-U），在随机分组后12个月内，由合格的住院医师和护理院工作人员代表（DEMQOL-P-U）帮助所有参与者自主完成。次要结局测量随机分组后1- 90、181 -270和271-360天的跌倒率，Barthel指数评分，以及随机分组后91、180、270和360天的体力活动测评-养老院（PAM-RC）评分。

入住的参与者平均年龄为85岁，32%为男性。GtACH培训对象为1051/1480名员工（71%）。GtACH组630名参与者和常规护理组712名参与者的主要结局数据可用。GtACH计划组与常规护理组相比，91-180天间未校正的跌倒率之比为0.57。两组在各时间点Barthel活动指数和PAM-RC评分相似。增量成本为108英镑，EQ-5D-5L-P获得的延长QALYs为0.024，DEMQOL-P-U为0.005。EQ-5D-5L-P和DEMQOL-P-U的QALY每增加1年的增量成本分别为4544英镑和20889英镑。

研究结果表明，GtACH项目与跌倒下降率和成本效益的降低有关，但未降低参与者的自主活动性或增加依赖性。

附：英文原文

Title: Multifactorial falls prevention programme compared with usual care in UK care homes for older people: multicentre cluster randomised controlled trial with economic evaluation

Author: Pip A Logan, Jane C Horne, John R F Gladman, Adam L Gordon, Tracey Sach, Allan Clark, Katie Robinson, Sarah Armstrong, Sue Stirling, Paul Leighton, Janet Darby, Fran Allen, Lisa Irvine, Ed C F Wilson, Chris Fox, Simon Conroy, Gail Mountain, Karen McCartney, Maureen Godfrey, Erika Sims

Issue&Volume: 2021/12/07

Abstract:

Objectives To determine the clinical and cost effectiveness of a multifactorial fall prevention programme compared with usual care in long term care homes.

Design Multicentre, parallel, cluster randomised controlled trial.

Setting Long term care homes in the UK, registered to care for older people or those with dementia.

Participants 1657 consenting residents and 84 care homes. 39 were randomised to the intervention group and 45 were randomised to usual care.

Interventions Guide to Action for Care Homes (GtACH): a multifactorial fall prevention programme or usual care.

Main outcome measures Primary outcome measure was fall rate at 91-180 days after randomisation. The economic evaluation measured health related quality of life using quality adjusted life years (QALYs) derived from the five domain five level version of the EuroQoL index (EQ-5D-5L) or proxy version (EQ-5D-5L-P) and the Dementia Quality of Life utility measure (DEMQOL-U), which were self-completed by competent residents and by a care home staff member proxy (DEMQOL-P-U) for all residents (in case the ability to complete changed during the study) until 12 months after randomisation. Secondary outcome measures were falls at 1-90, 181-270, and 271-360 days after randomisation, Barthel index score, and the Physical Activity Measure-Residential Care Homes (PAM-RC) score at 91, 180, 270, and 360 days after randomisation.

Results Mean age of residents was 85 years. 32% were men. GtACH training was delivered to 1051/1480 staff (71%). Primary outcome data were available for 630 participants in the GtACH group and 712 in the usual care group. The unadjusted incidence rate ratio for falls between 91 and 180 days was 0.57 (95% confidence interval 0.45 to 0.71, P<0.001) in favour of the GtACH programme (GtACH: six falls/1000 residents v usual care: 10 falls/1000). Barthel activities of daily living indices and PAM-RC scores were similar between groups at all time points. The incremental cost was ￡108 (95% confidence interval ￡271.06 to 487.58), incremental QALYs gained for EQ-5D-5L-P was 0.024 (95% confidence interval 0.004 to 0.044) and for DEMQOL-P-U was 0.005 (0.019 to 0.03). The incremental costs per EQ-5D-5L-P and DEMQOL-P-U based QALY were ￡4544 and ￡20889, respectively.

Conclusions The GtACH programme was associated with a reduction in fall rate and cost effectiveness, without a decrease in activity or increase in dependency.

DOI: 10.1136/bmj-2021-066991

Source: https://www.bmj.com/content/375/bmj-2021-066991

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