风险筛查和多方面干预并不能降低老年人的骨折

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风险筛查和多方面干预并不能降低老年人的骨折

本期文章:《新英格兰医学杂志》:Vol.383 No.19

英国埃克塞特大学Sarah E. Lamb团队研究了筛查和干预来防止老年人跌倒和骨折的效果。2020年11月5日,该研究发表在《新英格兰医学杂志》上。

社区筛查和治疗预防策略可以减少老年人跌倒的发生率。但这些措施对骨折的发生、健康资源的使用以及与健康相关生活质量的影响尚不清楚。

在一项实用、三组、随机分组、对照试验中,研究组评估了与仅邮件建议相比,采取邮件发送建议、跌倒风险筛查和针对性干预措施来降低骨折风险的效果。主要结局为18个月时每100人年的骨折率。

研究组在英格兰的63种常规实践中随机选择了9803名70岁以上的老年人:其中3223名被分配到仅通过邮件提供建议,3279名被分配到除邮件建议外,还进行跌倒风险筛查和有针对性的锻炼,3301名被分配到除邮件建议外,进行跌倒风险筛查,并针对性地采取多方面跌倒预防措施。

研究组向分配给运动组和多方面预防跌倒组的参与者发送跌倒风险筛查表。运动组中有2925名(89%)参与者完成了问卷调查,多方面预防组中有2854名(87%)。这两组返回调查表的5779名参与者中有2153名(37%)被认为跌倒风险增加,并邀请其接受干预。9803名参与者中有9802名可获得骨折数据。

风险筛查和有针对性的干预并未降低骨折发生率,与仅邮件建议相比,运动组的骨折比率为1.20;多因素预防跌倒组为1.30。运动组的健康相关生活质量小幅提高,且总成本最低。试验期间有3例不良事件,其中1例为心绞痛,1例为多因素跌倒预防评估中跌倒,1例为髋部骨折。

研究结果表明,通过邮件建议、筛查跌倒风险、针对性运动或多方面干预来预防跌倒,与单纯邮件建议相比,并不能降低骨折风险。

附:英文原文

Title: Screening and Intervention to Prevent Falls and Fractures in Older People

Author: Sarah E. Lamb, D.Phil.,, Julie Bruce, Ph.D.,, Anower Hossain, Ph.D.,, Chen Ji, Ph.D.,, Roberta Longo, Ph.D.,, Ranjit Lall, Ph.D.,, Chris Bojke, Ph.D.,, Claire Hulme, Ph.D.,, Emma Withers, H.N.D.,, Susanne Finnegan, Ph.D.,, Ray Sheridan, M.R.C.P.,, Keith Willett, M.D.,, and Martin Underwood, M.D.

Issue&Volume: 2020-11-04

Abstract:

Background

Community screening and therapeutic prevention strategies may reduce the incidence of falls in older people. The effects of these measures on the incidence of fractures, the use of health resources, and health-related quality of life are unknown.

Methods

In a pragmatic, three-group, cluster-randomized, controlled trial, we estimated the effect of advice sent by mail, risk screening for falls, and targeted interventions (multifactorial fall prevention or exercise for people at increased risk for falls) as compared with advice by mail only. The primary outcome was the rate of fractures per 100 person-years over 18 months. Secondary outcomes were falls, health-related quality of life, frailty, and a parallel economic evaluation.

Results

We randomly selected 9803 persons 70 years of age or older from 63 general practices across England: 3223 were assigned to advice by mail alone, 3279 to falls-risk screening and targeted exercise in addition to advice by mail, and 3301 to falls-risk screening and targeted multifactorial fall prevention in addition to advice by mail. A falls-risk screening questionnaire was sent to persons assigned to the exercise and multifactorial fall-prevention groups. Completed screening questionnaires were returned by 2925 of the 3279 participants (89%) in the exercise group and by 2854 of the 3301 participants (87%) in the multifactorial fall-prevention group. Of the 5779 participants from both these groups who returned questionnaires, 2153 (37%) were considered to be at increased risk for falls and were invited to receive the intervention. Fracture data were available for 9802 of the 9803 participants. Screening and targeted intervention did not result in lower fracture rates; the rate ratio for fracture with exercise as compared with advice by mail was 1.20 (95% confidence interval [CI], 0.91 to 1.59), and the rate ratio with multifactorial fall prevention as compared with advice by mail was 1.30 (95% CI, 0.99 to 1.71). The exercise strategy was associated with small gains in health-related quality of life and the lowest overall costs. There were three adverse events (one episode of angina, one fall during a multifactorial fall-prevention assessment, and one hip fracture) during the trial period.

Conclusions

Advice by mail, screening for fall risk, and a targeted exercise or multifactorial intervention to prevent falls did not result in fewer fractures than advice by mail alone.

DOI: NJ202011053831912

Source: https://www.nejm.org/doi/full/10.1056/NEJMoa2001500

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