Does multiple risk factor reduction explain the reduction in fall rate in the Yale FICSIT Trial? Frailty and Injuries Cooperative Studies of Intervention Techniques.
Does multiple risk factor reduction explain the reduction in fall rate in the Yale FICSIT Trial? Frailty and Injuries Cooperative Studies of Intervention Techniques.
复制标题
多重风险因素的减少是否可以解释耶鲁大学 FICSIT 试验中跌倒率的降低？
DOI：
10.1093/oxfordjournals.aje.a008940
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发表时间：
1996
影响因子：
5
通讯作者：
Claus,E
中科院分区：
文献类型：
--
作者：
Tinetti,ME;McAvay,G;Claus,E
在最近一项针对 301 名社区生活老年人的跌倒预防研究（耶鲁大学 FICSIT 试验，1990-1993 年）中，多因素针对性干预 (Tl) 组的参与者跌倒次数明显少于社交访问 (SV) 对照组的参与者。在本文中，作者探讨了所研究的危险因素的变化与跌倒发生之间的关系。与 SV 参与者相比，T1 参与者在体位血压变化 (p= 0.01)、步长 (p= 0.004)、使用 ≥4 种药物 (p= 0.003) 以及不安全的浴缸和厕所转移 (p= 0.05) 方面表现出显着更大的改善，而平衡变化具有临界显着性 (p= 0.08)。反过来，跌倒发生率的减少至少与平衡性、体位血压变化、步长、下肢力量/运动范围和转移能力的改善有一定程度的相关性。当基于综合风险因素变化评分将参与者分为三分位数时，处于最大风险因素减少三分位数的 T1 参与者 (42%) 的百分比显着高于 SV 参与者 (22%)。在 T1 参与者中，风险降低最小、中等和最大的三分位数中，每人每年的跌倒率逐渐降低（分别为 0.832、0.624 和 0.260）。在 SV 组中，危险因素减少与跌倒率之间存在类似但较弱的关系。在三分位内进行比较时，基本上调整了风险因素减少量，Tl 和 SV 参与者在最大风险因素减少三分位中的跌倒率相同（每人每年 0.260 次跌倒），并且在最小减少三分位中的跌倒率相似（每人每年 0.832 次与 1.040 次跌倒）；这表明危险因素的减少至少部分调节了治疗效果。这些结果支持了在老年人中实施和分析多重危险因素减少策略的有效性的可行性。Am J Epidemiol1996； 144：389-99。
In a recent study of fall prevention in 301 community-living older persons (the Yale FICSIT Trial, 1990–1993), participants in the murtifactorial targeted intervention (Tl) group experienced significantly fewer falls than participants in the social visit (SV) control group. In the present paper, the authors explore the relation between changes in the studied risk factors and the occurrence of falling. In comparison with SV participants, Tl participants showed significantly greater improvements in postural blood pressure change (p= 0.01), step length (p= 0.004), use of ≥4 medications (p= 0.003), and unsafe tub and toilet transfers (p= 0.05), while change in balance was of borderline significance (p= 0.08). Reduction in the occurrence of falling, in turn, was at least marginally associated with improvements in balance, postural blood pressure change, step length, lower extremity strength/range of motion, and transfers. When participants were divided into tertiles based on a composite risk factor change score, a significantly higher percentage of Tl participants (42%) than SV participants (22%) were in the greatest risk factor reduction tertile. Among Tl participants, there was a progressively lower fall rate per person per year in the tertiles with the least, intermediate, and greatest risk reduction (0.832, 0.624, and 0.260), respectively. A similar but weaker relation between risk factor reduction and fall rate was seen in the SV group. When compared within tertiles, essentially adjusting for the amount of risk factor reduction, the fall rates among Tl and SV participants in the greatest risk factor reduction tertile were identical (0.260 falls per person per year), and the rates in the least reduction tertile were similar (0.832 vs. 1.040 falls per person per year); this suggests that risk factor reduction at least partially mediated the treatment effect. These results support the feasibility of implementing and analyzing the effectiveness of a multiple risk factor reduction strategy in the aged.Am J Epidemiol1996; 144: 389–99.