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Individually-tailored multifactorial intervention to reduce falls in the Malaysian Falls Assessment and Intervention Trial (MyFAIT): A randomized controlled trial

Tan PJ 1 , Khoo EM 2 , Chinna K 3 , Saedon NI 1 , Zakaria MI 4 , Ahmad Zahedi AZ 4 Show all authors , Ramli N 5 , Khalidin N 5 , Mazlan M 6 , Chee KH 7 , Zainal Abidin I 7 , Nalathamby N 1 , Mat S 1 , Jaafar MH 1 , Khor HM 1 , Khannas NM 8 , Majid LA 8 , Tan KM 1 , Chin AV 1 , Kamaruzzaman SB 1 , Poi P 1 , Morgan K 9 , Hill KD 10 , MacKenzie L 11 , Tan MP 1

Affiliations 

  • 1 Ageing and Age-Associated Disorders Research Group, University of Malaya, Kuala Lumpur, Malaysia
  • 2 Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
  • 3 Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
  • 4 Department of Trauma and Emergency Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
  • 5 Department of Ophthalmology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
  • 6 Department of Rehabilitation Medicine, Faculty of Medicine, University of Malaya, Kuala Limpur, Malaysia
  • 7 Division of Cardiology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
  • 8 Department of Rehabilitation Medicine, Kuala Lumpur, University of Malaya Medical Centre, Kuala Limpur, Malaysia
  • 9 Department Psychology and Behavioural Science, Perdana University-RCSI School of Medicine, Serdang, Selangor, Malaysia
  • 10 School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, Australia
  • 11 Department of Occupational Therapy, Faculty of Health Sciences, University of Sydney, Sydney, Australia
PLoS One, 2018;13(8):e0199219.
PMID: 30074996 DOI: 10.1371/journal.pone.0199219

Abstract

OBJECTIVE: To determine the effectiveness of an individually-tailored multifactorial intervention in reducing falls among at risk older adult fallers in a multi-ethnic, middle-income nation in South-East Asia.

DESIGN: Pragmatic, randomized-controlled trial.

SETTING: Emergency room, medical outpatient and primary care clinic in a teaching hospital in Kuala Lumpur, Malaysia.

PARTICIPANTS: Individuals aged 65 years and above with two or more falls or one injurious fall in the past 12 months.

INTERVENTION: Individually-tailored interventions, included a modified Otago exercise programme, HOMEFAST home hazards modification, visual intervention, cardiovascular intervention, medication review and falls education, was compared against a control group involving conventional treatment.

PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was any fall recurrence at 12-month follow-up. Secondary outcomes were rate of fall and time to first fall.

RESULTS: Two hundred and sixty-eight participants (mean age 75.3 ±7.2 SD years, 67% women) were randomized to multifactorial intervention (n = 134) or convention treatment (n = 134). All participants in the intervention group received medication review and falls education, 92 (68%) were prescribed Otago exercises, 86 (64%) visual intervention, 64 (47%) home hazards modification and 51 (38%) cardiovascular intervention. Fall recurrence did not differ between intervention and control groups at 12-months [Risk Ratio, RR = 1.037 (95% CI 0.613-1.753)]. Rate of fall [RR = 1.155 (95% CI 0.846-1.576], time to first fall [Hazard Ratio, HR = 0.948 (95% CI 0.782-1.522)] and mortality rate [RR = 0.896 (95% CI 0.335-2.400)] did not differ between groups.

CONCLUSION: Individually-tailored multifactorial intervention was ineffective as a strategy to reduce falls. Future research efforts are now required to develop culturally-appropriate and affordable methods of addressing this increasingly prominent public health issue in middle-income nations.

TRIAL REGISTRATION: ISRCTN Registry no. ISRCTN11674947.

Study site: emergency department, medical outpatients and primary care clinic at a teaching hospital in Kuala Lumpur, Malaysia

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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