# Supplementary material 2 to:
Interventions for preventing falls in older people living in the community

Gillespie LD , Robertson MC , Gillespie WJ , Sherrington C , Gates S , Clemson L , Lamb SE
https://doi.org/10.1002/14651858.CD007146.pub3

Cochrane disclaims all liability and responsibility arising from any reliance placed on this supplementary material which has been supplied by the author(s). The above associated publication’s Author Licence will apply in respect of any supplemental materials published. How to cite the supplementary material is defined in the Cochrane policy.

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# Characteristics of included studies

## Table of contents

- Studies ordered by study ID
  - Assantachai 2002
  - Ballard 2004
  - Barnett 2003
  - Beling 2009
  - Beyer 2007
  - Bischoff-Ferrari 2006
  - Bischoff-Ferrari 2010
  - Blalock 2010
  - Brown 2002
  - Buchner 1997a
  - Bunout 2005
  - Campbell 1997
  - Campbell 1999
  - Campbell 2005
  - Carpenter 1990
  - Carter 1997
  - Carter 2002
  - Cerny 1998
  - Ciaschini 2009
  - Clemson 2004
  - Clemson 2010
  - Close 1999
  - Coleman 1999
  - Comans 2010
  - Conroy 2010
  - Cornillon 2002
  - Cumming 1999
  - Cumming 2007
  - Dangour 2011
  - Dapp 2011
  - Davis 2011a
  - Davison 2005
  - Day 2002
  - De Vries 2010
  - Dhesi 2004
  - Di Monaco 2008
  - Dukas 2004
  - Elley 2008
  - Fabacher 1994
  - Faes 2011
  - Fiatarone 1997
  - Foss 2006
  - Fox 2010
  - Gallagher 1996
  - Gallagher 2001
  - Gill 2008
  - Grahn Kronhed 2009
  - Grant 2005
  - Gray-Donald 1995
  - Greenspan 2005
  - Haines 2009
  - Haran 2010
  - Harari 2008
  - Harwood 2004
  - Harwood 2005
  - Hauer 2001
  - Helbostad 2004
  - Hendriks 2008
  - Hill 2000
  - Hogan 2001
  - Hornbrook 1994
  - Huang 2004
  - Huang 2005
  - Huang 2010
  - Huang 2011
  - Iwamoto 2009
  - Jitapunkul 1998
  - Kamide 2009
  - Kärkkäinen 2010
  - Kemmler 2010
  - Kenny 2001
  - Kingston 2001
  - Korpelainen 2006
  - Lannin 2007
  - Latham 2003
  - Li 2005
  - Lightbody 2002
  - Lin 2007
  - Liu-Ambrose 2004
  - Liu-Ambrose 2008
  - Logan 2010
  - Logghe 2009
  - Lord 1995
  - Lord 2003
  - Lord 2005
  - Luukinen 2007
  - Madureira 2010
  - Mahoney 2007
  - Markle-Reid 2010
  - McKiernan 2005
  - McMurdo 1997
  - McMurdo 2009
  - Means 2005
  - Meredith 2002
  - Morgan 2004
  - Newbury 2001
  - Nikolaus 2003
  - Nitz 2004
  - Pardessus 2002
  - Parry 2009
  - Pereira 1998
  - Perry 2008
  - Pfeifer 2000
  - Pfeifer 2009
  - Pighills 2011
  - Pit 2007
  - Porthouse 2005
  - Prince 2008
  - Ralston 2011
  - Reid 2006
  - Reinsch 1992
  - Resnick 2002
  - Robertson 2001a
  - Robson 2003
  - Rubenstein 2000
  - Rubenstein 2007
  - Russell 2010
  - Ryan 1996
  - Ryan 2010
  - Salminen 2009
  - Sanders 2010
  - Sato 2005a (Retracted)
  - Schrijnemaekers 1995
  - Sherrington 2004
  - Shigematsu 2008
  - Shumway-Cook 2007
  - Shyu 2010
  - Skelton 2005
  - Smith 2007
  - Smulders 2010
  - Spice 2009
  - Spink 2011
  - Steadman 2003
  - Steinberg 2000
  - Stevens 2001
  - Suman 2011
  - Suzuki 2004
  - Swanenburg 2007
  - Tinetti 1994
  - Trivedi 2003
  - Trombetti 2011
  - Van Haastregt 2000
  - Van Rossum 1993
  - Vellas 1991
  - Vetter 1992
  - Vind 2009
  - Von Stengel 2011
  - Voukelatos 2007
  - Wagner 1994
  - Weber 2008
  - Weerdesteyn 2006
  - Whitehead 2003
  - Wilder 2001
  - Wolf 1996
  - Wolf 2003
  - Woo 2007
  - Wu 2010
  - Wyman 2005
  - Yamada 2010
- Footnotes
- References to studies

## Studies ordered by study ID

Assantachai 2002
Study characteristics
Methods | CCT (cluster-randomised by community)
Participants | Setting: Bangkok, Thailand N = 1043 Sample: people living in 11 selected urban communities (64% women) Age (years): mean 67.6 (SD 6.2) Inclusion criteria: aged at least 60; living in one of the selected communities
Interventions | 1. Educational leaflet and free access to geriatric clinic. Leaflet about locally identified risk factors for falling (kyphoscoliosis, nutritional status, ADL, hypertension, special sense function, cognitive problems) and ways of preventing, correcting, coping with them. Assessed musculoskeletal deformity, arthralgia, hypertension, ADL, mobility, gait, hearing, vision, and presumably any problems addressed at geriatric clinic 2. Control: no intervention
Outcomes | 1. Number of people falling
Duration of the study | 1 year
Notes |
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | High risk | Communities drawn from pool of 20 until 1043 subjects recruited. Communities then allocated to intervention (odd number) or control (even number) using enrolment sequence (information provided by author).
Allocation concealment (selection bias) | High risk | Alternation
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Cluster-randomised by community. Control groups received leaflet and offer of hospital access and self reported falls every 2 months. Insufficient information to judge risk of bias.
Blinding of outcome assessment (detection bias) Falls and fallers | Unclear risk | Falls recorded in both groups by participants who were aware of their group allocation. Blinding of assessors not described.
Incomplete outcome data (attrition bias) Fallers | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | High risk | Interval recall. Falls ascertained by postcards every 2 months, and phone call if no card returned.

Ballard 2004
Study characteristics
Methods | RCT
Participants | Setting: USA N = 40 Sample: volunteers (100% women) Age (years): mean 72.9 (SD 6) Inclusion criteria: aged ≥ 65; ambulatory; community-dwelling; history of falling in previous year or fear of future fall; able to moderate exercise Exclusion criteria: cardiovascular disease or extreme vertigo that might prohibit moderate exercise; requiring walker for support
Interventions | 1. Exercise sessions (warm up, low impact aerobics, exercise for strength and balance, cool down) 1 hour, 3 x per wk, for 15 wk. Plus 6 home safety education classes. 2. Control: exercise sessions as above 1 hour, 3 x per wk, for 2 wk + videotape so could continue at home. Plus 6 home safety education classes as above.
Outcomes | 1. Rate of falls 2. Number of people falling Falls a secondary outcome of study Other outcomes reported but not included in this review
Duration of the study | 16 months
Notes |
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Unclear risk | Quote: "assigned to exercise and control groups using stratified randomisation".
Allocation concealment (selection bias) | Unclear risk | Insufficient information to permit judgement
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Control group had 2 wk exercise programme - study group 15 wk. Neither participants or study personnel blinded.
Blinding of outcome assessment (detection bias) Falls and fallers | Unclear risk | Falls data collected by telephone at 1 year. Blinding of telephone assessors not reported.
Incomplete outcome data (attrition bias) Falls | Low risk | See Supplementary material 9 for method of assessment
Incomplete outcome data (attrition bias) Fallers | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | High risk | Falls identified retrospectively during intervention at each home safety class (every 2 months), and by telephone follow-up 1 year after end of intervention

Barnett 2003
Study characteristics
Methods | RCT
Participants | Setting: Australia N = 163 Sample: elderly people identified (67% women) as at risk of falling by general practitioner or hospital physiotherapist using assessment tool Age (years): mean 74.9 (SD 10.9) Inclusion criteria: age over 65 years; identified as 'at risk' of falling (1 or more of the following risk factors: lower limb weakness, poor balance, slow reaction time) Exclusion criteria: cognitive impairment; degenerative conditions, e.g. Parkinson's disease or medical condition involving neuromuscular, skeletal, or cardiovascular system that precluded taking part in exercise programme
Interventions | 1. Exercise sessions (stretching, and for strength, balance, co-ordination, aerobic capacity) by accredited exercise instructor, in groups of 6 to 18, 1 hour per wk for 4 terms for 1 year (37 classes) Home exercise programme based on class content + diaries to record participation 2. Control: no exercise intervention Both groups received information on strategies for avoiding falls, e.g. hand and foot placement if loss of balance occurred
Outcomes | 1. Rate of falls 2. Number of people falling Other outcomes reported but not included in this review
Duration of the study | 1 year
Notes |
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Unclear risk | Quote: "randomised in matched blocks" (N = 6)
Allocation concealment (selection bias) | Low risk | Consecutively numbered, opaque envelopes
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Both groups received information on strategies for avoiding falls. Intervention group received structured weekly exercise sessions. Blinding not reported, but impact of non-blinding unclear.
Blinding of outcome assessment (detection bias) Falls and fallers | Unclear risk | Falls reported by participants who were aware of their group allocation, by postal surveys monthly in both groups. Telephone interview if not returned by 2 weeks. Unclear whether those conducting telephone check were unblinded.
Incomplete outcome data (attrition bias) Falls | Low risk | See Supplementary material 9 for method of assessment
Incomplete outcome data (attrition bias) Fallers | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Unclear risk | Interval recall. Falls identified by postal survey at the end of each calendar month. Phoned if not returned within 2 weeks.

Beling 2009
Study characteristics
Methods | RCT
Participants | Setting: California State University, Northridge, California, USA N = 23 Sample: volunteers recruited through press releases, newspaper advertisements and university website (42% women) Age (years): mean 80 (SD 5.7) Inclusion criteria: ≥ 65 years; community-dwelling; English speaking; minimal vision and hearing deficit; access to transportation; consenting; with physician approval to participate; MMSE ≥ 24/30; 3 m TUG test ≥ 13.5 sec and/or to have ≥ 2 falls in past year and/or 1 injurious fall in the past year Exclusion criteria: cardiac conditions; musculoskeletal and/or neurological impairment that could result in falls, e.g. stroke, Parkinson's disease, lower extremity joint replacement, fracture in last year
Interventions | Both groups received multifactorial intervention (assessment and referral) prior to randomisation 1. Intervention: physiotherapist-led, group-based balance training 3 x per wk for 12 wks. Tailored to address risk factors identified at pre-testing. Home assessment by physiotherapist students. Written recommendations given and discussed. Funding to assist with modifications. Measured and supplied with hip protectors. 2. Control: usual activities but offered intervention after post test
Outcomes | 1. Rate of falls Other outcomes reported but not included in this review
Duration of the study | 3 months
Notes | Required to attend minimum of 30 sessions
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Unclear risk | Quote: "Twelve subjects were randomly assigned to the experimental group and 11 subjects were assigned to the control group." Insufficient information to permit judgement.
Allocation concealment (selection bias) | Unclear risk | Quote: "randomly assigned". Insufficient information to permit judgement.
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Participants and personnel not blind to allocated group but impact of non-blinding unclear
Blinding of outcome assessment (detection bias) Falls and fallers | Unclear risk | No information on method of recording falls. Insufficient information to permit judgement.
Incomplete outcome data (attrition bias) Falls | High risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | High risk | Quote: "The number of falls that occurred in both groups during the 12 week intervention was also collected at the end of the intervention." Ascertainment relied on participant recall at the end of the 12 week intervention.

Beyer 2007
Study characteristics
Methods | RCT
Participants | Setting: Copenhagen, Denmark N = 65 Sample: women with a history of a fall identified from hospital records Age (years): range 70 to 90 Inclusion criteria: community-dwelling; at a relatively high risk of falls, defined as either ≥ 80 years old or ≥ 65 years with history of a fall in the previous 12 months or a timed up and go test score of at least 15 seconds; home-dwelling; aged 70 to 90 years; history of a fall requiring treatment in ED but not hospitalisation; able to come to training facility Exclusion criteria: lower limb fracture in last 6 months; neurological diseases, unable to understand Danish; cognitively impaired (MMSE < 24)
Interventions | 1. Supervised group exercise programme (flexibility, lower limb resistance exercise, balance training, stretching), 60 min, 2 x per wk, for 6 months 2. Control: no intervention, but offered intervention after 1 year
Outcomes | 1. Number of people falling Other outcomes reported but not included in this review
Duration of the study | 1 year
Notes |
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Quote: "…using the minimization method with the aid of a computer program for randomization"
Allocation concealment (selection bias) | Unclear risk | Insufficient information to permit judgement
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Participants and personnel not blind to allocated group but impact of non-blinding unclear
Blinding of outcome assessment (detection bias) Falls and fallers | Unclear risk | Falls were recorded in both allocated groups using the same method (a monthly falls calendar), but no mention of blinding of personnel confirming falls or carrying out data entry. Insufficient information to make a judgement of 'Low risk' or 'High risk'.
Incomplete outcome data (attrition bias) Fallers | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Low risk | Quote: "A falls calendar was sent to every participant on the first day of each month" for 1 year

Bischoff-Ferrari 2006
Study characteristics
Methods | RCT
Participants | Setting: Boston, MA, USA N = 445 Sample: men and women recruited by direct mailings and presentations (sample frame not given) (55% women) Age (years): mean 71 Inclusion criteria: aged ≥ 65 Exclusion criteria: current cancer or hyperparathyroidism; kidney stone in last 5 years; renal disease; bilateral hip surgery; bisphosphonate, calcitonin, oestrogen, tamoxifen, or testosterone therapy in past 6 months, or fluoride in past 2 years; femoral neck BMD > 2 SD below the mean for subjects of the same age and sex; dietary calcium intake > 1500 mg/day; laboratory evidence of kidney disease
Interventions | 1. Cholecalciferol (700 IU vitamin D) and calcium citrate malate (500 mg elemental calcium) orally, daily at bedtime for 3 years 2. Control: double placebo tablets
Outcomes | 1. Rate of falls 2. Number of people falling 3. Number sustaining a fracture 4. Adverse effects Other outcomes reported but not included in this review
Duration of the study | 3 years
Notes |
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Unclear risk | Quote: "Participants were randomly assigned ..." Quote: "Random group assignment was performed with stratification according to sex, race and decade of age."
Allocation concealment (selection bias) | Unclear risk | Insufficient information to permit judgement
Blinding of participants and personnel (performance bias) All outcomes | Low risk | Placebo-controlled medication trial
Blinding of outcome assessment (detection bias) Falls and fallers | Low risk | Falls reported by participants who were blind to their group allocation (placebo-controlled trial)
Blinding of outcome assessment (detection bias) Fractures | Low risk | Quote: "... cases of nonvertebral fracture were ascertained by means of interviews and verified with use of hospital records."
Incomplete outcome data (attrition bias) Falls | Low risk | See Supplementary material 9 for method of assessment
Incomplete outcome data (attrition bias) Fallers | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Low risk | Quote: "Participants were asked to send a postcard after every fall, which was then followed by a telephone call from a staff member to assess the circumstances of the fall. In addition, falls were ascertained at every follow-up visit."

Bischoff-Ferrari 2010
Study characteristics
Methods | RCT (2 x 2 factorial design)
Participants | Setting: hospital centre, Triemli, Switzerland N = 173 Sample: acute hip fracture (79% women) Age (years): mean 84 (range 65 to 99) Inclusion criteria: aged ≥ 65; acute hip fracture; MMSE ≥ 15; creatinine clearance > 15 mL/min; able to walk 3 m before hip fracture Exclusion criteria: prior hip fracture at same hip; cancer or chemotherapy in last year; severe visual or hearing impairment; kidney stone in past 5 years; hypercalcaemia; primary parathyroidism or sarcoidosis
Interventions | 1. Cholecalciferol (vitamin D3) 2000 IU/day (breakfast and bedtime 400 IU cholecalciferol + 500 mg calcium carbonate + 1200 IU cholecalciferol at breakfast) + standard physiotherapy (supervised physiotherapy 30 min/day in acute care) 2. Cholecalciferol 2000 IU/day (breakfast and bedtime 400 IU cholecalciferol + 500 mg calcium carbonate + 1200 IU cholecalciferol at breakfast) + extended physiotherapy (supervised physiotherapy 30 min/day + 30 min/day home programme instruction in acute care + unsupervised home programme for 12 months (standing on 1, 2 legs; Theraband for arms; getting in/out chairs; going up/down stairs)) 3. Cholecalciferol 800 IU/day (breakfast and bedtime 400 IU cholecalciferol + 500 mg calcium carbonate + placebo cholecalciferol at breakfast) + standard physiotherapy (as above) 4. Cholecalciferol 800 IU/day (breakfast and bedtime 400 IU cholecalciferol + 500 mg calcium carbonate + placebo cholecalciferol at breakfast) + extended physiotherapy (as above)
Outcomes | 1. Rate of falls 2. Number sustaining a hip fracture 3. Adverse effects
Duration of the study | 1 year
Notes |
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Quote: "Computer-based randomization was performed by the study statistician"
Allocation concealment (selection bias) | Unclear risk | Insufficient information to permit judgement of 'high' or 'low'
Blinding of participants and personnel (performance bias) All outcomes | Low risk | Quote: "Randomization for the dosage of cholecalciferol was double-blinded, whereas randomization for PT was single-blinded (all study staff except the treating physiotherapist who instructed the home program were blinded to the PT treatment allocation)." Trial with 4 arms (factorial design) with varying risk of bias. Drug intervention placebo-controlled (low risk). Although participants and PT aware of which physiotherapy intervention they were receiving the impact of non-blinding likely to be low or unclear
Blinding of outcome assessment (detection bias) Falls and fallers | Low risk | Phoned by assessor blind to allocation. Quote: "... all study staff except the treating physiotherapist who instructed the home program were blinded to the PT treatment allocation." "To maintain the blinding of our study staff to the PT group, we assessed adherence to the home program (at least once per wk vs less) only at the 12-month follow-up visit or by telephone call."
Blinding of outcome assessment (detection bias) Fractures | Low risk | Quote: "Falls, fall-related injuries, and hospital readmissions were assessed by monthly telephone calls and a patient diary." "All admission records were reviewed by 3 blinded coinvestigators (H.A.B.-F., A.E., and N.J.M.) to determine the main cause of readmission." Hip fracture data used in this review and these participants would have been hospitalised and therefore confirmed by blinded coinvestigators.
Incomplete outcome data (attrition bias) Falls | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Low risk | Quote: "Falls, fall-related injuries, and hospital readmissions were assessed by monthly telephone calls and a patient diary. In addition, a telephone hotline was provided to report these events at any time."

Blalock 2010
Study characteristics
Methods | RCT
Participants | Setting: North Carolina, USA N = 186 Sample: recruited through a chain of community pharmacies (71% women) Age (years): mean 74.8 (SD 6.9) Inclusion criteria: aged ≥ 65 years; ≥ 1 falls during 12-month period before study entry; taking ≥ 4 prescription medications; taking ≥ 1 high falls-risk medication; able to speak and read English Exclusion criteria: resident of long-term care facility; cognitively impaired; housebound
Interventions | 1. Pharmacist intervention: face-to-face consultation with community pharmacist about medication regimen (identifying side effects etc). Pharmacist follow-up as required; participants' physicians to co-ordinate any recommended medication changes. Given fall prevention brochure and home safety checklist 2. Control: given fall prevention brochure and home safety checklist
Outcomes | 1. Rate of falls 2. Number of people falling
Duration of the study | 1 year
Notes |
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Quote: "The allocation sequence used for making group assignments was created using a list of random numbers, generated in blocks of 20 to ensure balancing of group assignment over the duration of participant recruitment."
Allocation concealment (selection bias) | Unclear risk | Quote: "The allocation sequence was concealed from all study personnel except the principal investigator, who had no contact with study participants during the process of data collection or intervention delivery." Insufficient information to permit judgement.
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Participants and personnel not blind to allocated group but impact of non-blinding unclear
Blinding of outcome assessment (detection bias) Falls and fallers | Low risk | Participants contacted by phone if calendars not returned, or reporting a fall. The only unblinded member of the research group was not involved in data collection (see above).
Incomplete outcome data (attrition bias) Falls | Low risk | See Supplementary material 9 for method of assessment
Incomplete outcome data (attrition bias) Fallers | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Low risk | Quote: "... each participant received a set of twelve 1-month calendars. They were asked to record each fall they experienced on the calendar for the current month. …asked to return each calendar to study staff at the end of the month. Participants who did not return a calendar by the 10th of the following month were called by study personnel to obtain the required information by phone."

Brown 2002
Study characteristics
Methods | RCT (individually randomised, but 6 clusters containing couples at same address)
Participants | Setting: Perth, Western Australia N = 149 Sample: men and women recruited by press releases in 11 newspapers and information brochures distributed to organisations, GPs, etc (79% women) Age (years): N = 101 aged 75 to 84, N = 48 aged 85 to 94 Inclusion criteria: age ≥ 75; community-living; independent in basic ADL; able to walk 20 m without personal assistance Exclusion criteria: cognitive impairment (MMSE ≤ 24); various conditions, e.g. angina, claudication, cerebrovascular disease, low or high blood pressure, major systemic disease, mental illness
Interventions | 1. Exercise intervention to improve cardiovascular endurance, general muscle performance, balance, co-ordination and flexibility. 60 min, 2 x per wk for 16 wks (32 hours). 2. Social intervention for 13 wks involving presentations of travel slides and videos by participants 3. Control: no intervention
Outcomes | 1. Number of participants falling
Duration of the study | 14 months
Notes |
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Quote: "randomised into one of three groups using a table of random numbers".
Allocation concealment (selection bias) | Low risk | Randomised into one of 3 groups "by a physiotherapist uninvolved in the study."
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Participants and personnel not blind to allocated group but impact of non-blinding unclear
Blinding of outcome assessment (detection bias) Falls and fallers | Low risk | Falls reported by participants who were aware of their group allocation, but outcome assessors were blinded
Incomplete outcome data (attrition bias) Fallers | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Low risk | Participants provided details of falls in monthly report sheet returned in reply paid addressed envelopes

Buchner 1997a
Study characteristics
Methods | RCT
Participants | Setting: Seattle, USA N = 105 Sample: random sample of HMO members (FICSIT intervention groups only) (51% women) Age (years): mean 75 Inclusion criteria: aged 68 to 85; unable to do 8-step tandem gait test without errors; below 50th percentile in knee extensor strength for height and weight Exclusion criteria: active cardiovascular, pulmonary, vestibular, and bone disease; positive cardiac stress test; body weight > 180% ideal; major psychiatric illness; active metabolic disease; chronic anaemia; amputation; chronic neurological or muscle disease; inability to walk; dependency in eating, dressing, transfer or bathing; terminal illness; inability to speak English or complete written forms
Interventions | Randomised into 7 groups: 6 intervention groups (3 FICSIT trial, 3 MoveIT trial), and 1 control group. Only FICSIT trial and control groups included in this review. Supervised exercise classes 1 hour, 3 x per wk for 24 to 26 wks followed by unsupervised exercise 1. 6 months endurance training (ET) (stationary cycles) with arms and legs propelling wheel 2. 6 months strength training (ST) classes (using weight machines for resistance exercises for upper and lower body) 3. 6 months ST plus ET 4. Control: usual activity levels but "allowed to exercise after 6 months" Exercise sessions started with a 10 to 15-minute warm-up and ended with a 5 to 10-minute cool down
Outcomes | 1. Rate of falls 2. Number of people falling 3. Number of people with adverse effects "A priori decision" to report fall outcomes for "any exercise" (all 3 exercise groups combined) compared with control group
Duration of the study | Maximum 25 months (median 18 months)
Notes | Seattle FICSIT trial. Only 1.3% of original sample randomised. Falls not primary outcome. Other outcomes assessed at end of intervention (6 months) then "control group allowed to exercise after 6 months" (7/30 participants did). Cost analysis reported in primary reference.
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Randomised "using a variation of randomly permuted blocks."
Allocation concealment (selection bias) | Unclear risk | Insufficient information to permit judgement
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Participants and personnel not blind to allocated group but impact of non-blinding unclear
Blinding of outcome assessment (detection bias) Falls and fallers | Unclear risk | Falls reported by participants who were aware of their group allocation. Quote: "Most study outcomes were measured by blinded examiners..." but unclear whether this applies to personnel carrying out telephone follow-up of falls.
Incomplete outcome data (attrition bias) Falls | Low risk | See Supplementary material 9 for method of assessment
Incomplete outcome data (attrition bias) Fallers | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Low risk | Falls reported immediately by mail, also monthly postcard return; telephone follow-up if no postcard received

Bunout 2005
Study characteristics
Methods | RCT
Participants | Setting: Chile N = 298 Sample: men and women (71% women) Age (years): mean 75 (SD 5) Inclusion criteria: "elderly subjects" consenting to participate; able to reach community centre Exclusion criteria: severe disabling condition; cognitive impairment (MMSE < 20)
Interventions | 1. Exercise class: 1 hour, 2 x per wk, for 1 year, moderate-intensity resistance exercise training (functional weight bearing exercises, exercises with TheraBands and walking (see Appendix 2 of supplementary data on journal website for details) 2. Control: no intervention
Outcomes | 1. Rate of falls 2. Number of people falling Other outcomes reported but not included in this review
Duration of the study | For the 1 year of intervention
Notes | Journal website for supplementary data www.ageing.oupjournals.org. Additional data obtained from author.
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Randomised using computer-generated random number table
Allocation concealment (selection bias) | Unclear risk | Insufficient information to permit judgement
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Participants and personnel not blind to allocated group but impact of non-blinding unclear
Blinding of outcome assessment (detection bias) Falls and fallers | Unclear risk | Falls reported at follow-up clinics by participants who were aware of their group allocation. Blinding of researchers at follow-up not reported.
Incomplete outcome data (attrition bias) Falls | Low risk | See Supplementary material 9 for method of assessment
Incomplete outcome data (attrition bias) Fallers | High risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Unclear risk | Interval recall. Falls ascertained at monthly outpatient clinic or by telephone.

Campbell 1997
Study characteristics
Methods | RCT
Participants | Setting: Dunedin, New Zealand N = 233 Sample: women identified from general practice registers Age (years): mean 84.1 (SD 3.1) Inclusion criteria: at least 80 years old; community-living Exclusion criteria: cognitive impairment; not ambulatory in own residence; already receiving physiotherapy
Interventions | Baseline health and physical assessment for both groups. 1. 1-hour visits by physiotherapist x 4 in first 2 months to prescribe home-based individualised exercise and walking programme. Exercise, 30 min, 3 x per wk plus walk outside home 3 x per wk. Encouraged to continue for 1 year. Regular phone contact to maintain motivation after first 2 months. 2. Control: social visit by research nurse x 4 in first 2 months. Regular phone contact.
Outcomes | 1. Rate of falls 2. Number of people falling
Duration of the study | 24 months but 12-month data used in analyses
Notes | Otago Exercise Programme manual can be obtained from www.cdc.gov/HomeandRecreationalSafety/Falls/compendium/1.2_otago.html. Cost-effectiveness analysis reported (1).
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Allocation schedule developed using computer-generated numbers
Allocation concealment (selection bias) | Low risk | Assignment by independent person off site
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Participants and personnel not blind to allocated group but impact of non-blinding unclear
Blinding of outcome assessment (detection bias) Falls and fallers | High risk | Falls reported by participants who were aware of group allocation. Blinding of adjudicator reported, but researcher making telephone contact was aware of group allocation as she also did social visits (personal communication).
Incomplete outcome data (attrition bias) Falls | Low risk | See Supplementary material 9 for method of assessment
Incomplete outcome data (attrition bias) Fallers | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Low risk | Falls recorded daily on postcard calendars, mail registration monthly by postcard, telephone follow-up

Campbell 1999
Study characteristics
Methods | RCT (2 x 2 factorial design)
Participants | Setting: community. Dunedin, New Zealand N = 93 Sample: identified from general practice registers (76% women) Age (years): mean 74.7 (SD 7.2) Inclusion criteria: at least 65 years old; currently taking a benzodiazepine, any other hypnotic, or any antidepressant or major tranquilliser; ambulatory in own residence; not receiving physiotherapy; thought by GP to benefit from psychotropic medication withdrawal Exclusion criteria: cognitive impairment
Interventions | Baseline assessment 1. Gradual withdrawal of psychotropic medication (placebo substitution) over 14 wk period plus home-based exercise programme 2. Psychotropic medication withdrawal (placebo substitution) with no exercise programme 3. No change in psychotropic medication plus exercise programme 4. No change in psychotropic medication, no exercise programme Exercise programme: 1-hour physiotherapist visits 4 x in first 2 months to prescribe home-based individualised exercises (muscle strengthening and balance retraining exercises 30 min, 3 x per wk) and walking 2 x per wk Regular phone contact to maintain motivation Study capsules created by grinding tablets and packing into gelatin capsules. Capsules containing inert and active ingredients looked and tasted the same.
Outcomes | 1. Rate of falls 2. Number of people falling
Duration of the study | 44 wks
Notes | Only 19% randomised. Psychotropic medications recorded 1 month after completion of study. 8 of the 17 who had taken the placebo for 44 wks had restarted 1 month after end of study. Otago Exercise Programme manual can be obtained from www.cdc.gov/HomeandRecreationalSafety/Falls/compendium/1.2_otago.html. Cost-effectiveness analysis reported (2).
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Allocation schedule developed using computer-generated numbers
Allocation concealment (selection bias) | Low risk | Assignment by independent person off site
Blinding of participants and personnel (performance bias) All outcomes | Low risk | Participants and personnel blinded to psychotropic medication dose. Although participants and PT aware of which physiotherapy intervention they were receiving this is unlikely to have introduced performance bias.
Blinding of outcome assessment (detection bias) Falls and fallers | Low risk | Falls reported by participants who were aware of exercise allocation, but not medication withdrawal. Investigator confirming fall events blind to group allocation.
Incomplete outcome data (attrition bias) Falls | High risk | See Supplementary material 9 for method of assessment
Incomplete outcome data (attrition bias) Fallers | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Low risk | Falls recorded daily on postcard calendars, mail registration monthly by postcard, telephone follow-up

Campbell 2005
Study characteristics
Methods | RCT (2 x 2 factorial design)
Participants | Setting: New Zealand N = 391 Sample: men and women with severe visual impairment (visual acuity 6/24 or worse) identified in blind register, university and hospital outpatient clinics, and private ophthalmology practice (68% women) Age (years): mean 83.6 (SD 4.8), range 75 to 96 Inclusion criteria: vision worse than 6/24 in better eye; age ≥ 75 years Exclusion criteria: unable to walk around home
Interventions | 1. Home safety programme 2. Otago Exercise Programme plus vitamin D supplements 3. Both of the above 4. Control: 2 x 1-hour social visits during the first 6 months of the trial
Outcomes | 1. Rate of falls 2. Number of people falling
Duration of the study | 1 year
Notes | Otago Exercise Programme manual can be obtained from www.cdc.gov/HomeandRecreationalSafety/Falls/compendium/1.2_otago.html. Cost-effectiveness analysis reported in the primary reference.
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Computer-generated random numbers
Allocation concealment (selection bias) | Low risk | Schedule held by independent person at separate site, telephone access
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Participants and personnel not blind to allocated group but impact of non-blinding unclear
Blinding of outcome assessment (detection bias) Falls and fallers | Low risk | Falls reported by participants who were aware of their group allocation. Phoned by independent assessor blind to allocation. Person classifying fall events also blind to allocation.
Incomplete outcome data (attrition bias) Falls | Low risk | See Supplementary material 9 for method of assessment
Incomplete outcome data (attrition bias) Fallers | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Low risk | Prospective. Falls recorded on daily on monthly pre-paid postcard calendars, telephone follow-up

Carpenter 1990
Study characteristics
Methods | RCT (individually randomised, but small number of clusters as husbands allocated to same group)
Participants | Setting: Andover, United Kingdom N = 539 Sample: women and men recruited from patient lists of 2 general medical practices. The sample represents 89.5% of those in the age group in the participating practices (65% women) Age (years): ≥ 75; 23 men and 49 women > 85 Inclusion criteria: aged ≥ 75; living in Andover area Exclusion criteria: living in residential care
Interventions | 1. Visit by trained volunteers for dependency surveillance using Winchester disability rating scale. The intervention was stratified by degree of disability on the entry evaluation. For those with no disability, the visit was every 6 months; for those with disability, 3 months. Scores compared with previous assessment and referral to GP if score increased by 5 or more. 2. Control: no disability surveillance between initial and final evaluation
Outcomes | 1. Rate of falls (in each group in the month before the final interview at 3 years) Other outcomes reported but not included in this review
Duration of the study | 3 years
Notes |
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Randomised by random number tables
Allocation concealment (selection bias) | Unclear risk | Insufficient information to permit judgement
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Participants and personnel no blind to allocated group, but impact of non-blinding unclear
Blinding of outcome assessment (detection bias) Falls and fallers | Unclear risk | Recollection of falls in the preceding month was ascertained at final interview in both groups by an assessor. Blinding not described.
Incomplete outcome data (attrition bias) Falls | High risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Unclear risk | Retrospective recall, but over 1-month period

Carter 1997
Study characteristics
Methods | RCT
Participants | Setting: Hunter Valley, Australia N = 657 Sample: men and women identified by 37 general practitioners as meeting inclusion criteria (30% women) Age (years): ≥ 70 Inclusion criteria: aged ≥ 70; able to speak and understand English; community-dwelling; living independently Exclusion criteria: psychiatric disturbance affecting comprehension of the aims of the study
Interventions | 1. Brief feedback on home safety plus pamphlets on home safety and medication use (low-intensity intervention) 2. Action plan for home safety plus medication review (high-intensity intervention) 3. Control: no intervention during study period but intervention after the end of the study period
Outcomes | 1. Number of people falling (during previous month at 3, 6, and 12 months)
Duration of the study | 1 year
Notes | Unpublished study
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Random number generator
Allocation concealment (selection bias) | Unclear risk | Insufficient information to permit judgement
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Participants and personnel not blind to allocated group but impact of non-blinding unclear
Blinding of outcome assessment (detection bias) Falls and fallers | Unclear risk | Self reported falls and blinding of personnel carrying out structured interview at 3, 6, and 12 months not described
Incomplete outcome data (attrition bias) Fallers | High risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | High risk | 4-week retrospective diary used by participants prior to structured interview at 3, 6, and 12 months

Carter 2002
Study characteristics
Methods | RCT
Participants | Setting: Vancouver, Canada N = 93 Subjects: community-dwelling osteoporotic women Age (years): mean 69 (SD 3) Inclusion criteria: aged 65 to 75 years; residents of greater Vancouver; osteoporotic (based on BMD) Exclusion criteria: < 5 years post menopause; weighed > 130% ideal body weight; other contraindications to exercising; already doing > 8 hours/wk moderate to hard exercise; planning to be out of city > 4 wk during 20 wk programme
Interventions | 1. Exercise class (Osteofit) for 40 min, 2 x per wk, for 20 wks in community centres. Classes of 12 per instructor. 8 to 16 strengthening and stretching exercises using Theraband elastic bands and small free weights. Bimonthly social seminar. 2. Control: usual routine activities and bimonthly social seminar separate from intervention group
Outcomes | 1. Rate of falls Other outcomes reported but not included in this review
Duration of the study | 20 wks
Notes |
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Randomised by computer-generated programme
Allocation concealment (selection bias) | Unclear risk | Insufficient information to permit judgement
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Participants and personnel not blind to allocated group but impact of non-blinding unclear
Blinding of outcome assessment (detection bias) Falls and fallers | Low risk | Quote: "All data were collected by trained researchers blinded to group assignment."
Incomplete outcome data (attrition bias) Falls | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Low risk | Falls recorded in falls calendars returned monthly

Cerny 1998
Study characteristics
Methods | RCT (individually randomised but some clusters, e.g. couples or 2 ladies where one was dependent on the other for transport)
Participants | Setting: California, USA N = 28 Sample: community-dwelling "well elderly" (proportion of women not stated) Age (years): mean 71 (SD 4) Inclusion criteria: none described Exclusion criteria: none described
Interventions | 1. Exercise programme of progressive resistance, stretching, aerobic and balance exercises, and brisk walking over various terrains for 1.5 hours, 3 x per wk, for 6 months 2. Control: no intervention
Outcomes | 1. Number of people falling Other outcomes reported but not included in this review. Falls a secondary outcome
Duration of the study | 6 months
Notes | Contact with lead author but no full paper or report prepared
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Randomised by coin toss. Individually randomised but some clusters, e.g. couples or 2 ladies where one was dependent on the other for transport (information from author).
Allocation concealment (selection bias) | High risk | Coin toss on site
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Participants and personnel not blind to allocated group but impact of non-blinding unclear
Blinding of outcome assessment (detection bias) Falls and fallers | Unclear risk | Reported only in abstract. Insufficient information to permit judgement.
Incomplete outcome data (attrition bias) Fallers | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | High risk | Assume retrospective recall and 3 and 6 months assessment

Ciaschini 2009
Study characteristics
Methods | RCT
Participants | Setting: Algoma District (including Sault Ste Marie), Ontario, Canada N = 201 Sample: community-dwelling people at risk of a fall-related fracture (94% women) Age (years): mean 72 (SD 8.4) Inclusion criteria: community-dwelling; > 55 years old; able to consent; at risk of fracture (non-pathological fracture in past year with T-score < 2.0; attended ED with a fall, self referred, or referred by health professional and at high risk of falls (TUG test > 14 sec)) Exclusion criteria: if already receiving therapy for osteoporosis as per Osteoporosis Canada guidelines
Interventions | 1. Multifactorial falls risk assessment by nurse + counselling and referral for PT and OT and interventions, plus recommendations for osteoporosis therapy targeting physicians and their patients 2. Control: usual care until 6 months, then same as intervention group
Outcomes | 1. Number of people falling 2. Number of sustaining a fracture Other outcomes reported but not included in this review: primary outcome implementation of appropriate falls risk management by 6 months
Duration of the study | 6 months
Notes | 12-month study but 6-month data used in review analysis as control group participants were offered the intervention after 6 months
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Quote: "Eligible patients were randomized using a computer generated randomization scheme under supervision of the study biostatistician, into an immediate intervention protocol (IP) group or to a delayed intervention protocol (DP) group".
Allocation concealment (selection bias) | Unclear risk | Insufficient information to permit judgement (see above)
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Quote: "The patients, treating physicians and outcomes collectors could not be blinded to the intervention status." but impact of non-blinding unclear.
Blinding of outcome assessment (detection bias) Falls and fallers | High risk | Outcome collection stated not to be blind to allocation
Blinding of outcome assessment (detection bias) Fractures | Low risk | Probably low risk as fractures ascertained in both groups from patient records
Incomplete outcome data (attrition bias) Fallers | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Low risk | Quote: "Falls and falls-related injuries were obtained from electronic medical records as well as patient diaries." Quote: "the number of falls and fractures as recorded in monthly patient diaries. Followup telephone calls every 3 months were used to obtain this data and completed patient diaries were mailed to the investigators at study end."

Clemson 2004
Study characteristics
Methods | RCT. Randomised in blocks of 4 stratified by sex and number of falls in previous 12 months
Participants | Setting: Sydney, Australia N = 310 Sample: volunteer community-dwelling men and women recruited by various strategies (74% women) Age (years): mean 78 (SD 5) Inclusion criteria: aged ≥ 70; community-dwelling; fallen in past year or felt themselves to be at risk of falling. Exclusion criteria: dementia (> 3 errors on Short Portable Mental Status Questionnaire); homebound; unable to independently leave home; unable to speak English
Interventions | Both groups received baseline assessment at home before randomisation 1. Stepping On programme. Multifaceted small-group (N = 12) learning environment to encourage self efficacy, behaviour change, and reduce falls using decision-making theory and a variety of learning strategies. Facilitated by OT. 2 hours per wk, for 7 wks; taught exercises and practised in classes. OT home visit within 6 wks of final programme session; booster session 3 months after final session. 2. Control: at least 2 social visits from student OT with no discussion of falls or fall prevention
Outcomes | 1. Rate of falls 2. Number of people falling
Duration of the study | 14 months
Notes | Details of programme in Appendix A of Clemson 2004: risk appraisal, exercise, moving safely, home hazards, community safety, footwear, vision and falls, vitamin D, hip protectors, medication management, mobility mastery, review and plan
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Unclear risk | Quote: "Randomised by researcher not involved in subject screening or assessment". Method not described.
Allocation concealment (selection bias) | Unclear risk | Insufficient information to permit judgement
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Study participants and personnel not blinded, but staff visiting control group instructed not to discuss falls or fall prevention
Blinding of outcome assessment (detection bias) Falls and fallers | Unclear risk | All participants used monthly calendar; telephone contact if not returned in 2 weeks. Blinding of study personnel recording data from the calendars not described.
Incomplete outcome data (attrition bias) Falls | Unclear risk | See Supplementary material 9 for method of assessment. Insufficient information to permit judgement.
Incomplete outcome data (attrition bias) Fallers | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Low risk | Prospective. Monthly falls postcard calendar.

Clemson 2010
Study characteristics
Methods | RCT
Participants | Setting: Sydney, Australia N = 34 Sample: volunteer community-dwelling men and women recruited by various strategies (47% women) Age (years): mean 82 (SD 5.9) Inclusion criteria: aged > 70 years; ≥ 2 falls or an injurious fall in previous year Exclusion criteria: cognitive impairment; no conversational English; unable to ambulate independently; resident in nursing home or hostel; unstable or terminal illness that would preclude planned exercises; neurological conditions, e.g. Parkinson's disease
Interventions | 1. LiFE (Lifestyle approach to reducing Falls through Exercise) programme (progressive balance and strength training embedded in daily life activities). Taught in 5 home visits + 2 booster visits over 3 months + 2 phone calls. Included evaluation of functional balance and strength, profile of current activities, taught LiFE principles and given safety advice relating to activities, planning of activities, and goal setting. 2. Control: no intervention
Outcomes | 1. Rate of falls 2. Number of people falling Other outcomes reported but not included in this review
Duration of the study | 6 months
Notes |
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Quote: "Randomisation was conducted … using a random numbers table"
Allocation concealment (selection bias) | Low risk | Quote: "Randomisation was conducted by an investigator not involved in assessment or intervention …" "Once baseline assessments were completed by the research assistant (RA), participants were then allocated in order of completion from the generated lists by the blinded investigator."
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Participants and personnel carrying out the intervention were not blind to allocated groups. Unclear whether this could result in performance bias.
Blinding of outcome assessment (detection bias) Falls and fallers | Unclear risk | Quote: "An RA who was not involved in the intervention and masked to the group allocation conducted all assessments. Falls surveillance was by daily calendar, which participants mailed monthly, using pre-addressed envelopes to the RA. An investigator telephoned any participant who failed to return the calendar or who reported a fall." Unclear whether the investigator carrying out the telephone calls was blind to group allocation.
Incomplete outcome data (attrition bias) Falls | Unclear risk | See Supplementary material 9 for method of assessment. Insufficient information to permit judgement.
Incomplete outcome data (attrition bias) Fallers | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Low risk | Quote: "Falls surveillance was by daily calendar, which participants mailed monthly, using pre-addressed envelopes …"

Close 1999
Study characteristics
Methods | RCT
Participants | Setting: London, United Kingdom N = 397 Sample: community-dwelling individuals presenting at A&E after a fall (68% women). Admitted patients not recruited until discharge Age (years): mean 78.2 (SD 7.5) Inclusion criteria: aged ≥ 65; history of falling Exclusion criteria: cognitive impairment (AMT < 7) and no regular carer (for informed consent reasons); speaking little or no English; not living locally
Interventions | 1. Medical and occupational therapy assessments and interventions Medical assessment to identify primary cause of fall and other risk factors present (general examination and visual acuity, balance, cognition, affect, medications). Intervention and referral as required. Home visit by occupational therapist (functional assessment and environmental hazards). Advice, equipment, and referrals as required. 2. Control: usual care only
Outcomes | 1. Rate of falls 2. Number of people falling Other outcomes reported but not included in this review
Duration of the study | 1 year
Notes | Cost analysis reported in 3
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Randomised by random numbers table
Allocation concealment (selection bias) | Low risk | List held independently of the investigators
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Participants and personnel not blind to allocated group but impact of non-blinding unclear
Blinding of outcome assessment (detection bias) Falls and fallers | Unclear risk | All participants received falls diary and 4-monthly postal questionnaire. Blinding of personnel recording the questionnaires not described.
Blinding of outcome assessment (detection bias) Fractures | Unclear risk | Self reported and blinding of personnel recording the questionnaires not described, confirmation of fractures not described
Incomplete outcome data (attrition bias) Falls | High risk | See Supplementary material 9 for method of assessment
Incomplete outcome data (attrition bias) Fallers | High risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Low risk | Quote: "Each participant was given a “falls diary” with 12 monthly sheets to assist with the recall of further falls." Quote: "Follow-up was done by postal questionnaire, which was sent to all participants every 4 months for 1 year after the fall. Information about subsequent falls, fall-related injury, and details of doctor and hospital visits or admissions and degree of function were requested.

Coleman 1999
Study characteristics
Methods | RCT (cluster-randomised by physician practice)
Participants | Setting: HMO members, Washington, USA N = 169 Sample: community-dwelling men and women in 9 physician practices in an ambulatory clinic (49% women) Age (years): mean 77 Inclusion criteria: aged ≥ 65; high risk of being hospitalised or of developing functional decline; community-dwelling Exclusion criteria: living in nursing home; terminal illness; moderate to severe dementia or "too ill" (physician's judgement)
Interventions | 1. Half-day Chronic Care Clinics every 3 to 4 months in 5 practices focusing on planning chronic disease management (physician and nurse); reducing polypharmacy and high-risk medications (pharmacist); patient self management/support group 2. Control: usual care (4 practices)
Outcomes | 1. Number of people falling
Duration of the study | 24 months (data at 12 months used in analysis)
Notes | Cost analysis reported in primary reference
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Unclear risk | Quote: "randomized using simple randomization"
Allocation concealment (selection bias) | High risk | Cluster-randomised
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Participants and personnel not blind to allocated group but impact of non-blinding unclear
Blinding of outcome assessment (detection bias) Falls and fallers | Low risk | Falls were recorded by participants on a standardised questionnaire at 12 and 24 months. Chart abstraction conducted by a member of the study team and an additional reviewer blinded to study group.
Incomplete outcome data (attrition bias) Fallers | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | High risk | Retrospective recall. Quote: "Falls were assessed using a standardized questionnaire" at 12 and 24 months.

Comans 2010
Study characteristics
Methods | RCT
Participants | Setting: Metro South Community Rehabilitation Service, Brisbane, Australia N = 107 Sample: recruited from people referred to Metro South Community Rehabilitation Service from 3 local EDs following presentation for a fall, or from local GPs (66% women) Age (years): mean 78.9 (SD 7.7) Inclusion criteria: community-dwelling; age > 60 years; referred with history of a fall (see above) and/or declining mobility, function, or physical conditioning; able to complete TUG test Exclusion criteria: living in high-level care; non-ambulant; assessed by OP or PT as unable to participate due to cognitive and/or physical function
Interventions | 1. Centre-based (group) intervention: 2 hours, 1 x per wk, for 8 wks. Group exercises (modified Tai Chi warm-up, balance exercises, indoors walking circuit, lower limb strengthening exercises (30 min); education and discussion group covering falls prevention, promoting physical activity, National Nutritional Guidelines, relaxation, stress management, future planning; upper limb strengthening and functional activities (30 min) 2. Home-based (individual) intervention: 1 x per wk, for 8 wks. Home visits by Community Rehabilitation Service (CRS) staff 45 to 60 min, 1 to 2 x wk, for 8 wks. Visits include 30 to 45 min personalised exercises and education modules as for the group programme but outdoors walking and ADL, e.g. hanging out washing for upper limb functional activities Both groups received OT home safety recommendations and a tailored balance-specific home exercise programme (10 min, 2 x per day)
Outcomes | 1. Rate of falls 2. Number of fallers Other outcomes reported but not included in this review
Duration of the study | 6 months
Notes |
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | A list of computer-generated random numbers was used to allocate subjects to home or centre-based treatment
Allocation concealment (selection bias) | Low risk | Quote: "The randomization sequence was placed into sealed, opaque numbered envelopes by administration staff not connected with research. Following consent, the assessing therapist contacted administration staff who opened the next envelope in the sequence and informed the therapist of the participant's group allocation."
Blinding of participants and personnel (performance bias) All outcomes | Low risk | Although participants and personnel carrying out the intervention were not blind to allocated groups this is unlikely to have introduced bias as both groups received a similar intervention, but in different settings
Blinding of outcome assessment (detection bias) Falls and fallers | Low risk | Quote: "Participants were followed up by monthly telephone contact for falls data and reassessed 6 months after initial randomization again by a blinded assessor."
Incomplete outcome data (attrition bias) Falls | High risk | See Supplementary material 9 for method of assessment
Incomplete outcome data (attrition bias) Fallers | High risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Unclear risk | No mention of concurrent recording of falls by participants Quote: "Falls after the intervention commenced were collected monthly by telephone contact and at interview at the 8-week and 6-month follow-up assessments."

Conroy 2010
Study characteristics
Methods | RCT (multicentre)
Participants | Setting: Nottingham and Derbyshire, United Kingdom N = 364 Sample: community-dwelling people registered with participating GPs (N = 8) (60% women) Age (years): mean 78.6 (SD 5.7), range 70 to 101 Inclusion criteria: > 70 years; identified as being at high risk of falling by a postal screening questionnaire Exclusion criteria: living in care home; receiving end of life care; already receiving a falls prevention programme; unwilling or unable to attend falls prevention programme; unable to provide informed consent
Interventions | 1. Screening questionnaire, information leaflets, and invitation to attend the day hospital for multifactorial assessment and any subsequent intervention 2. Control: screening questionnaire, information leaflets, and usual care from primary care service until outcome data collected, then offered day-hospital intervention
Outcomes | 1. Rate of falls 2. Number of people falling 3. Number sustaining a fracture
Duration of the study | 1 year
Notes | Cost-effectiveness analysis reported in 4
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Quote: "The randomisation list was computer generated using a random block size to maximise allocation concealment"
Allocation concealment (selection bias) | Low risk | Quote: "participants were allocated into the intervention or control arm by research assistants using an internet based randomization service"
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Quote: "Owing to the nature of the intervention, it was not possible to blind participants or researchers to allocation" but impact of non-blinding unclear.
Blinding of outcome assessment (detection bias) Falls and fallers | Low risk | Outcome assessor stated to be blinded. Quote: "Participants will be contacted via telephone by the "blinded" assessor at the end of each month to encourage return of the diary." (protocol paper)
Blinding of outcome assessment (detection bias) Fractures | Unclear risk | Not completely clear that fractures were recorded in diaries in the same way as falls but seems to be the case. Quote: "Participants will be asked to record falls in the diary, along with the outcome (saw GP, phoned ambulance, sent to hospital, injuries)." Contacted by "blinded" assessor but no confirmation of fractures from medical records.
Incomplete outcome data (attrition bias) Falls | Low risk | See Supplementary material 9 for method of assessment
Incomplete outcome data (attrition bias) Fallers | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Low risk | Quote: "… ascertained using prospective, participant-completed monthly falls diaries, mailed to the research team at the end of every month."

Cornillon 2002
Study characteristics
Methods | RCT
Participants | Setting: St Étienne, France N = 303 Subjects: community-dwelling and independent in ADL (83% women) Age (years): mean 71 Inclusion criteria: aged over 65; living at home; ADL independent; consented Exclusion criteria: cognitively impaired (MMSE < 20); obvious disorder of walking or balance
Interventions | 1. Information on fall risk, and balance and sensory training in groups of 10 to 16. One session per wk, for 8 wks. Session started with foot and ankle warm-up (walking on tip toe and on heels etc), walking following verbal orders, walking bare foot on different surfaces, standing on one leg with eyes open and shut, practising getting up from the floor 2. Control: normal activities
Outcomes | 1. Rate of falls 2. Number of people falling
Duration of the study | 1 year
Notes |
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Randomised by random number tables
Allocation concealment (selection bias) | Unclear risk | Insufficient information to permit judgement
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Participants and personnel not blind to allocated group but impact of non-blinding unclear
Blinding of outcome assessment (detection bias) Falls and fallers | Unclear risk | Falls recorded on 6-monthly falls calendars. No telephone contact described. Blinding of study personnel recording data from the calendars not described.
Incomplete outcome data (attrition bias) Falls | Low risk | See Supplementary material 9 for method of assessment
Incomplete outcome data (attrition bias) Fallers | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Low risk | Prospective. Falls recorded on 6 monthly falls calendars.

Cumming 1999
Study characteristics
Methods | RCT (randomised consent design)
Participants | Setting: Sydney, Australia N = 530 Sample: community-dwelling people recruited in hospital wards, clinics, and day care centres (57% women) Age (years): mean 77 (SD 7.2) Inclusion criteria: aged ≥ 65; community-dwelling within study area Exclusion criteria: cognitively impaired and not living with someone who could give informed consent and report falls; if OT home visit already planned
Interventions | 1. One home visit by experienced OT assessing environmental hazards (standardised form) and supervision of home modifications Telephone follow-up after 2 wks 2. Control: usual care
Outcomes | 1. Rate of falls 2. Number of people falling
Duration of the study | 1 year
Notes | Cost-effectiveness analysis reported in 5
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Stratified block randomisation using random numbers table
Allocation concealment (selection bias) | Low risk | Randomised off site by person not involved in recruitment
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Participants and personnel not blind to allocated group but impact of non-blinding unclear
Blinding of outcome assessment (detection bias) Falls and fallers | Low risk | Falls self reported by participants. Quote: "Subjects who had not returned a calendar within 10 days of the end of the month were telephoned and asked about falls in the previous month. If one or more falls were reported, a telephone-administered questionnaire was used to elicit details of each fall". Quote: "Follow-up interviews were blind to group allocation"
Incomplete outcome data (attrition bias) Falls | Unclear risk | See Supplementary material 9 for method of assessment. Insufficient information to permit judgement.
Incomplete outcome data (attrition bias) Fallers | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Low risk | Prospective. Falls ascertained using monthly falls calendar.

Cumming 2007
Study characteristics
Methods | RCT
Participants | Setting: Sydney, Australia N = 616 Sample: men and women from outpatient aged care services, some volunteers recruited by advertisement (68% women) Age (years): mean 80.6 (SD 6) Inclusion criteria: age 70 and older; living independently in the community; no cataract surgery or new eye glass prescription in previous 3 months; participant or care giver able to complete monthly falls calendar Exclusion criteria: none noted
Interventions | 1. Vision tests and eye examinations. Dispensing of new spectacles if required. Referral for expedited ophthalmology treatment if appropriate occular pathology identified. Mobility training and canes if required. 2. Control: usual care
Outcomes | 1. Rate of falls 2. Number of people falling 3. Number sustaining a fracture
Duration of the study | 1 year
Notes |
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Unclear risk | Not described
Allocation concealment (selection bias) | Low risk | Randomised off site by person not involved in recruitment
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Participants and personnel not blind to allocated group but impact of non-blinding unclear
Blinding of outcome assessment (detection bias) Falls and fallers | Unclear risk | All participants used monthly falls diary, with telephone contact if not returned in 2 weeks. Blinding of study personnel recording data from the calendars not described.
Blinding of outcome assessment (detection bias) Fractures | High risk | Fractures were self reported by participants who were aware of their group allocation, and not confirmed by the results of radiological examination or from primary care case records
Incomplete outcome data (attrition bias) Falls | Unclear risk | See Supplementary material 9 for method of assessment. Insufficient information to permit judgement.
Incomplete outcome data (attrition bias) Fallers | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Low risk | Quote: "Ascertainment of falls involved a self-report falls calendar ... Subjects were asked to record on each day an "N" if they did not fall and an "F" if they had a fall. If a fall occurred, the subject completed an additional postcard about fall-related injuries (including fractures)".

Dangour 2011
Study characteristics
Methods | RCT (cluster-randomised by health centre, 2 x 2 factorial design)
Participants | Setting: Santiago, Chile N = 2799. N = 28 clusters; N = 20 clusters only for fallers and fractures Sample: randomly sampled households in health centre catchment areas and health centre registries (68% women) Age (years): range 65 to 68 Inclusion criteria (clusters): health centres with > 400 residents aged 65 to 67.9 years in low-middle economic status municipalities Exclusion criteria (individuals): unable to walk unaided; seeking medical advice for unplanned 3 kg weight loss over 3 months; planning to move house within 3 months; already enrolled in national Programme of Complementary Feeding for the Older Population (PACAM) or consuming PACAM programme supplements; scoring ≥ 6 on Pfeffer screen (poor cognitive function)
Interventions | 1. Nutritional supplements (50 g daily of a vegetable powdered food and 50 g daily of a powdered low-lactose milk based drink) 2. Physical activity classes (1 hour supervised group training sessions, 2 x per wk, encouraged to walk to sessions) 3. Nutritional supplements + physical activity classes 4. Control: no intervention
Outcomes | 1. Number of people falling Other outcomes reported but not included in this review Primary outcomes were pneumonia and walking capacity
Duration of the study | 24 months
Notes | Cost analysis reported in primary reference.
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Quote: "The center names (clusters) were put into a hat. The four treatment arms (nutritional supplementation, nutritional supplementation+physical activity, physical activity, control) were randomly numbered 1–4. As each name was drawn out of the hat by a member of the study team, it was assigned to the next treatment number until each arm contained five clusters."
Allocation concealment (selection bias) | High risk | In the Methods section, page 3, the following paragraph came after the paragraph about random sequence generation in item 1 above: "Participants were recruited from May to December 2005.", implying recruitment took place after health centres were randomised to the 4 groups. There was no mention of active blinding of research team members recruiting participants.
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Participants and personnel not blind to allocated group but impact of non-blinding unclear
Blinding of outcome assessment (detection bias) Falls and fallers | High risk | Although assessors of the primary outcomes (pneumonia, physical function) were blind to group allocation, this was not mentioned, therefore assumed not to apply, for secondary outcomes (included fallers and fractures)
Blinding of outcome assessment (detection bias) Fractures | High risk | Self reported fractures, not confirmed by the results of radiological examination or from primary care case records
Incomplete outcome data (attrition bias) Fallers | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | High risk | Participant recall for falls was at 12 and 24 months. For secondary outcomes including "self-reported incidence of falls" ... "Participants in the original 20 clusters were re-interviewed after 12 and 24 mo for outcome data."

Dapp 2011
Study characteristics
Methods | RCT (cluster-randomised by household if more than one person per household)
Participants | Setting: 14 general practices, Hamburg, Germany N = 2580 Sample: registered with participating practices (63% women) Age (years): mean 71.8 (SD 7.6) Inclusion criteria: aged ≥ 60 Exclusion criteria: need for human help or nursing care; cognitive impairment; terminal disease
Interventions | 1. High-risk appraisal with GP feedback. Patients chose reinforcement with group sessions or home visits 2. Control: usual care
Outcomes | 1. Number of fallers
Duration of the study | 1 year
Notes | Health promotion rather than fall prevention specifically
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Quote: "computer generated allocation sequence"
Allocation concealment (selection bias) | Low risk | Quote: "randomly allocated to intervention and control groups by the independent study centre"
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Participants and personnel not blind to allocated group but impact of non-blinding unclear
Blinding of outcome assessment (detection bias) Falls and fallers | Low risk | Questionnaire completed independently by participant at home, and then "All data were double entered by staff blinded for subject allocation."
Incomplete outcome data (attrition bias) Fallers | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | High risk | Retrospective recall at 12 months

Davis 2011a
Study characteristics
Methods | RCT
Participants | Setting: Vancouver, Canada N = 155 Sample: community-dwelling women Age (years): mean 70 (range 65 to 75) Inclusion criteria: aged 65 to 75; cognitively intact; visual acuity 20/40 or better Exclusion criteria: resistance training in the last 6 months; medical condition for which exercise is contraindicated; neurogenerative disease; taking cholinesterase inhibitors; depression; on hormone replacement therapy during previous 12 months
Interventions | 1. Resistance training classes, 1 x per wk 2. Resistance training classes, 2 x per wk 3. Control: balance and tone classes, 2 x per wk
Outcomes | 1. Rate of falls
Duration of the study | 1 year
Notes | Cost-effectiveness analysis and cost utility analysis reported in primary reference
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Quote: "The randomization sequence was generated by http://www.randomization.com"
Allocation concealment (selection bias) | Low risk | Quote: "The randomization sequence … was concealed until interventions were assigned. This sequence was held independently and remotely by the research coordinator"
Blinding of participants and personnel (performance bias) All outcomes | Low risk | Not possible to blind participants or personnel but both groups received an exercise intervention so unlikely to introduce bias
Blinding of outcome assessment (detection bias) Falls and fallers | Low risk | Quote: "The assessors were blinded to the participants' assignments"
Incomplete outcome data (attrition bias) Falls | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Low risk | Quote: "We used monthly fall diary calendars to track all falls for each participant during the 12-month study period."

Davison 2005
Study characteristics
Methods | RCT
Participants | Setting: A&E, Newcastle, United Kingdom N = 313 Sample: people presenting at A&E with a fall or fall-related injury (72% women) Age (years): mean 77 (SD 7) Inclusion criteria: age > 65 years, presenting at A&E with a fall or fall-related injury; history of at least 1 additional fall in previous year; community-dwelling Exclusion criteria: cognitively impaired (MMSE < 24); > 1 previous episode of syncope; immobile; live > 15 miles away from A&E; registered blind; aphasic; clear medical explanation for their fall, e.g. acute myocardial infarction, stroke, epilepsy; enrolled in another study
Interventions | 1. Multifactorial post-fall assessment and intervention. Hospital-based medical assessment and intervention: fall history and examination including medications, vision, cardiovascular assessment, laboratory blood tests, ECG. Home-based physiotherapist assessment and intervention: gait, balance, assistive devices, footwear. Home-based OT home hazard assessment and interventions. 2. Control: usual care
Outcomes | 1. Rate of falls 2. Number of people falling
Duration of the study | 1 year
Notes | Only 1 participant in residential/nursing care. More detailed description of intervention on journal website (www.ageing.oupjournals.org)
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Randomised by computer-generated block randomisation
Allocation concealment (selection bias) | Unclear risk | Insufficient information to permit judgement
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Participants and personnel not blind to allocated group but impact of non-blinding unclear
Blinding of outcome assessment (detection bias) Falls and fallers | Low risk | All participants used monthly falls diaries. Quote: "These data were processed by a researcher blinded to randomisation and otherwise unconnected with the study."
Blinding of outcome assessment (detection bias) Fractures | Low risk | Quote: "Secondary outcome measures [including fractures] were recorded with interviewer-led questionnaires ... The interviewer was blind to randomisation". "Hospital records were checked retrospectively at 1 year for all participants."
Incomplete outcome data (attrition bias) Falls | Low risk | See Supplementary material 9 for method of assessment
Incomplete outcome data (attrition bias) Fallers | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Low risk | Prospective. Falls data collected using fall diaries returned 4-weekly.

Day 2002
Study characteristics
Methods | RCT (factorial design)
Participants | Setting: Melbourne, Australia N = 1107 Sample: community-dwelling men and women identified from electoral roll (60% women) Age (years): mean 76.1 (SD 5.0) Inclusion criteria: aged ≥ 70; community-dwelling and able to make modifications; expected to remain in area for 2 years (except for short absences); have approval of family physician Exclusion criteria: undertaken regular to moderate exercise with a balance component in previous 2 months; unable to walk 10 to 20 m without rest or help or having angina; severe respiratory or cardiac disease; psychiatric illness prohibiting participation; dysphasia; recent major home modifications; education and language adjusted score > 4 on the short portable mental status questionnaire
Interventions | 1. Exercise: 1 hour class per wk for 15 wks, plus daily home exercises. Designed by physiotherapist to improve flexibility, leg strength, and balance (or less demanding routine depending on subject's capability). 2. Home hazard management: home assessed by "trained assessor", hazards removed or modified by participants or City of Whitehorse's home maintenance programme. Staff visited home, provided quote for work including free labour and materials up to AUD 100. 3. Vision improvement: assessed at baseline using dual visual acuity chart. Referred to usual eye care provider, general practitioner, or local optometrist if not already receiving treatment for identified impairment. 4. (1) + (2) 5. (1) + (3) 6. (3) + (2) 7. (1) + (2) + (3) 8. No intervention. Received brochure on eye care for over 40-year olds.
Outcomes | 1. Rate of falls 2. Number of people falling
Duration of the study | 18 months
Notes |
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Randomised by "adaptive biased coin" technique, to ensure balanced group numbers
Allocation concealment (selection bias) | Low risk | Computer-generated by an independent third party contacted by telephone
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Participants and personnel not blind to allocated group but impact of non-blinding unclear
Blinding of outcome assessment (detection bias) Falls and fallers | Low risk | All participants used monthly falls diary, with telephone contact from a researcher blinded to group allocation if not returned in 5 days
Incomplete outcome data (attrition bias) Falls | Unclear risk | Insufficient information to permit judgement. See Supplementary material 9 for method of assessment.
Incomplete outcome data (attrition bias) Fallers | Unclear risk | Insufficient information to permit judgement. See Supplementary material 9 for method of assessment.
Risk of bias in recall of falls | Low risk | Falls reported using monthly postcard to record daily falls. Telephone follow-up if calendar not returned within 5 working days of the end of each month, or reporting a fall.

De Vries 2010
Study characteristics
Methods | RCT
Participants | Setting: Amsterdam, the Netherlands N = 217 Sample: people consulting ED or family physician after a fall (71% women) Age (years): mean 79.8 (SD 7.35) Inclusion criteria: aged ≥ 65 years; living independently or in assisted living facility; living near University Medical Center; history of fall in previous 3 months Exclusion criteria: unable sign informed consent or provide a fall history; cognitive impairment (MMSE < 24); fall due to traffic or occupational accident; living in nursing home; acute pathology requiring long-term rehabilitation, e.g. stroke
Interventions | 1. Multidisciplinary assessment in geriatric outpatient clinic and individually tailored treatment in collaboration with patient's GP e.g. withdrawal of psychotropic drugs, balance and strength exercises, home hazard reduction, referral to specialists 2. Control: usual care
Outcomes | 1. Number of people falling 2. Number sustaining a fracture Other outcomes reported but not included in this review
Duration of the study | 1 year
Notes | Cost-effectiveness analysis and cost utility analysis reported in 6
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Quote: "computer-generated random sequence"
Allocation concealment (selection bias) | Low risk | Quote: "…opaque envelopes are numbered and filled with group names. When a participant is designated to the high-risk group, the interviewer, who is unaware of the content, opens the envelope with the lowest number." (from protocol paper)
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Quote: "Participants, intervention caregivers, and interviewers could not be blinded to group assignment." but impact of non-blinding unclear.
Blinding of outcome assessment (detection bias) Falls and fallers | High risk | Not completely clear but study personnel stated to be non-blinded, and falls self reported
Blinding of outcome assessment (detection bias) Fractures | High risk | Quote: "By their response to a questionnaire sent 11⁄2 years after the first home visit, participants were asked to indicate whether they had sustained a fracture since the first home visit." Study personnel non-blinded, and no confirmation of fractures from medical records.
Incomplete outcome data (attrition bias) Fallers | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Low risk | Quote: "For 1 year, the participants recorded each week whether they had fallen." "Once per 3 months the participants return a calendar sheet by mail. When no sheet is received, or when the sheet is completed incorrectly, we inquire by telephone whether, and if yes, when the participant has fallen in the past 3 months."

Dhesi 2004
Study characteristics
Methods | RCT
Participants | Setting: United Kingdom N = 139 Sample: patients attending a falls clinic (78% women) Age (years): mean 76.8 (SD 6.2) Inclusion criteria: aged ≥ 65; community-dwelling; fallen in previous 8 wks; normal bone chemistry; 25 OHD ≤ 12 µg/litre Exclusion criteria: AMT < 7/10; taking vitamin D or calcium supplements; history of chronic renal failure, alcohol abuse, conditions or medications likely to impair postural stability or vitamin D metabolism
Interventions | 1. One intramuscular injection (2 ml) of 600,000 IU ergocalciferol 2. Control: one placebo injection of 2 ml normal saline
Outcomes | 1. Rate of falls 2. Number of people falling
Duration of the study | 6 months
Notes | Flowchart in Figure 1 shows N = 139 randomised with 70 in intervention group, but Table 1 (baseline characteristics) shows N = 138 randomised with 69 in intervention group
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Randomised in blocks of 20, by computer program
Allocation concealment (selection bias) | Low risk | Randomised independently of the investigators
Blinding of participants and personnel (performance bias) All outcomes | Low risk | Double-blind, placebo-controlled study
Blinding of outcome assessment (detection bias) Falls and fallers | Low risk | All participants used a 6-month falls diary which was reviewed with the patient by blinded trialist
Incomplete outcome data (attrition bias) Falls | Low risk | See Supplementary material 9 for method of assessment
Incomplete outcome data (attrition bias) Fallers | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Low risk | Falls recorded in falls diary which was reviewed at follow-up assessment

Di Monaco 2008
Study characteristics
Methods | Quasi-randomised trial (alternation)
Participants | Setting: Torino, Italy N = 119 Sample: women in hospital after a fall-related hip fracture Age (years): mean 80 (SD 6.6) Inclusion criteria: history of fall-related hip fracture; returning to same dwelling in the community; aged ≥ 60 years Exclusion criteria: not living in Turin; MMSE < 23
Interventions | 1. Multidisciplinary fall prevention programme during hospital stay plus single home visit by OT (median 20 days post discharge); assessed hazards, gave advice on modifying home environment, behaviour changes and use of assistive devices 2. Control: as above but no home visit
Outcomes | 1. Rate of falls 2. Number of people falling
Duration of the study | 6 months
Notes | Intervention commences in hospital but designed to prevent falls in the community
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | High risk | Quote: "...119 women were allocated to intervention or control groups alternately."
Allocation concealment (selection bias) | High risk | Randomised by alternation. No concealment.
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Participants and personnel not blind to allocated group but impact of non-blinding unclear
Blinding of outcome assessment (detection bias) Falls and fallers | High risk | Falls data were collected at home visit at 6 months by same OTs that carried out the interventions, i.e. not blind to intervention group
Incomplete outcome data (attrition bias) Falls | High risk | See Supplementary material 9 for method of assessment
Incomplete outcome data (attrition bias) Fallers | High risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Unclear risk | Quote: "During their stay in hospital, all the women were asked to record falls occurring after discharge, and to report them at a home visit by an occupational therapist scheduled for approximately 6 months after discharge. During this home visit, the occupational therapist asked the women in detail about falls occurring after discharge from hospital."

Dukas 2004
Study characteristics
Methods | RCT
Participants | Setting: Basel, Switzerland N = 378. Sample: volunteers recruited from long-term cohort study, and newspaper advertisements (52% women) Age (years): mean 75 (SD 4.2) Inclusion criteria: aged over 70; mobile; independent lifestyle Exclusion criteria: primary hyperparathyroidism; polyarthritis or inability to walk; calcium supplementation > 500 mg/day; vitamin D intake > 200 IU/day, active kidney stone disease; history of hypercalcuria, cancer or other incurable diseases; dementia, elective surgery planned within next 3 months; severe renal insufficiency; fracture or stroke within last 3 months
Interventions | 1. Alfacalcidol (Alpha D3 TEVA) 1 µg/day for 36 wks 2. Placebo daily for 36 wks
Outcomes | 1. Number of people falling 2. Adverse effects Other outcomes reported but not included in this review
Duration of the study | 9 months
Notes |
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Randomised using "numbered containers"; numbered and blinded by independent statistical group
Allocation concealment (selection bias) | Low risk | Numbered and blinded by independent statistical group
Blinding of participants and personnel (performance bias) All outcomes | Low risk | Double-blind, placebo-controlled study
Blinding of outcome assessment (detection bias) Falls and fallers | Low risk | Subjects (blind to intervention group) asked to record falls in a diary and to telephone within 48 hours of a fall. Questionnaire about incidence of falls at clinic visits (4 wks, 12 wks, and every 12 wks subsequently to 36 wks) and "All investigators and staff conducting the study remained blinded throughout the treatment period."
Incomplete outcome data (attrition bias) Fallers | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Unclear risk | Subjects asked to record falls in a diary and to telephone within 48 hours of a fall. Also questionnaire about incidence of falls at clinic visits (4 wks, 12 wks, and every 12 wks subsequently to 36 wks).

Elley 2008
Study characteristics
Methods | RCT
Participants | Setting: Hutt Valley, New Zealand N = 312 Sample: patients from 19 primary care practices (69% women) Age (years): mean 80.8 (SD 5) Inclusion criteria: aged ≥ 75 (> 50 years for Maori and Pacific people), fallen in last year, living independently Exclusion criteria: unable to understand study information and consent processes, unstable or progressive medical condition, severe physical disability, dementia (< 7 on Abbreviated Mental Test Score)
Interventions | 1. Community-based nurse assessment of falls and fracture risk factors, home hazards, referral to appropriate community interventions, and strength and balance exercise programme 2. Control: usual care and social visits
Outcomes | 1. Rate of falls 2. Number of people falling
Duration of the study | 1 year
Notes |
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Quote: "computer randomisation"
Allocation concealment (selection bias) | Low risk | Quote: "independent researcher at a distant site"
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Participants and personnel not blind to allocated group but impact of non-blinding unclear
Blinding of outcome assessment (detection bias) Falls and fallers | Low risk | Partipants recorded falls prospectively using postcard calendars, completed daily and mailed monthly. Follow-up telephone calls were by blinded research staff.
Incomplete outcome data (attrition bias) Falls | Low risk | See Supplementary material 9 for method of assessment
Incomplete outcome data (attrition bias) Fallers | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Low risk | Quote: "Postcard calendars completed daily and posted monthly".

Fabacher 1994
Study characteristics
Methods | RCT
Participants | Setting: California, USA N = 254 Sample: men and women aged over 70 years and eligible for veterans medical care. Identified from voter registration lists and membership lists of service organisations (2% women) Age (years): mean 73 years Inclusion criteria: aged ≥ 70; not receiving health care at Veterans Administration Medical Centre Exclusion criteria: known terminal disease, dementia
Interventions | 1. Home visit by health professional to screen for medical, functional, and psychosocial problems, followed by a letter for participants to show to their personal physician. Targeted recommendations for individual disease states, preventive health practices 2. Control: follow-up telephone calls for outcome data only
Outcomes | 1. Number of people falling Other outcomes reported but not included in this review
Duration of the study | 1 year
Notes |
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Unclear risk | Quote: "randomly assigned ... using randomly generated assignment cards in sealed envelopes". Judged to be unclear.
Allocation concealment (selection bias) | Unclear risk | Quote: "randomly assigned ... using randomly generated assignment cards in sealed envelopes". Judged to be unclear.
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Participants and personnel not blind to allocated group but impact of non-blinding unclear
Blinding of outcome assessment (detection bias) Falls and fallers | High risk | Intervention group data collected on a structured interview form at 4-monthly face to face visits. Control group received only 4-monthly telephone interviews.
Incomplete outcome data (attrition bias) Fallers | High risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | High risk | Falls identified at 4-monthly intervals, by structured interview for active arm and by telephone for controls

Faes 2011
Study characteristics
Methods | RCT (cluster-randomised in pairs: participant + caregiver)
Participants | Settting: Arnhem and Nijmegan, the Netherlands N = 33 pairs Sample: patients recruited from 3 geriatric outpatient clinics (70% women) Age (years): mean 78.3 (SD 7) Inclusion criteria: fallen in previous 6 months; able to walk 15 m independently (with or without walking aid); had a primary informal caregiver; community-dwelling; life expectancy > 1 year; frail (≥ 2 frailty indicators) Exclusion criteria: awaiting nursing home admission; MMSE < 15
Interventions | 1. Psychological teaching and training + physical training in small groups. 10 x 2 h sessions 2 x per wk + booster session 6 wks later. Caregivers trained in autonomy boosting strategies, and being co-therapist at home 2. Control: usual care
Outcomes | 1. Rate of falls 2. Number of people falling Other outcomes reported but not included in this review
Duration of the study | 7 months
Notes | Trial terminated due to "Extremely difficult recruitment. Preliminary analysis showed no effect of the intervention." Target sample 160 people plus their carer (N = 320)
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Quote: "Treatment allocation…was based on a minimization algorithm that balanced for the minimization factors"
Allocation concealment (selection bias) | Low risk | Quote: "allocation, carried out by an independent statistician"
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Participants and personnel not blind to allocated group but impact of non-blinding unclear
Blinding of outcome assessment (detection bias) Falls and fallers | Low risk | Quote: "Nonresponders were contacted over the telephone so that the fall history for the missing calendar weeks and underlying reasons for their lack of response could be assessed" "The assessors (M.F.R. and M.C.F.) were blinded."
Incomplete outcome data (attrition bias) Falls | High risk | See Supplementary material 9 for method of assessment
Incomplete outcome data (attrition bias) Fallers | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Low risk | Quote: "Falls were registered daily using a preaddressed, reply-paid 2-weekly fall registration calendar throughout the whole course of the trial."

Fiatarone 1997
Study characteristics
Methods | RCT
Participants | Setting: USA N = 34 Sample: frail older people (94% women) Age (years): mean 82 (SD 1) Inclusion criteria: community-dwelling older people; moderate to severe functional impairment Exclusion criteria: none given
Interventions | 1. High-intensity progressive resistance training exercises in own home (3 day/wk for 16 wks). 2 weeks instruction and then weekly phone calls. 11 different upper and lower limb exercises with arm and leg weights 2. Control: wait list control. Weekly phone calls
Outcomes | 1. "Frequency of falls" but probably means fallers Other outcomes reported but not included in this review
Duration of the study | 16 wks (duration of intervention)
Notes | Abstract only
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Unclear risk | Method of randomisation not described
Allocation concealment (selection bias) | Unclear risk | Insufficient information to permit judgement
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Insufficient information to permit judgement
Blinding of outcome assessment (detection bias) Falls and fallers | Unclear risk | Insufficient information to permit judgement
Incomplete outcome data (attrition bias) Fallers | Unclear risk | See Supplementary material 9 for method of assessment. Insufficient information to permit judgement.
Risk of bias in recall of falls | Unclear risk | Interval recall. Falls identified weekly by phone call.

Foss 2006
Study characteristics
Methods | RCT
Participants | Setting: Nottingham, United Kingdom N = 239 Sample: women referred to ophthalmology outpatient clinic Age (years): median 79.5 (range 70 to 92) Inclusion criteria: over 70 years of age; following successful cataract operation and with operable second cataract Exclusion criteria: having complex cataracts; visual field defects or severe comorbid eye disease affecting visual acuity; memory problems preventing completion of questionnaires or reliable recall of falls
Interventions | 1. Small incision cataract surgery with insertion of intraocular lens under local anaesthetic 2. Control: waiting list
Outcomes | 1. Rate of falls 2. Number of people falling 3. Number sustaining a fracture
Duration of the study | 1 year
Notes | Cost utility analysis reported in 7
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Quote: "lists prepared from random numbers in variably sized permuted blocks to maintain approximate equality in the size of the groups".
Allocation concealment (selection bias) | Low risk | Sequentially numbered, opaque envelopes
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Participants and personnel not blind to allocated group but impact of non-blinding unclear
Blinding of outcome assessment (detection bias) Falls and fallers | High risk | Falls were noted on diary by participants who were aware of their group allocation, and the data collected at 3 and 9 months by telephone and at 4 and 6 months at interview. These assessments were "not masked to allocation."
Blinding of outcome assessment (detection bias) Fractures | High risk | Fractures were noted on diary by participants who were aware of their group allocation, and the data collected at 3 and 9 months by telephone and at 4 and 6 months at interview. These assessments were "not masked to allocation." No mention of confirmation by radiological examination reports or from primary care case records.
Incomplete outcome data (attrition bias) Falls | Low risk | See Supplementary material 9 for method of assessment
Incomplete outcome data (attrition bias) Fallers | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Low risk | Prospective. Falls recorded on daily diary. Data collected by phone at 3 and 9 months, and by interview at 6 and 12 months.

Fox 2010
Study characteristics
Methods | RCT (individually randomised, but small number of clusters as husbands allocated to same group)
Participants | Setting: Humboldt County and San Diego County, California, USA N = 552 Sample: new and existing 'Preventive Health Care for the Aging' (PHCA) clients (67% women) Age (years): mean 76.9 (SD 6.8) Inclusion criteria: ≥ 65 years; no plans to move within 1 year; speaking English, Spanish, Cantonese or Vietnamese Exclusion criteria: serious cognitive impairment; medical disorders that would affect participation
Interventions | 1. Usual PHCA care (community-based health promotion programme) + multifactorial fall prevention programme targeting 10 risk factors: fall risk factor assessment by public health nurse followed by education and written care plan with fall prevention goals; referral to individually tailored physical activity programmes. 50% received a home hazard assessment. 2. Control: usual PHCA care
Outcomes | 1. Number of people falling
Duration of the study | 1 year
Notes | Only adjusted odds ratio reported. No raw data. Mean number of falls (SD) reported, but only by quarter year.
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Quote: "computer-generated list of random numbers"
Allocation concealment (selection bias) | Unclear risk | Insufficient information to permit judgement
Blinding of participants and personnel (performance bias) All outcomes | High risk | Neither clinicians nor participants blinded
Blinding of outcome assessment (detection bias) Falls and fallers | Unclear risk | Not stated whether assessors were blind to randomised group
Incomplete outcome data (attrition bias) Fallers | Unclear risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Unclear risk | Quote: "Clients in both the treatment and control groups were given calendars to record falls and fall-related physician visits" Quote: "We measured fall frequency at 3-month intervals using a form developed for this project. We asked clients questions regarding the occurrence of falls in the previous quarter ..."

Gallagher 1996
Study characteristics
Methods | RCT
Participants | Setting: Victoria, British Columbia, Canada N = 100 Sample: community-dwelling volunteers (80% women) Age (years): mean 74.6 Inclusion criteria: aged ≥ 60; fallen in previous 3 months Exclusion criteria: none described
Interventions | 1. 2 risk assessment interviews of 45 min each. One counselling interview of 60 min showing video and booklet and results of risk assessment 2. Control: baseline interview and follow-up only. No intervention
Outcomes | 1. Rate of falls Other outcomes reported but not included in this review
Duration of the study | 6 months
Notes |
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Unclear risk | Method of randomisation not described
Allocation concealment (selection bias) | Unclear risk | Method of randomisation not described
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Participants and personnel not blind to allocated group but impact of non-blinding unclear
Blinding of outcome assessment (detection bias) Falls and fallers | Unclear risk | Participants completed a calendar daily and returned it every 2 weeks; a telephone interview was then conducted. At final interview at 6 months, the interviewer was not blinded.
Incomplete outcome data (attrition bias) Falls | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Low risk | Calendar postcards completed and returned every 2 weeks for 6 months. Telephone follow-up of reported falls.

Gallagher 2001
Study characteristics
Methods | RCT
Participants | Setting: presumed community, Omaha, USA N = 489 Sample: mailing lists used to contact women aged 65 to 77 years in Omaha and surrounding district Age (years): mean 71 (SD 4), range 65 to 77 Inclusion criteria: 65 to 77 years; not osteoporotic (femoral neck density in normal range for age) Exclusion criteria: severe chronic illness; primary hyperparathyroidism or active renal stone disease; on certain medications in last 6 months, e.g. bisphosphonates, anticonvulsants, oestrogen, fluoride, thiazide diuretics
Interventions | 1. Calcitriol (Rocaltrol) 0.25 µg twice daily for 3 years 2. HRT/ERT (conjugate estrogens (Premarin) 0.625 mg daily + medroxyprogesterone (Provera) 2.5 mg daily 3. Calcitriol plus HRT/ERT as above 4. Control: placebo (ERT given to hysterectomised women N = 290, i.e. not given progestin) All groups advised to increase dietary calcium if daily intake < 500 mg/day and to decrease dietary calcium if intake > 1000 mg/day
Outcomes | 1. Rate of falls 2. Number of people falling 3. Number sustaining a fracture 4. Number of people with adverse effects Other outcomes reported but not included in this review
Duration of the study | 3 years
Notes |
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Unclear risk | Quote: "Simple randomisation", stratified on presence or absence of uterus. No further details.
Allocation concealment (selection bias) | Unclear risk | Quote: "randomly assigned". No methods described.
Blinding of participants and personnel (performance bias) All outcomes | Low risk | Double-blind, placebo-controlled study
Blinding of outcome assessment (detection bias) Falls and fallers | Low risk | Data on falls and fractures were collected by questionnaire at interview at intervals over 36 months. Participants and assessors both blinded.
Blinding of outcome assessment (detection bias) Fractures | Low risk | Data on falls and fractures were collected by questionnaire at interview at intervals over 36 months. Quote: "All fractures were confirmed from x-ray reports."
Incomplete outcome data (attrition bias) Falls | Low risk | See Supplementary material 9 for method of assessment
Incomplete outcome data (attrition bias) Fallers | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | High risk | Falls retrospectively monitored by interview questionnaire at 6 weeks, 3 months, and-6 monthly thereafter

Gill 2008
Study characteristics
Methods | RCT
Participants | Setting: Ontario, Canada N = 241 Sample: male Canadian veterans of WWII and Korean War living in south-west Ontario Age (years): mean 81 (SD 3.8) Inclusion criteria: living independently in the community; able to understand and respond to questionnaire; at least 1 modifiable risk factor for falling identified by initial screening questionnaire
Interventions | Initial postal risk factor screening questionnaire to all potential participants 1. Specialised geriatric services group: comprehensive geriatric assessment by geriatrician or PT with individual recommendations for fall risk factor reduction 2. Family physician group: participants sent letter summarising risk factors reported in questionnaire. Similar letter sent to participant's family physician. Treatment left to discretion of family physician
Outcomes | 1. Number of fallers
Duration of the study | 1 year
Notes |
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Unclear risk | Quote: "Randomized". No description of sequence generation.
Allocation concealment (selection bias) | Unclear risk | Insufficient information to permit judgement
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Participants and personnel not blind to allocated group but impact of non-blinding unclear
Blinding of outcome assessment (detection bias) Falls and fallers | Unclear risk | Falls reported by participants who were aware of their group allocation. Unclear whether staff who confirmed falls by telephone were blinded.
Incomplete outcome data (attrition bias) Fallers | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Low risk | Monthly falls calendars returned for 1 year. Telephone follow-up if calendar not returned or falls reported.

Grahn Kronhed 2009
Study characteristics
Methods | RCT
Participants | Setting: Linköping, Sweden N = 73 Sample: women with osteoporosis identified from Linköping Hospital, Osteoporosis Unit files Age (years): mean 71.4, range 60 to 81 Inclusion criteria: BMD measured within previous 9 months and T-score ≤ -2.5 SD Exclusion criteria: enrolled in a pharmacological RCT; requiring indoor walking aids; cognitively impaired (MMSE < 20); severe heart disease, malignancy, recent arthroplasty, unhealed fractures; unable to understand Swedish
Interventions | 1. Group exercise programme (60 min, 2 x per wk, for 4 months) supervised by PT 2. Control: no intervention. Instructed not to change exercise routines for 1 year
Outcomes | 1. Mean number of falls (no SD reported) 2. Number sustaining a fracture Other outcomes reported but not included in this review
Duration of the study | 1 year
Notes | No participants sustained a fracture during follow-up
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Method not described but assume it was truly random given that "An independent statistical unit randomized the participants ..."
Allocation concealment (selection bias) | Low risk | Quote: "An independent statistical unit randomized the participants..."
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Participants and personnel not blind to allocated group but impact of non-blinding unclear
Blinding of outcome assessment (detection bias) Falls and fallers | Low risk | Quote: "… participants were followed-up concerning … falls … for 1 year by the independent statistical unit." Probably blind to allocated group or at least unlikely to introduce bias.
Blinding of outcome assessment (detection bias) Fractures | High risk | Appear to be participant-reported fractures with no description of confirmation
Incomplete outcome data (attrition bias) Falls | Unclear risk | See Supplementary material 9 for method of assessment. Insufficient information to permit judgement.
Risk of bias in recall of falls | Low risk | Quote: "... participants reported number of falls each week for the 1-year study period"

Grant 2005
Study characteristics
Methods | RCT (multicentre, 2 x 2 factorial design)
Participants | Setting: United Kingdom N = 5292 Sample: 21 centres in England and Scotland (85% women) Age (years): mean 77 (SD 6) Inclusion criteria: aged ≥ 70; recent fracture caused by a fall Exclusion criteria: bed or chair bound prior to fracture; abbreviated mental test score 6 or less; cancer likely to metastasise to bone within previous 10 years; fracture associated with pre-existing bone abnormality; known hypercalcaemia; renal stone in last 10 years; life expectancy < 6 mo; known to be leaving the UK; taking > 200 IU (5 µg) vitamin D or > 500 mg calcium supplements daily; had fluoride, calcitonin, tibolone, HRT, selective oestrogen receptor modulators or any vitamin D metabolite (such as calcitriol) in the last 5 years; vitamin D by injection in preceding year
Interventions | 2 tablets daily with meals for 2 years. Tablets delivered every 4 months by post. Randomised to tablets containing a total of either: 1. 800 IU (20 µg) vitamin D3 plus placebo calcium 2. 800 IU vitamin D3 + 1000 mg calcium 3. 1000 mg elemental calcium (calcium carbonate) plus placebo vitamin D 4. Double placebo
Outcomes | 1. Number of people falling 2. Number sustaining a fracture 3. Number of people with adverse effects
Duration of the study | 60 months
Notes |
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Computer-generated, centralised randomisation, stratified by centre
Allocation concealment (selection bias) | Low risk | Centralised randomisation
Blinding of participants and personnel (performance bias) All outcomes | Low risk | Double-blind, placebo-controlled study
Blinding of outcome assessment (detection bias) Falls and fallers | Low risk | Data from falls window periods throughout the study collected by self report - both participants and assessors were blinded to allocation
Blinding of outcome assessment (detection bias) Fractures | Low risk | Fracture data from participants in all groups were confirmed by the checking of patient records by blinded assessors
Incomplete outcome data (attrition bias) Fallers | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Unclear risk | Interval recall. Falls ascertained in 4-monthly postal questionnaire ("Have you fallen during the last week") with telephone follow-up if required, also from hospital and GP staff annotating notes

Gray-Donald 1995
Study characteristics
Methods | RCT
Participants | Setting: Quebec, Canada N = 50 Subjects: recruited from people receiving long-term home help services (71% women) Age (years): mean 77.5 (SD 8) Inclusion criteria: aged over 60; requiring community services; elevated risk of under-nutrition (excessive weight loss or BMI < 24 kg/m2) Exclusion criteria: alcoholic; terminal illness
Interventions | 1. 12 wk intervention of high energy nutrient dense supplements provided by dietitian. Two 235 ml cans/day (1045 to 1480 kj per can) for 12 wks. 2. Control: visits only (encouragement and suggestions about improving diets)
Outcomes | 1. Number of people falling
Duration of the study | 12 wks
Notes |
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Unclear risk | Method of randomisation not described. Stratified by gender and nutritional risk criteria.
Allocation concealment (selection bias) | Unclear risk | Insufficient information to permit judgement
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Participants and personnel not blind to allocated group but impact of non-blinding unclear
Blinding of outcome assessment (detection bias) Falls and fallers | Unclear risk | Fall events ascertained at each of two 6-weekly interviews. Blinding of assessors not reported.
Incomplete outcome data (attrition bias) Fallers | High risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | High risk | Retrospectively monitored at 6 and 12 weeks

Greenspan 2005
Study characteristics
Methods | RCT (2 x 2 factorial design)
Participants | Setting: Boston, USA N = 373 Sample: women identified from newspaper advertisements, targeted mailings, presentations to seniors groups, and physician referrals Age (years): mean 71.3 (SD 5.2) Inclusion criteria: community-dwelling women including women with hysterectomy; aged 65 and older Exclusion criteria: illness that could affect bone mineral metabolism; current use of medications known to alter bone mineral metabolism; known contraindication to HRT use
Interventions | 1. HRT/ERT plus placebo alendronate 2. HRT/ERT plus alendronate 3. Alendronate plus placebo HRT/ERT 4. Placebo HRT/ERT plus placebo alendronate All participants received calcium and vitamin D supplementation throughout the study (ERT given to hysterectomised women, i.e. not given progestin)
Outcomes | 1. Number of people falling Falls a secondary outcome of study. Other outcomes reported but not included in this review
Duration of the study | 3 years
Notes | In the 2005 report the data presented are for all women receiving HRT. This includes women who received HRT + alendronate. Although there is no evidence of an interaction between these agents which might plausibly affect falls, this cannot be absolutely ruled out. Therefore in this review we have taken a conservative approach, and not used data the group who received HRT + alendronate.
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Computer random number generation
Allocation concealment (selection bias) | Low risk | Sequentially numbered, opaque, sealed envelopes
Blinding of participants and personnel (performance bias) All outcomes | Low risk | Double-blind, placebo-controlled study
Blinding of outcome assessment (detection bias) Falls and fallers | Low risk | Participants in both groups and assessors blinded to treatment group
Incomplete outcome data (attrition bias) Fallers | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | High risk | Interval recall, but at 6 months and 1 year

Haines 2009
Study characteristics
Methods | RCT
Participants | Setting: Brisbane, Australia N = 53 Sample: patients in geriatric rehabilitation, medical, or surgical units in Princess Alexandra Hospital (60% women) Age (years): mean 80.7 (SD 7.7) Inclusion criteria: aged > 65 years; gait instability or walking with a mobility aid; discharged from hospital to a community-dwelling Exclusion criteria: unstable severe cardiac disease; cognitive impairment; aggressive behaviour; restricted weight-bearing status; referred for post-discharge community rehabilitation services
Interventions | 1. 'Kitchen Table Exercise Program': DVD and workbook. Progressive lower limb strength and balance exercises, 3 to 7 x per wk. DVD player provided if required. At least 1 home visit from project PT, then telephone contact weekly for 8 wks from first home visit, then 18 wks without active encouragement 2. Control: no exercise intervention
Outcomes | 1. Rate of falls 2. Number of people falling 3. Number sustaining a fracture Other outcomes reported but not included in this review
Duration of the study | 6 months
Notes |
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Quote: "The random allocation sequence was generated by an investigator (TH) using a computerized random number generator."
Allocation concealment (selection bias) | Low risk | Quote: "This sequence was entered into sealed, consecutively numbered, opaque envelopes. Each envelope corresponding to the participants study number (allocated in the order in which participants consented to participate in the study) was opened following completion of the baseline assessment. The envelopes containing the allocation sequence were secured within a locked office."
Blinding of participants and personnel (performance bias) All outcomes | High risk | Participants and personnel not blind to intervention, and falls were self reported
Blinding of outcome assessment (detection bias) Falls and fallers | Low risk | Quote: "All participants received monthly follow-up phone calls from the blinded outcome assessor."
Blinding of outcome assessment (detection bias) Fractures | High risk | The only evidence for fractures was from self reports from participants
Incomplete outcome data (attrition bias) Falls | Unclear risk | See Supplementary material 9 for method of assessment
Incomplete outcome data (attrition bias) Fallers | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Low risk | Quote: "Participants in both group were provided with a log for recording falls and details surrounding them." "All participants received monthly follow-up phone calls from the blinded outcome assessor."

Haran 2010
Study characteristics
Methods | RCT
Participants | Setting: Sydney and Illawarra regions, New South Wales, Australia N = 606 Sample: sample from electoral roll; residents of retirement villages; outpatients and inpatients discharged from rehabilitation and orthopaedic ward; responders to advertising etc (65% women) Age (years): mean 80 (SD 6.6) Inclusion criteria: community-dwelling; at a relatively high risk of falls (≥ 80 years, or 65 to 79 and TUG test ≥ 15 sec and/or ≥ 1 fall in past 12 mo); using bifocal, trifocal, or progressive lens glasses ≥ 3 x per wk when walking outdoors; reviewed by an optometrist or ophthalmologist in previous 24 months; "quite or very confident" that they could comply with the study recommendations Exclusion criteria: using single lens distance glasses; residing in high-care residential facility; cognitive impairment (MMSE < 24); severe visual impairment (MET < 16 dB); insufficient English language skills; ophthalmic surgery planned in the next 12 months; unstable medical condition
Interventions | 1. Optometrist examination; prescribed single lens distance glasses for use in most walking or standing activities and given advice on use of their glasses 2. Control: used their multifocal glasses in their usual manner (no advice) All participants received an optometry assessment and updated multifocal glasses (if required) at baseline
Outcomes | 1. Rate of falls 2. Number of people falling 3. Number sustaining fall-related fractures Other outcomes reported but not included in this review
Duration of the study | 13 months
Notes |
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Quote: "Each stratum was randomly allocated in permuted blocks of 10 generated externally (by JS)" a professor of statistics
Allocation concealment (selection bias) | Low risk | Quote: "by using sequentially numbered opaque sealed envelopes containing group assignment"
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Both groups received an intervention, i.e. an optometrist examination and updated multifocal lens prescription if required. The intervention group were prescribed a pair of single lens distance glasses and advice.
Blinding of outcome assessment (detection bias) Falls and fallers | Low risk | Monthly calendars and follow-up telephone calls as required. Research personnel who received the calendars and made the calls were blinded to group allocation.
Blinding of outcome assessment (detection bias) Fractures | High risk | Injurious falls were defined as those that resulted in fractures, dislocations, and organ and soft tissue trauma. These were collected as self report from the monthly calendars and telephone calls and not verified from primary source.
Incomplete outcome data (attrition bias) Falls | Low risk | See Supplementary material 9 for method of assessment
Incomplete outcome data (attrition bias) Fallers | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Low risk | Daily diaries returned monthly with a follow-up phone call if not returned

Harari 2008
Study characteristics
Methods | RCT (cluster-randomised by household if more than 1 person per household)
Participants | Setting: London, United Kingdom N = 2503 Sample: patients in 3 computerised group practices (26 GPs) (55% women) Age (years): mean 74 (SD 6.2) Inclusion criteria: aged ≥ 65; registered with participating group practice Exclusion criteria: needing human assistance with basic ADL; living in a nursing/residential home; dementia; terminal disease; non-English speaking
Interventions | 1. Participants sent Health Risk Appraisal for Older Persons (HRA-O) questionnaire; feedback (20 to 35 page report) from GP on modifying risk, personalised preventive health checklist, sources of support including local exercise schemes etc. Advised to discuss issues with GP or practice nurse; reminder card sent to non-responders 6 months later. HRA-O and feedback documented in patient record 2. Control: usual care
Outcomes | No useable data. Obtained number of multiple fallers from author. Other outcomes reported but not included in this review
Duration of the study | 1 year
Notes | Initially 4 practices, 3 randomised to participate in trial and 1 to act as a control. Patients within the participating practices randomised to intervention or control group. 1 centre from an international multicentre study (PRO-AGE) (see Dapp 2011a for other centre recording falls)
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Quote: "Randomisations were computer generated at an independent centre."
Allocation concealment (selection bias) | Low risk | Quote: "Randomisations were computer generated at an independent centre." Although people living in the same household were allocated to the same group (so this could not be concealed) this should not have introduced bias given that the randomisation took place at an independent centre.
Blinding of participants and personnel (performance bias) All outcomes | High risk | Participants and GPs not blind to allocated group. Patients were individually randomised in each practice which could mean there is a risk of contamination as GPs treating both intervention and control participants were given training, and additionally those not in the intervention group could have sought health advice elsewhere.
Blinding of outcome assessment (detection bias) Falls and fallers | Unclear risk | Participants and health practitioners not blind to group allocation, but does not mention whether person abstracting data from the questionnaire was blind to allocation
Incomplete outcome data (attrition bias) Fallers | Unclear risk | See Supplementary material 9 for method of assessment. Insufficient information to permit judgement.
Risk of bias in recall of falls | High risk | No concurrent recording of falls. Quote: "... at the one year follow-up, as a secondary outcome, we asked people about falls in the previous year." (personal communication).

Harwood 2004
Study characteristics
Methods | RCT
Participants | Setting: Nottingham, United Kingdom N = 150 Sample: women admitted to orthogeriatric rehabilitation ward within 7 days of surgery for hip fracture Age (years): mean 81.2, range 67 to 92 Inclusion criteria: recent surgery for hip fracture; previous community residence; previous independence in ADL Exclusion criteria: previously institutionalised; disease or medication known to affect bone metabolism; < 7 on 10-point mental state score
Interventions | 1. Single injection of vitamin D2 (ergocalciferol) 300,000 units 2. Single injection of vitamin D2 (ergocalciferol) 300,000 units plus oral calcium carbonate (Calcichew) 1 tablet x 2/day (1 g elemental calcium daily) 3. Oral vitamin D3 + calcium carbonate (Calceos) 1 tablet x 2/day (cholecalciferol 800 units/day + calcium 1 g/day) 4. Control: no treatment
Outcomes | 1. Number of people falling 2. Number sustaining a fracture 3. Number of people with adverse effects Other outcomes reported but not included in this review
Duration of the study | 1 year
Notes | Recruited in hospital but meets the inclusion criteria as participants were all community-dwelling and intervention was designed to prevent falls in the community
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Randomised to 4 groups by computer-generated random number lists
Allocation concealment (selection bias) | Unclear risk | Quote: "using sealed, opaque, envelopes"
Blinding of participants and personnel (performance bias) All outcomes | High risk | No placebo was used; participants aware of whether they were receiving medication or no treatment
Blinding of outcome assessment (detection bias) Falls and fallers | High risk | Falls reported at intervals by participants to researchers who were aware of their group allocation
Blinding of outcome assessment (detection bias) Fractures | High risk | Fractures reported by participants to researchers who were aware of their group allocation. Fracture reports were not verified.
Incomplete outcome data (attrition bias) Fallers | High risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | High risk | Falls not recorded in diaries. Presume falls and fractures ascertained at dedicated clinic at 3, 6 and 12 months.

Harwood 2005
Study characteristics
Methods | RCT
Participants | Setting: Nottingham, United Kingdom N = 306 Sample: women referred to 1 of 3 consultant ophthalmologists (or optometrist-led cataract clinic) Age (years): median 78.5, range 70 to 95 Inclusion criteria: women; aged > 70 years; with cataract; no previous ocular surgery Exclusion criteria: cataract not suitable for surgery by phacoemulsification; severe refraction error in 2nd eye; visual field deficits; severe co-morbid eye disease affecting visual acuity; registrable partially sighted as a result of cataract; memory problems
Interventions | 1. Expedited cataract surgery (target within 1 month) 2. Routine waiting list for surgery (within 13 months) plus up-to-date spectacle prescription
Outcomes | 1. Rate of falls 2. Number of people falling 3. Number sustaining a fracture Other outcomes reported but not included in this review
Duration of the study | 1 year
Notes | Cost-effectiveness analysis and cost utility analysis reported in 8
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Random numbers in variably sized permuted blocks. Quote: "Block randomised consecutively to groups."
Allocation concealment (selection bias) | Low risk | Sequentially numbered, opaque, sealed envelopes
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Participants and personnel not blind to allocated group but impact of non-blinding unclear
Blinding of outcome assessment (detection bias) Falls and fallers | High risk | All participants used falls diaries. Neither assessors nor participants were blinded.
Blinding of outcome assessment (detection bias) Fractures | Unclear risk | Neither assessors nor participants were blinded. Unclear whether fracture were confirmed.
Incomplete outcome data (attrition bias) Falls | Low risk | See Supplementary material 9 for method of assessment
Incomplete outcome data (attrition bias) Fallers | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Low risk | Prospective. Falls recorded in diaries, telephoned at 3 and 9 months, interviewed at 6 and 12 months for data.

Hauer 2001
Study characteristics
Methods | RCT
Participants | Setting: Germany N = 57 Sample: women recruited at the end of ward rehabilitation in a geriatric hospital Age (years): mean 82 (SD 4.8), range 75 to 90 Inclusion criteria: ≥ 75 years; fall(s) as reason for admission to hospital or recent history of injurious fall leading to medical treatment; residing within study community Exclusion criteria: acute neurological impairment; severe cardiovascular disease; unstable chronic or terminal illness; major depression; severe cognitive impairment; musculoskeletal impairment preventing participation in training regimen; falls known to be due to a single, identifiable disease, e.g. stroke or hypoglycaemia
Interventions | 1. Exercise: group lower-extremity progressive resistance training and progressive functional balance training, 90 min, 3 x per wk, for 12 wks 2. Control: "motor placebo", i.e. flexibility, calisthenics, ball games, and memory tasks while seated, 60 min, 3 x per wk, for 12 wks Both groups also received identical physiotherapy (25 min, 2 x per wk)
Outcomes | 1. Number of people falling
Duration of the study | 6 months after intervention
Notes |
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Unclear risk | Stratified randomisation
Allocation concealment (selection bias) | Unclear risk | Insufficient information to permit judgement
Blinding of participants and personnel (performance bias) All outcomes | Low risk | Control group received "placebo activities" and both groups received identical physiotherapy sessions
Blinding of outcome assessment (detection bias) Falls and fallers | Low risk | Falls reported by participants but control group received "placebo activities". Assessor was blinded.
Incomplete outcome data (attrition bias) Fallers | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Low risk | Prospective. Daily diaries collected every 2 weeks.

Helbostad 2004
Study characteristics
Methods | RCT
Participants | Setting: 6 local districts in Trondheim, Norway N = 77 Sample: volunteers recruited through newspapers and invitations from health workers (81% women) Age (years): mean 81 (SD 4.5) Inclusion criteria: aged ≥ 75; fallen in last year; using walking aid indoor or outdoor Exclusion criteria: exercising 1 or more times weekly; terminal illness; cognitive impairment (MMSE < 22); recent stroke; unable to tolerate exercise
Interventions | 1. Combined training: home visit by physical therapist for assessment; group classes, 5 to 8 people (individually tailored progressive resistance exercises, functional balance training) 1 h, 2 x per wk, for 12 wks + home exercises as below (2) 2. Home training: 4 non-progressive exercises (functional balance and strength exercises) 2 x daily, for 12 wks + 3 group meetings
Outcomes | 1. Rate of falls 2. Number of people falling
Duration of the study | 1 year
Notes |
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Unclear risk | Quote: "randomised into one of two exercise programs"
Allocation concealment (selection bias) | Low risk | Randomised by independent research office using sealed envelopes
Blinding of participants and personnel (performance bias) All outcomes | Low risk | Cluster-randomised trial comparing 2 types of exercise intervention. Low risk of performance bias.
Blinding of outcome assessment (detection bias) Falls and fallers | Low risk | Falls reported by participants but both groups received an exercise intervention. Assessors blind to subjects' assignment.
Incomplete outcome data (attrition bias) Falls | Low risk | See Supplementary material 9 for method of assessment
Incomplete outcome data (attrition bias) Fallers | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Low risk | Monthly falls diary (pre-paid post card), telephone call if no response or fall reported

Hendriks 2008
Study characteristics
Methods | RCT with economic evaluation
Participants | Setting: Maastricht, The Netherlands N = 333 Sample: people who have visited an ED or a GP because of a fall (68% women) Age (years): mean 74.8 (SD 6.4) Inclusion criteria: ≥ 65 years; community-dwelling; history of a fall requiring visit to ED or GP; living in Maastricht area Exclusion criteria: not able to speak or understand Dutch; unable to complete questionnaires or interviews by telephone; cognitive impairment (< 4 on AMT4); long-term admission to hospital or other institution (> 4 wks from date of inclusion); permanently bedridden; fully dependent on a wheelchair
Interventions | 1. Multifactorial intervention: detailed assessment by geriatrician, rehabilitation physician, geriatric nurse; recommendations and indications for referral sent to participants' GPs. GPs could then take action if they agreed with the recommendations and/or referrals. Home assessment by OT; recommendations sent to participants and their GPs, and direct referral to social or community services for provision of technical aids and adaptations or additional support. 2. Control: usual care
Outcomes | 1. Number of people falling
Duration of the study | 1 year
Notes | Cost analysis reported in primary reference
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Unclear risk | Quote: "Randomisation was achieved by means of computerised alternative allocation and performed by an external agency".
Allocation concealment (selection bias) | Unclear risk | Quote: "Randomisation was achieved by means of computerised alternative allocation and performed by an external agency".
Blinding of participants and personnel (performance bias) All outcomes | High risk | GPs received copy of notes made for intervention group participants. Although GPs may have been unaware which participants were in the control group this may have influenced treatment that they prescribed to control participants, especially as the trialists "placed no restrictions on co-interventions".
Blinding of outcome assessment (detection bias) Falls and fallers | Low risk | Falls reported by participants who were aware of their group allocation. Quote: "To ensure blinding during data collection, measurements by phone were contracted out to an independent call centre ..., whose operators were unaware of group allocation."
Incomplete outcome data (attrition bias) Fallers | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Low risk | Quote: "Participants recorded their falls continuously on a fall calendar during twelve months after baseline. They were contacted monthly by telephone by an independent call centre (MEMIC) to report the falls noted on the calendar".

Hill 2000
Study characteristics
Methods | RCT
Participants | Setting: Staffordshire, United Kingdom N = 78 Sample: people referred to falls assessment clinic (73% women) Age (years): mean 78.5 Inclusion criteria: history of recurrent falls referred to falls clinic Exclusion criteria: cognitive impairment
Interventions | 1. Supervised group balance exercise and individualised fall prevention advice. Daily exercise, 2 x per wk 2. Control: standard fall prevention advice
Outcomes | 1. Rate of falls
Duration of the study | 6 months
Notes |
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Unclear risk | Method of randomisation not described
Allocation concealment (selection bias) | Unclear risk | Insufficient information to permit judgement
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Insufficient detail for judgement
Blinding of outcome assessment (detection bias) Falls and fallers | Unclear risk | Falls reported by participants who were aware of their group allocation. Unclear whether assessors collecting data were.
Incomplete outcome data (attrition bias) Falls | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | High risk | Recall at end of study period (6 months)

Hogan 2001
Study characteristics
Methods | RCT
Participants | Setting: Calgary, Canada N = 163 Sample: high-risk community-dwelling men and women (72% women) Age (years): mean 77.6 (SD 6.8) Inclusion criteria: aged ≥ 65; fallen in previous 3 months; community-dwelling; ambulatory (with or without aid); mentally intact (able to give consent) Exclusion criteria: qualifying fall resulted in lower extremity fracture, resulted from vigorous or high-risk activities, because of syncope or acute stroke, or while undergoing active treatment in hospital
Interventions | 1. One in-home assessment by a geriatric specialist (doctor, nurse, physiotherapist, or OT) lasting 1 to 2 hours. Intrinsic and environmental risk factors assessed. Multidisciplinary case conference (20 min). Recommendations sent to patients and patients' doctor for implementation. Subjects referred to exercise class if problems with balance or gait and not already attending an exercise programme. Given instructions about exercises to do at home 2. Control: 1 home visit by recreational therapist
Outcomes | 1. Rate of falls 2. Number of people falling 3. Number of fractures (not number of people sustaining a fracture)
Duration of the study | 1 year
Notes |
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Computer-generated. Stratified by number of falls in previous year: 1 or > 1.
Allocation concealment (selection bias) | Unclear risk | Sequence concealed in locked cabinet prior to randomisation
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Participants and personnel not blind to allocated group but impact of non-blinding unclear
Blinding of outcome assessment (detection bias) Falls and fallers | Low risk | Falls reported by participants who were aware of their group allocation. Quote: "The RA (research assistant) remained blinded throughout the study as to each subject's group assignment."
Blinding of outcome assessment (detection bias) Fractures | Unclear risk | No mention of whether fractures reported were confirmed
Incomplete outcome data (attrition bias) Falls | Unclear risk | See Supplementary material 9 for method of assessment
Incomplete outcome data (attrition bias) Fallers | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Unclear risk | Falls recorded on monthly calenders (47.8% returned). Also retrospective recall at 3, 6 months (at visit), and 12 months (by phone).

Hornbrook 1994
Study characteristics
Methods | RCT (cluster-randomised by household)
Participants | Setting: USA N = 3182 (N = 2509 households) Sample: independently living members of HMO recruited by mail (62% women) Age (years): mean 73 (SD 6) Inclusion criteria: aged over 65; ambulatory; living within 20 miles of investigation site; consenting Exclusion criteria: blind; deaf; institutionalised; housebound; non-English speaking; severely mentally ill; terminally ill; unwilling to travel to research centre
Interventions | 1. Home visit, safety inspection (prior to randomisation), hazards booklet, repair advice, fall prevention classes (addressing environmental, behavioural, and physical risk factors), financial and technical assistance 2. Control: home visit, safety inspection (prior to randomisation), hazards booklet
Outcomes | 1. Rate of falls 2. Number of people falling 3. Number sustaining a fracture
Duration of the study | 23 months
Notes | Cost description reported in primary reference.
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Unclear risk | Quote: "randomly assigned"
Allocation concealment (selection bias) | Unclear risk | Insufficient information to permit judgement
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Participants and personnel not blind to allocated group but impact of non-blinding unclear
Blinding of outcome assessment (detection bias) Falls and fallers | Low risk | Falls self reported by postcard, which prompted telephone interview. Quote: "Fall interviewers were blind to group assignment and did not include anyone who had interacted with participants during intervention sessions."
Blinding of outcome assessment (detection bias) Fractures | Unclear risk | Quote: "Fall interviewers were blind to group assignment and did not include anyone who had interacted with participants during intervention sessions." but "Fracture falls and hospitalised falls defined based on participant report" and not confirmed by the results of radiological examination or from primary care case records.
Incomplete outcome data (attrition bias) Falls | Unclear risk | See Supplementary material 9 for method of assessment. Insufficient information to permit judgement.
Incomplete outcome data (attrition bias) Fallers | Unclear risk | See Supplementary material 9 for method of assessment. Insufficient information to permit judgement.
Risk of bias in recall of falls | Low risk | Prospective. Returned a postcard after each fall. Also recorded falls on monthly diaries, and received quarterly mail/telephone contacts.

Huang 2004
Study characteristics
Methods | RCT
Participants | Setting: Hsin-Chu County, Northwest Taiwan N = 120 Sample: persons in registered households (46% women) Age (years): mean 72 (SD 5.7) Inclusion criteria: aged ≥ 65; community-dwelling; cognitively intact Exclusion criteria: none stated
Interventions | 1. 3 home visits over 4 months (HV1, HV2, and HV3) by a nurse HV1: risk assessment (medications and environmental hazards) HV2: 2 months later: standard fall prevention brochure plus individualised verbal teaching and brochure relating to fall risk factors identified at HV1 HV3: assessment and collection of falls data 2. Control: HV1: risk assessment HV2: standard fall prevention brochure HV3: assessment and collection of falls data
Outcomes | 1. Number of people falling Other outcomes reported but not included in this review
Duration of the study | 4 months
Notes |
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Unclear risk | Method of randomisation not described. Quote: "In applying cluster sampling, half of the sample was randomly assigned to the experimental group, and the other half as the comparison group".
Allocation concealment (selection bias) | Unclear risk | Insufficient information to permit judgement
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Participants may have been unaware of which group they were in but personnel not blind to allocated group. Impact of non-blinding unclear.
Blinding of outcome assessment (detection bias) Falls and fallers | High risk | Falls self reported. Researcher who carried out the intervention also collected "Falls Record Checklist" at second and third home visits.
Incomplete outcome data (attrition bias) Fallers | High risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Low risk | Prospective. Self reported falls recorded on a Falls Record Checklist for the 2 months after the intervention visit.

Huang 2005
Study characteristics
Methods | RCT
Participants | Setting: hospital, northern Taiwan N = 141 Sample: people in hospital with a fall-related hip fracture (69% women) Age (years): mean 77 (SD 7.6) Inclusion criteria: in hospital with fall-related hip fracture; aged ≥ 65; discharged within medical centre catchment area Exclusion criteria: cognitively impaired; too ill (comorbidities, unable to communicate or in intensive care unit)
Interventions | 1. Discharge planning intervention by masters-level gerontological nurse, from hospital admission until 3 months after discharge (first visit within 48 hours of admission, seen every 48 hours while in hospital, 1 home visit 3 to 7 days after discharge, available by phone 8am - 8pm 7 days/wk, phoned participant or care-giver once a week). Nurse created individualised discharge plan and facilitated set up of home-care services etc. Participants provided with brochures on self care for hip fracture patients and fall prevention (environmental safety and medication issues). Nurse provided direct care and education on correct use of assistive devices, assessed rehabilitation needs, and collaborated with physicians to modify therapies. 2. Control: usual discharge planning also by nurses, but not specialists. No brochures, written discharge summaries, home visits, or phone calls.
Outcomes | 1. Number of people falling Other outcomes reported but not included in this review
Duration of the study | 3 months
Notes | Majority were community-dwelling as states "the majority of older people with hip fracture who are discharged from hospital are at home..." Intervention included a home visit. 91% living with family.
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Randomly assigned using a computer-generated table
Allocation concealment (selection bias) | Unclear risk | Insufficient information to permit judgement
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | The discharge planning in the intervention group was conducted by a full-time geriatric nurse. Discharge planning in the control group was conducted by general nurses. Impact of non-blinding of participants and personnel unclear.
Blinding of outcome assessment (detection bias) Falls and fallers | Unclear risk | Falls reported by participants who would have some knowledge of their group allocation. Research assistant stated to be blinded on page 1194, but on page 1295 to have conducted the allocation to groups. Unclear whether same research assistant carried out assessments.
Incomplete outcome data (attrition bias) Fallers | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Unclear risk | Falls data collected using falls diary. Appear to have been interviewed at 2 weeks and 3 months. No mention of diaries being returned by post.

Huang 2010
Study characteristics
Methods | RCT (cluster-randomised by village). Not analysed as factorial design
Participants | Setting: Taipei, Taiwan N = 261 (N = 4 villages) Sample: people registered as living in 4 randomly selected villages (48% women after loss to follow-up) Age (years): mean 71.5 (SD 0.64) in people not lost to follow-up Inclusion criteria: aged > 65 years; living in a non-organised community of Taiwan Exclusion criteria: immobile; living outside registered living area
Interventions | 1. Education: 5 group teaching sessions over 5 months (medications, nutrition, environment (inside and outside), footwear) plus discussion 2. Tai Chi Chuan: 13 simple movements, 40 min, 3 x per wk for 20 wks 3. Tai Chi Chuan + education 4. Control
Outcomes | 1. Number of people falling
Duration of the study | 5 months and 18 months
Notes | Reported results not adjusted for clustering. Raw data at 5 months used in the review and adjusted for clustering. No raw data for 18 months so not possible to adjust for clustering.
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Unclear risk | Quote: "The three intervention groups and one control group were then assigned randomly to one each of the four selected villages."
Allocation concealment (selection bias) | High risk | Individual participant recruitment was undertaken after group allocation of the 4 villages. There was no mention of active blinding of research team members recruiting participants.
Blinding of participants and personnel (performance bias) All outcomes | High risk | Interventions (Tai Chi, education classes) were such that it was not possible to blind either participants or those delivering the interventions
Blinding of outcome assessment (detection bias) Falls and fallers | Unclear risk | Insufficient information to permit judgement
Incomplete outcome data (attrition bias) Fallers | High risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Unclear risk | No mention of how falls were monitored

Huang 2011
Study characteristics
Methods | RCT
Participants | Setting: Yi-Lan county, Taiwan N = 186 Sample: randomly selected sample of registered households in Yi-Lan county (59% women) Age (years): not stated Inclusion criteria: aged ≥ 60; community-dwelling; able to communicate in Mandarin or Taiwanese Exclusion criteria: cognitively impaired; artificial leg or leg brace; unstable health problems or terminally ill
Interventions | 1. Cognitive behavioural intervention: 60 to 90 min 1 x per wk for 8 wks, in groups of 8 to 12. Promoting view that fall risk and fear of falling is controllable 2. Cognitive behavioural intervention + intense Tai Chi: as above plus Tai Chi 60 min, 5 x per wk for 8 wks, in groups of 10 to 16 3. Control: no intervention
Outcomes | 1. Rate of falls 2. Number of people falling Other outcomes not included in this review
Duration of the study | 5 months (3-month follow-up after intervention completed)
Notes | Fear of falling the primary outcome
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Quote: "The first author used a computer-developed random table to randomly assign patients to three intervention groups … "
Allocation concealment (selection bias) | Low risk | Quote: "Allocation was concealed from the recruiting RA"
Blinding of participants and personnel (performance bias) All outcomes | High risk | Participants and personnel not blind to allocation and self reported falls
Blinding of outcome assessment (detection bias) Falls and fallers | Low risk | Quote: "Participants in all three groups were assessed in their homes for outcomes at baseline, 2 months, and 5 months by an RA blinded to their group allocation." Outcomes include falls.
Incomplete outcome data (attrition bias) Falls | Low risk | See Supplementary material 9 for method of assessment
Incomplete outcome data (attrition bias) Fallers | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Unclear risk | Quote: "Participants in all three groups were assessed in their homes for outcomes (see below) at baseline, 2 months, and 5 months by an RA blinded to their group allocation." "Number of falls was recorded using the Falls Record Checklist (Huang & Acton 2004), which has a calendar for participants to circle dates when a fall occurred." Unclear whether falls were recorded concurrently or retrospectively at 2-month and 5-month assessments. No regular telephone follow-up described.

Iwamoto 2009
Study characteristics
Methods | RCT
Participants | Setting: Tokyo, Japan N = 68 Sample: volunteer patients from Department of Orthopaedic Surgery (2 hospitals) and Orthopaedic Clinics (3) (90% women) Age (years): mean 76.4 (SD 5.6), range 66 to 88 Inclusion criteria: aged > 50 years; fully ambulatory; able to complete physical assessments Exclusion criteria: using walking aids; severe kyphosis due to osteoporotic vertebral fractures; acute illness; severe cardiovascular disease
Interventions | 1. Exercise: supervised daily exercise programme, in clinic or hospital: 30 min, 3 x per wk for 20 wks 2. Control: no exercise
Outcomes | 1. Rate of falls 2. Number of people falling 3. Number sustaining a fracture
Duration of the study | 5 months
Notes | Place of residence not specified, i.e. not specifically community-dwelling, but not preventing falls in hospital or specifically in an institution
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Unclear risk | Quote: "The subjects were randomly divided into two groups ..."
Allocation concealment (selection bias) | Unclear risk | Quote: "The subjects were randomly divided into two groups ..."
Blinding of participants and personnel (performance bias) All outcomes | High risk | Participants and personnel not blinded to allocation and falls were self reported. Control group received no intervention but were aware of study aims.
Blinding of outcome assessment (detection bias) Falls and fallers | Unclear risk | Insufficient information to permit judgement
Blinding of outcome assessment (detection bias) Fractures | High risk | Fractures appear to be self reported with no confirmation from medical records
Incomplete outcome data (attrition bias) Falls | Low risk | See Supplementary material 9 for method of assessment. Insufficient information to permit judgement.
Incomplete outcome data (attrition bias) Fallers | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | High risk | Quote: "The incidence of fall and fracture … was assessed 2.5 and 5 months after the start of the trial. In particular, information regarding falls and fractures was obtained every week by directly asking the participants." No mention of diaries or calendars. Retrospective recall. Possibly only the intervention group were asked every week (at class) and remainder at 2.5 and 5 months.

Jitapunkul 1998
Study characteristics
Methods | RCT
Participants | Setting: Thailand N = 160 Sample: people recruited from a sample for a previous study (65% women) Age (years): mean 75.6 (SD 5.8) Inclusion criteria: aged ≥ 70; living at home Exclusion criteria: none stated
Interventions | 1. Home visit from non-professional personnel with structured questionnaire. 3-monthly visits for 3 years. Referred to nurse/geriatrician (community-based) if Barthel ADL index and/or Chula ADL index declined ≥ 2 points, or ≥ 1 fall in previous 3 months. Nurse/geriatrician would visit, assess, educate, prescribe drugs/aids, provide rehabilitation programme, make referrals 2. Control: no intervention. Visit at the end of 3 years
Outcomes | 1. Number of people falling
Duration of the study | Falls measured at the end of 3 years. Falls during previous 3 months only.
Notes |
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Unclear risk | Quote: "... divided into case group (n = 80) and control group (n = 80) at random." Insufficient information to permit judgement.
Allocation concealment (selection bias) | Unclear risk | Insufficient information to permit judgement
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Participants and personnel not blind to allocated group but impact of non-blinding unclear
Blinding of outcome assessment (detection bias) Falls and fallers | High risk | Falls reported by participants who were aware of their group allocation to personnel who were aware of group allocation. Possible bias. Intervention group provided falls data every 3 months for 3 years, but control group received only 1 visit in which falls data were collected.
Incomplete outcome data (attrition bias) Fallers | High risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | High risk | Retrospective, and different methods used in the 2 groups. Intervention group provided falls data every 3 months for 3 years, but falls data for control group only collected at exit assessment at 3 years, and data for preceding 3 months only.

Kamide 2009
Study characteristics
Methods | RCT
Participants | Setting: Kanagawa, Japan N = 57 Sample: women registered at an employment agency for older people (see Notes) Age (years): mean 71 (SD 3.6) Inclusion criteria: aged ≥ 65 years; community-dwelling; independently mobile; no restriction on physical activities Exclusion criteria: cerebrovascular, cardiopulmonary, neuromuscular, liver, or kidney disease; hyperparathyroidism; unstable diabetes mellitus or hypertension; fracture of spine or lower limbs; taking prednisolone; exercising regularly
Interventions | 1. Home-based exercise at least 3 days/wk for 24 wks. Initial 1-hour educational session plus 1-hour exercise instruction by PT. Exercise: stretching, moderate intensity lower-limb strength training, balance training, impact training. No home visits but telephone or mail contact monthly. 2. Control: usual activities. Telephone or mail contact from PT every 3 months
Outcomes | 1. Number of people falling
Duration of the study | Falls data for previous 6 months collected retrospectively at the end of 12 months follow-up
Notes | Employment agency providing light work or volunteer activities for older people and encouraging social activities
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Quote: "The random assignment procedure was performed using random numbers generated by a computer program ..."
Allocation concealment (selection bias) | Unclear risk | Quote: "The subjects were randomly assigned to either the home-based exercise group or the control group". Insufficient information to permit judgement.
Blinding of participants and personnel (performance bias) All outcomes | High risk | Participants and therapists aware of group allocation with potential for performance bias. Intervention group: "the therapist contacted each subject by telephone or mail every month to maintain their motivation." Control group: "The subjects who were assigned to the control group were instructed to continue with their usual daily activities, with no restrictions on their exercise activities. A therapist contacted them every 3 months by telephone or mail."
Blinding of outcome assessment (detection bias) Falls and fallers | Low risk | Quote: "Functional capacity, physical function, and bone mineral density were assessed in all subjects in both groups before and after the 6-month intervention. The staff performing the assessments were blinded to each subject's group assignment. Falls were also assessed before and after the 12-month followup."
Incomplete outcome data (attrition bias) Falls | Unclear risk | See Supplementary material 9 for method of assessment
Incomplete outcome data (attrition bias) Fallers | High risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | High risk | Quote: "Falls were also assessed before and after the 12-month followup." No concurrent recording described. No mention of frequent telephone monitoring.

Kärkkäinen 2010
Study characteristics
Methods | RCT
Participants | Setting: Kuopio, Finland N = 3432 Sample: women from the OSTPRE (Osteoporosis Risk Factor and Prevention Study) cohort Age (years): mean 67.3 (SD 1.8) Inclusion criteria: aged 65 or older at end of November 2002; living in the Kuopio province area Exclusion criteria: not belonging to OSTPRE bone densitometry sample
Interventions | 1. Cholecalciferol 800 IU + calcium carbonate 1000 mg daily 2. Control: no supplementation
Outcomes | 1. Rate of falls 2. Number of fallers 3. Number sustaining a fracture 4. Number with adverse effects
Duration of the study | 3 years
Notes |
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Quote: "Randomization was performed with SPSS ... statistical software without any blocking or stratification."
Allocation concealment (selection bias) | Unclear risk | Quote: "… randomized into intervention (n = 1718) and control (n = 1714) groups by an based on simple randomization. " "The subjects were informed by letter to which group they were randomized. The letter contained information concerning the trial and the prescription for the intervention." Unclear whether person sending letter was blind to allocation.
Blinding of participants and personnel (performance bias) All outcomes | High risk | Quote: "OSTPRE-FPS was conducted as an open-label trial and neither placebo control nor blinding was applied."
Blinding of outcome assessment (detection bias) Falls and fallers | High risk | Quote: "OSTPRE-FPS was an open trial and neither placebo control nor blinding was applied."
Blinding of outcome assessment (detection bias) Fractures | Low risk | Period of recall differed between the randomly selected subgroup and the remaining sample. Quote: "However, the average time of phone contacts was similar in both groups." Quote: "All self-reported fractures were validated using medical records or radiologic reports. Only fractures with radiologic confirmation were regarded as valid fractures, with the exception of rib fractures, for which a physician's clinical diagnosis was regarded as valid."
Incomplete outcome data (attrition bias) Falls | Low risk | See Supplementary material 9 for method of assessment
Incomplete outcome data (attrition bias) Fallers | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | High risk | Retrospective recall over a long period of time with no concurrent recording described. Period of recall differed between the randomly selected subgroup and the remaining sample. Quote: "However, the average time of phone contacts was similar in both groups." Quote: "The participants in the subsample were telephoned at 4-month intervals to record the incidence and circumstances of falls ... " "The rest of the trial population was interviewed by phone once a year between January and April during the trial."

Kemmler 2010
Study characteristics
Methods | RCT
Participants | Setting: Erlangen-Nuremberg area, Germany N = 246 Sample: women members of Siemens Health Insurance living in Erlangen-Nuremberg area Age (years): mean 69 (SD 4) Inclusion criteria: aged ≥ 65; community-dwelling; consenting Exclusion criteria: diseases affecting bone metabolism or fall risk; medication affecting bone metabolism or fall risk; history of profound coronary heart diseases (stroke, cardiac events), acute or chronic inflammatory diseases, or secondary osteoporosis; participation in exercise studies during previous 2 years; very low physical capacity (< 50 W during ergometry)
Interventions | 1. Intervention: progressive high-intensity exercise programme (group classes in gymnasium 60 min, 2 x per wk): warm up, static and dynamic balance training, functional gymnastics, isometric strength training, and stretching for trunk, hip, and thigh, and upper body exercises using elastic belts + progressive home training sessions (20 min, 2 x per wk) emphasising strength and flexibility. 2. Control: low to moderate intensity (low frequency) "Wellness programme" (not progressive) (1 hour, 1 x per wk for 10 wks then 10 wk rest): relaxation, games/interaction, general co-ordination, endurance, balance, dances, body sensitivity, muscle strength, breathing, and flexibility
Outcomes | 1. Rate of falls 2. Number of people falling 3. Number of fractures (not number of people with fracture) Other outcomes reported but not included in this review
Duration of the study | 18 months
Notes | Cost analysis in primary reference
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Quote: "computer-generated block randomization"
Allocation concealment (selection bias) | Low risk | Quote: "Computer-generated block randomization stratified for age performed by an independent statistician." "The allocation sequence and group assignment were performed by the Institute of Biometry and Epidemiology. Participants were enrolled by the Institute of Medical Physics."
Blinding of participants and personnel (performance bias) All outcomes | Low risk | Quote: "The study was blinded for the outcome assessors and participants ..." "To blind the participants, the control group performed a program that focused on well-being and was designed not to cause physical adaptations" "The effectiveness of the blinding in the control group was proven in structured interviews conducted by the primary investigators at the end of the 18 months"
Blinding of outcome assessment (detection bias) Falls and fallers | Low risk | Falls reported by participants who were aware of their group allocation. Outcome assessors were blind to allocation.
Blinding of outcome assessment (detection bias) Fractures | Unclear risk | Quote: "The study was blinded for the outcome assessors". No report of radiological confirmation of fractures.
Incomplete outcome data (attrition bias) Falls | Low risk | See Supplementary material 9 for method of assessment
Incomplete outcome data (attrition bias) Fallers | Unclear risk | See Supplementary material 9 for method of assessment. Insufficient information to permit judgement
Risk of bias in recall of falls | Low risk | Quote: "Injurious falls and overall fractures were monitored daily with the use of fall calendars compiled by the participants. Outcome assessors contacted subjects who fell and nonresponders monthly by telephone."

Kenny 2001
Study characteristics
Methods | RCT
Participants | Setting: Cardiovascular Investigation Unit, Newcastle, United Kingdom N = 175 Sample: individuals presenting at A&E with non-accidental fall (59% women) Age (years): mean 73 (SD 10) Inclusion criteria: aged ≥ 50; history of a non-accidental fall; diagnosed as having cardioinhibitory CSH Exclusion criteria: cognitive impairment; medical explanation of fall within 10 days of presentation; blind; lived > 15 miles from A&E; had contraindication to CSM; receiving medications known to cause a hypersensitive response to CSM
Interventions | 1. Pacemaker (rate drop response physiologic dual-chamber pacemaker: Thera RDR, Medtronic, Minneapolis, Minnesota) 2. Control: no pacemaker
Outcomes | 1. Rate of falls 2. Number sustaining a fracture Other outcomes reported but not included in this review
Duration of the study | 1 year after randomisation
Notes | Out of 3384 A&E attendees with non-accidental falls, 257 were diagnosed as having carotid sinus hypersensitivity. 175 of these were randomised, i.e. 5% of non-accidental falls.
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Unclear risk | Quote: "Randomised ... block randomisation; in blocks of eight". Method of sequence generation not described.
Allocation concealment (selection bias) | Unclear risk | Insufficient information to permit judgement
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Participants and personnel not blind to allocated group but impact of non-blinding unclear
Blinding of outcome assessment (detection bias) Falls and fallers | Unclear risk | Falls reported by participants who were aware of their group allocation. Blinding of assessment personnel not mentioned in report. Insufficient evidence to make judgement.
Blinding of outcome assessment (detection bias) Fractures | Unclear risk | Insufficient information in the report to permit judgement
Incomplete outcome data (attrition bias) Falls | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Low risk | Prospective. Falls recorded daily on self completion diary cards which were returned at the end of each week for 1 year.

Kingston 2001
Study characteristics
Methods | RCT
Participants | Setting: A&E, Staffordshire, United Kingdom N = 109 Sample: community-dwelling women attending A&E with a fall Age (years): mean 71.9 Inclusion criteria: female; aged 65 to 79; history of a fall; discharged directly to own home Exclusion criteria: admitted from A&E to hospital or any form of institutional care
Interventions | 1. Rapid Health Visitor intervention within 5 working days of index fall: pain control and medication, how to get up after a fall, education about risk factors (environmental and drugs, alcohol etc), advice on diet and exercise to strengthen muscles and joints. 2. Control: usual post fall treatment, i.e. letter to GP from A&E detailing the clinical event, any interventions carried out in hospital and recommendations about follow-up
Outcomes | 1. Number of people falling Falls not primary outcome of study. Other outcomes reported but not included in this review
Duration of the study | 12 wks
Notes |
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Unclear risk | Quote: "randomly allocated"
Allocation concealment (selection bias) | Unclear risk | Quote: "randomly allocated". Insufficient information to permit judgement.
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Participants and personnel not blind to allocated group but impact of non-blinding unclear
Blinding of outcome assessment (detection bias) Falls and fallers | Low risk | Quote: "Both groups ... were assessed by face-to-face interview with an independent researcher at baseline ..." and "... by the same researcher 12 weeks after the fall"
Incomplete outcome data (attrition bias) Fallers | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | High risk | Quote: "Falls were recorded at week twelve assessment" (information from author)

Korpelainen 2006
Study characteristics
Methods | RCT
Participants | Setting: Oulu, Finland N = 160 Sample: birth cohort of women Age (years): mean 73 (SD 1.2) Inclusion criteria: hip BMD > 2 less than the reference value Exclusion criteria: "medical reasons"; use of a walking aid other than a stick; bilateral total hip joint replacement; unstable chronic illness; malignancy; medication known to affect bone density; severe cognitive impairment; involvement in other interventions
Interventions | 1. Supervised exercise programme (physiotherapist led). Mixed home and supervised group programme plus twice yearly seminars on nutrition, health, medical treatment and fall prevention 2. Control: twice yearly seminars on nutrition, health, medical treatment, and fall prevention
Outcomes | 1. Rate of falls 2. Number sustaining a fracture
Duration of the study | 30 months
Notes |
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Quote: "Each participant received sequentially, according to the original identification numbers, the next random assignment in the computer list".
Allocation concealment (selection bias) | Low risk | The randomisation was "provided by a technical assistant not involved in the conduction of the trial."
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Participants and personnel not blind to allocated group but impact of non-blinding unclear
Blinding of outcome assessment (detection bias) Falls and fallers | Low risk | Falls reported by participants who were aware of their group allocation. Assessors blind to allocation.
Blinding of outcome assessment (detection bias) Fractures | Low risk | Fractures reported by participants who were aware of their group allocation. Assessors blind to allocation. Quote: "In the event of a need for medical treatment, the self reported information was checked from the medical records."
Incomplete outcome data (attrition bias) Falls | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | High risk | 3-monthly retrospective recall

Lannin 2007
Study characteristics
Methods | RCT
Participants | Setting: Sydney, Australia N = 10 Sample: patients admitted to a rehabilitation facility and referred to OT (80% women) Age (years): mean 81 (SD 7) Inclusion criteria: mild or no cognitive impairment; community-dwelling (non institutional); aged 65 or older; no medical contraindications that would require strict adherence to equipment recommendations Exclusion criteria: none
Interventions | 1. Best practice occupational therapy home visit intervention 2. Control: standard practice in-hospital assessment and education
Outcomes | 1. Number of people falling
Duration of the study | 3 months
Notes | Pilot study
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Allocation schedule computer-generated
Allocation concealment (selection bias) | Low risk | Quote: "Concealed in opaque, consecutively numbered envelopes by a person not involved in the study."
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Participants and personnel not blind to allocated group but impact of non-blinding unclear
Blinding of outcome assessment (detection bias) Falls and fallers | Low risk | Falls reported by participants who were aware of their group allocation. Quote: "The assessor was blinded to group allocation."
Incomplete outcome data (attrition bias) Fallers | High risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Unclear risk | Interval recall. Falls ascertained by assessor at home visit at 2 weeks, and 1, 2 and 3 months after discharge.

Latham 2003
Study characteristics
Methods | RCT (factorial design)
Participants | Setting: 5 hospitals in Auckland, New Zealand and Sydney, Australia N = 243 Sample: frail older people recently discharged from hospital (53% women) Age (years): mean 79 Inclusion criteria: aged ≥ 65, considered frail (one or more health problems, e.g. dependency in an ADL, prolonged bed rest, impaired mobility, or a recent fall); no clear indication or contraindication to either of the study treatments Exclusion criteria: poor prognosis and unlikely to survive 6 months; severe cognitive impairment; physical limitations that would limit adherence to exercise programme; unstable cardiac status; large ulcers around ankles that would preclude use of ankle weights; living outside hospitals' geographical zone; not fluent in English
Interventions | 1. Exercise: quadriceps exercises using adjustable ankle cuff weights 3 x per wk for 10 wks. First 2 sessions in hospital, remainder at home. Monitored weekly by physiotherapist: alternating home visit with telephone calls. 2. "Attention" control: frequency matched telephone calls and home visits from research physical therapist including general enquiry about recovery, general advice on problems, support 3. Vitamin D: single oral dose of six 1.25 mg calciferol (300,000 IU) 4. Vitamin D control: placebo tablets
Outcomes | 1. Rate of falls 2. Number of people falling 3. Number of people with adverse effects from exercise (not vitamin D) Other outcomes reported but not included in this review
Duration of the study | 6 months
Notes | Detailed description of exercise regimen given in paper
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Study biostatistician-generated random sequence. Block randomisation technique.
Allocation concealment (selection bias) | Low risk | Computerised centralised randomisation scheme
Blinding of participants and personnel (performance bias) All outcomes | Low risk | Trial with 4 arms with varying risk of bias (factorial design). 2 arms double-blind, placebo-controlled (low risk) and 2 arms exercise and attention control with matched frequency of visits where impact of non-blinding likely to be low or unclear.
Blinding of outcome assessment (detection bias) Falls and fallers | Low risk | Falls reported by participants who were blinded to group allocation (placebo-controlled arms) and assessor blind to group allocation. Falls reported by participants who were aware of their group allocation (exercise and exercise control arms) but assessor blind to group allocation.
Incomplete outcome data (attrition bias) Falls | Low risk | See Supplementary material 9 for method of assessment
Incomplete outcome data (attrition bias) Fallers | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Low risk | Prospective. Falls recorded in fall diary with weekly reminders for first 10 weeks. Nurses examined fall diaries and sought further details about each fall at 3 and 6-month visits. Reminder phone call between visits.

Li 2005
Study characteristics
Methods | RCT
Participants | Setting: Legacy Health System, Portland, Oregon, USA N = 256 Sample: people enrolled in health maintenance organisation (70% women) Age (years): mean 77.5 (SD 5), range 70 to 92 Inclusion criteria: age ≥ 70; physician clearance to participate; inactive (no moderate to strenuous activity in last 3 months); walks independently Exclusion criteria: chronic medical problems that would limit participation; cognitive impairment
Interventions | 1. Exercise intervention: Tai Chi 1 hour, 3 x per wk for 26 wks 2. Control: low-level stretching 1 hour, 3 x per wk for 26 wks
Outcomes | 1. Rate of falls 2. Number of people falling Other outcomes reported but not included in this review
Duration of the study | 1 year
Notes |
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Computer-generated random numbers
Allocation concealment (selection bias) | Unclear risk | Insufficient information to permit judgement
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Participants and personnel not blind to allocated group but impact of non-blinding unclear
Blinding of outcome assessment (detection bias) Falls and fallers | Low risk | Falls reported by participants who were aware of their group allocation. Fall diaries coded by blinded research assistant.
Incomplete outcome data (attrition bias) Falls | High risk | See Supplementary material 9 for method of assessment
Incomplete outcome data (attrition bias) Fallers | High risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Low risk | Prospective. Quote: "... recorded by each participant in a daily "fall calendar." Collected on a monthly basis.

Lightbody 2002
Study characteristics
Methods | RCT
Participants | Setting: hospital, Liverpool, United Kingdom N = 348 Subjects: consecutive patients attending A&E with a fall (74% women) Age (years): median (IQR) 75 (70 to 81) Inclusion criteria: aged > 65, patients attending A&E with a fall Exclusion criteria: admitted to hospital as result of index fall, living in institutional care, refused or unable to consent, lived out of the area
Interventions | 1. Multifactorial assessment by falls nurse at 1 home visit (medication, ECG, blood pressure, cognition, visual acuity, hearing, vestibular dysfunction, balance, mobility, feet and footwear, environmental assessment). Referral for specialist assessment or further action (relatives, community therapy services, social services, primary care team. No referrals to day hospital or hospital outpatients). Advice and education about home safety and simple modifications, e.g. mat removal 2. Control: usual care
Outcomes | 1. Rate of falls 2. Number of people falling 3. Number sustaining a fracture Other outcomes reported but not included in this review
Duration of the study | 6 months
Notes | Assessment of risk factors: medication, ECG, blood pressure, cognition, visual acuity, hearing, vestibular dysfunction, balance, mobility, feet and footwear. Environmental assessment. Falls reported in diary and by questionnaire different
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Unclear risk | Quote: "Patients were block-randomized consecutively to groups". Insufficient information to permit judgement.
Allocation concealment (selection bias) | Unclear risk | Insufficient information to permit judgement
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Participants and personnel not blind to allocated group but impact of non-blinding unclear
Blinding of outcome assessment (detection bias) Falls and fallers | Unclear risk | Participants completed a falls diary for up to 6 months. Postal questionnaires completed at 6 months. Insufficient information to permit judgement.
Blinding of outcome assessment (detection bias) Fractures | Low risk | Quote: "Further falls, consequent injury and subsequent place of treatment (i.e. GP, hospital) were recorded." Quote: "GP records were reviewed and hospital databases interrogated for attendances and admissions."
Incomplete outcome data (attrition bias) Falls | Low risk | See Supplementary material 9 for method of assessment
Incomplete outcome data (attrition bias) Fallers | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Low risk | Prospective. Falls, injury, and treatment recorded in diary. Postal questionnaire at 6 months to collect data. GP records and hospital databases searched.

Lin 2007
Study characteristics
Methods | RCT
Participants | Setting: Taiwan N = 150 Sample: residents of rural agricultural area (51% women) Age (years): mean 76.5 Inclusion criteria: medical attention for a fall in previous 4 wks, ≥ 65 years Exclusion criteria: none described
Interventions | 1. Home-based exercise training (physiotherapist) 2. Home safety assessment and modification (public health worker) 3. Control: "education". 1 social visit 30 to 40 min every 2 wks for 4 months with fall prevention pamphlets provided (public health worker)
Outcomes | 1. Rate of falls Other outcomes reported but not included in this review
Duration of the study | 6 months
Notes |
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Unclear risk | Block randomised. Insufficient information to permit judgement.
Allocation concealment (selection bias) | Unclear risk | Insufficient information to permit judgement
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Participants and personnel not blind to allocated group but impact of non-blinding unclear
Blinding of outcome assessment (detection bias) Falls and fallers | Unclear risk | Quote: "Participants were asked to report their falls by telephone or postcard; they were also contacted by telephone every 2 weeks to ascertain the occurrence of falling". Blinding of assessors not reported.
Incomplete outcome data (attrition bias) Falls | High risk | High risk of bias for both home-based exercise versus control and home safety intervention versus control. See Supplementary material 9 for method of assessment.
Risk of bias in recall of falls | Low risk | Prospective. Reported falls by telephone or postcard when they occurred. Phoned every 2 weeks to ascertain occurrence of falls.

Liu-Ambrose 2004
Study characteristics
Methods | RCT
Participants | Setting: British Colombia (BC), Canada N = 104 Sample: women with osteoporosis or osteopenia diagnosed at BC Women's Hospital and Health Centre; individuals with low BMD identified through Osteoporosis Society of Canada; advertising Age (years): mean 79 (SD 3), range 75 to 85 Inclusion criteria: women aged 75 to 85; osteoporosis or osteopenia (BMD total hip or spine T score at least 1 SD below young normal sex matched area BMD of the Lunar reference database); resident in greater Vancouver Exclusion criteria: living in care facility; non-Caucasian race; regularly exercising 2 x per wk or more; history of illness or a condition affecting balance (stroke, Parkinson's disease); unable to safely participate in exercise programme; MMSE 23 or less
Interventions | 1. High-intensity resistance training 50 min, 2 x per wk 25 wks using Keiser Pressurized Air system and free weights. Instructor:participant ratio 1:2 2. Agility training 50 min, 2 x per wk for 25 wks. Training (ball games, relay races, dance movements, obstacle courses wearing hip protectors) designed to challenge hand-eye and foot-eye co-ordination, and dynamic, standing and leaning balance, and reaction time. Instructor:participant ratio 1:3 3. Control: sham exercises 50 min, 2 x per wk for 25 wks. Stretching, deep breathing, relaxation, general posture. Instructor:participant ratio 1:4
Outcomes | 1. Rate of falls 2. Number of people with more than 1 fall (i.e. frequent fallers) 3. Number of people with adverse effects Other outcomes reported but not included in this review
Duration of the study | 25 wks
Notes |
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Unclear risk | Method of randomisation not described but stratified by baseline performance in postural sway
Allocation concealment (selection bias) | Unclear risk | Insufficient information to permit judgement
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Participants and personnel not blind to allocated group but impact of non-blinding unclear
Blinding of outcome assessment (detection bias) Falls and fallers | High risk | All participants asked to keep falls diary. All groups had exercise interventions. Study described as "single blind" which indicates that assessors were not blinded.
Incomplete outcome data (attrition bias) Falls | Low risk | See Supplementary material 9 for method of assessment
Incomplete outcome data (attrition bias) Fallers | Unclear risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Low risk | Prospective. Quote: "Falls documented using monthly falls calendars."

Liu-Ambrose 2008
Study characteristics
Methods | RCT
Participants | Setting: Vancouver, Canada N = 74 Sample: people attending a falls clinic after presenting at ED or to GP with a fall or fall-related injury (41/59 completing baseline assessment (69%) were women) Age (years): mean 82.2 (SD 6.3) (in 59 participants completing baseline assessment) Inclusion criteria: aged ≥ 70; community-dwelling; attending one of 2 falls clinics (criteria for attending clinic: history of a fall and considered at risk for further falls); able to walk at least 3 m; 1 additional nonsyncopal fall in previous year (if index fall was suspected to be due to carotid sinus syndrome); at risk of further falls (TUG test > 15 seconds or PPA z-score of ≥ 1) Exclusion criteria: progressive neurological condition (e.g. Parkinson's disease); life expectancy < 12 months; cognitively impaired (MMSE score < 24)
Interventions | 1. 12-month home-based strength and balance-retraining programme (Otago Exercise Programme) 2. Control: semi-structured interview about their presenting fall and their experience seeking care for the fall at ED Both groups received falls risk factor assessment and comprehensive geriatric assessment followed by "Guideline Care" through falls clinic
Outcomes | 1. Rate of falls 2. Number of people falling Other outcomes not included in this review
Duration of the study | 1 year
Notes | Cost-effectiveness analysis reported in 9
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Quote: "The randomization sequence was computer generated (www.randomization.com)"
Allocation concealment (selection bias) | Low risk | Quote: "The Family Practice Research Coordinator at the University of British Columbia held this sequence independently and remotely"
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Participants and personnel not blind to allocated group but impact of non-blinding unclear
Blinding of outcome assessment (detection bias) Falls and fallers | High risk | Falls self reported and "A research assistant who was not blinded to treatment group" phoned participants at the end of each month
Incomplete outcome data (attrition bias) Falls | Unclear risk | See Supplementary material 9 for method of assessment
Incomplete outcome data (attrition bias) Fallers | High risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Low risk | Quote: "Ascertainment of falls ... documented on monthly calendars that were returned in prepaid preaddressed envelopes at the end of each month." "A research assistant who was not blinded to treatment group but was unaware of the study hypotheses made three attempts by telephone to contact participants at the end of each month. The purpose of each phone call was to inquire about falls (both groups) ... for all participants regardless of whether the calendar was returned."

Logan 2010
Study characteristics
Methods | RCT
Participants | Setting: 4 primary care trusts, Nottinghamshire, United Kingdom N = 204 Sample: people living in the 4 primary care trust areas (65% women) Age (years): median (IQR) 83 (77 to 86) Inclusion criteria: aged ≥ 60; living at home or in a care home (see Notes); called for an ambulance after a fall and not taken to hospital, or taken to hospital but not admitted Exclusion criteria: receiving a falls prevention services (in geriatric day hospitals or hospital out-patient departments)
Interventions | 1. Intervention: referred to multidisciplinary falls prevention service for assessment and interventions. Tailored interventions including balance training, muscle strengthening, reduction of environmental hazards, education about how to get off the floor, and provision of equipment. If medical assessment required for medication check or visual problems, referred to GP in first instance and then to the community geriatrician if necessary 2. Control: no intervention by falls prevention service
Outcomes | 1. Rate of falls 2. Number of people falling 3. Only reported number sustaining a fracture requiring admission to hospital, i.e. subgroup of fractures Other outcomes reported but not included in this review
Duration of the study | 1 year
Notes | Predominantly community-dwelling (only 5% in care home or hospital) Trial acronym: SAFER (Support and Assessment for Fall Emergency Referrals) Trial
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Quote: "Nottingham Clinical Trials Unit produced a computer generated randomisation scheme with stratification by primary care trust"
Allocation concealment (selection bias) | Low risk | Quote: "The allocation sequence was concealed until allocation. After written consent had been obtained, PAL accessed the randomisation sequence through the internet and assigned the participants to their group."
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Quote: "It was not possible to blind the participants and treating therapists to allocation group as they would be aware of receiving or giving falls rehabilitation." Unclear whether this would introduce bias in this study
Blinding of outcome assessment (detection bias) Falls and fallers | Low risk | Quote: "A trained assessor who was independent of the community fall team and masked to group allocation contacted by telephone or visited those participants who did not return their diaries or questionnaires." The assessors who contacted the participants to collect missing data on outcome measures and the research staff who input data were blinded to allocation group
Blinding of outcome assessment (detection bias) Fractures | Low risk | To ascertain number of participants sustaining a fracture "a researcher blind to allocation checked the Nottingham University Hospital computer system." Assume that checking this one hospital system would identify all fractures.
Incomplete outcome data (attrition bias) Falls | Low risk | See Supplementary material 9 for method of assessment
Incomplete outcome data (attrition bias) Fallers | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Low risk | Quote: "Data on falls were recorded monthly using a diary. Participants were sent a diary by post each month with a stamped addressed envelope to return the completed previous month's diary."

Logghe 2009
Study characteristics
Methods | RCT
Participants | Setting: 2 industrial towns in the western Netherlands N = 269 Sample: registered with participating 23 general practices (71% women) Age (years): mean 77 (SD 4.6) Inclusion criteria: aged ≥ 70; community-dwelling; high falls risk (1 or more falls in previous year or 2 or more risk factors for falling (disturbed balance, mobility problems, dizziness, using benzodiazepines or diuretics) Exclusion criteria: none described
Interventions | 1. Tai Chi Chuan training (1 hour, 2 x per wk for 13 wks) + fall prevention brochure 2. Control: fall prevention brochure
Outcomes | 1. Rate of falls 2. Number of people falling Other outcomes reported but not included in this review
Duration of the study | 1 year
Notes |
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Quote: "An independent research assistant performed a prestratified block randomization using a computer-generated randomization list"
Allocation concealment (selection bias) | Low risk | Quote: "An independent research assistant performed a prestratified block randomization using a computer-generated randomization list"
Blinding of participants and personnel (performance bias) All outcomes | High risk | Participants and/or intervention delivery personnel were not blind to group allocation, and the outcomes (falls and fractures) are likely to be influenced by lack of blinding
Blinding of outcome assessment (detection bias) Falls and fallers | Low risk | Falls self reported but "The blinded research assistant contacted the participant when forms were missing or incomplete, and they then completed the forms together over the telephone"
Incomplete outcome data (attrition bias) Falls | Unclear risk | See Supplementary material 9 for method of assessment. Insufficient information to permit judgement.
Incomplete outcome data (attrition bias) Fallers | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Low risk | Quote: "At baseline, the participants received a falls calendar and the instruction to fill it out on a daily basis for 1 year ... The fall calendars were collected monthly by mail. The blinded research assistant contacted the participant when forms were missing or incomplete, and they then completed the forms together over the telephone"

Lord 1995
Study characteristics
Methods | RCT. Pre-randomisation prior to consent, from a schedule of participants in a previous study
Participants | Setting: Australia N = 197 Sample: women recruited from a schedule from a previous epidemiologic study. Fitness level not defined. Age (years): mean 71.6 (SD 5.4), range 60 to 85 Inclusion criteria: living independently in the community Exclusion criteria: unable to use English
Interventions | 1. Intervention: exercise classes (warm-up, conditioning, stretching, relaxation) 1 hour, 2 x per wk for 52 wks 2. Control: no intervention
Outcomes | 1. Rate of falls 2. Number of people falling
Duration of the study | 1 year
Notes |
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Unclear risk | Quote: "randomly assigned"
Allocation concealment (selection bias) | Unclear risk | Insufficient information to permit judgement
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Participants and personnel not blind to allocated group but impact of non-blinding unclear
Blinding of outcome assessment (detection bias) Falls and fallers | High risk | Falls reported by participants who were aware of their group allocation. Assessors not blind to treatment status.
Incomplete outcome data (attrition bias) Falls | Low risk | See Supplementary material 9 for method of assessment
Incomplete outcome data (attrition bias) Fallers | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Unclear risk | Interval recall. Fall ascertainment questionnaires sent out every 2 months. Telephone call if questionnaire not returned.

Lord 2003
Study characteristics
Methods | RCT. Cluster-randomised by village. Stratified by accommodation (self care or intermediate care) and by cluster size (< 75 or at least 75 residents)
Participants | Setting: retirement villages, Sydney, Australia N = 551 (N = 20 clusters) Sample: recruited from self care apartment villages (78%) and intermediate-care hostels (22%) (86% women) Age (years): mean 79.5 (SD 6.4), range 62 to 95 Inclusion criteria: resident in one of 20 retirement villages Exclusion criteria: MMSE < 20; already attending exercise classes of equivalent intensity; medical conditions that precluded participation as determined by nurse or physician (neuromuscular, skeletal, cardiovascular); in hospital or away at recruitment time
Interventions | 1. Group exercise classes (1 hour, 2 x per wk for 52 wks). Designed to improve strength, speed, co-ordination, balance and gait, and to improve performance in ADLs (turning and reaching, rising from chair, stair climbing, standing and walking balance). 35 to 40-minute conditioning period. Aerobic exercises, strengthening exercises, activities for balance and hand-eye and foot-eye co-ordination, and flexibility (mostly weight bearing) 2. Control: seated flexibility and relaxation activities by yoga instructors (1 hour, 2 x per wk for 52 wks) 3. Control: no group activity
Outcomes | 1. Rate of falls
Duration of the study | 1 year
Notes |
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Unclear risk | Method of randomisation not described
Allocation concealment (selection bias) | Unclear risk | Insufficient information to permit judgement
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Participants and personnel not blind to allocated group but impact of non-blinding unclear
Blinding of outcome assessment (detection bias) Falls and fallers | High risk | Falls reported by completion of questionnaire monthly by all participants; if not returned telephone calls were made. No mention of blinding of personnel carrying out phone calls, but in intermediate-care sites, falls record book was kept by nursing staff (unblinded).
Incomplete outcome data (attrition bias) Falls | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Unclear risk | Retrospective. Falls ascertained by questionnaires given to residents every month, with follow-up phone calls or home visit for none responders. In addition nurses recorded falls in falls record book in intermediate-care hostels.

Lord 2005
Study characteristics
Methods | RCT
Participants | Setting: Sydney, Australia N = 620 Sample: health insurance membership database (66% women) Age (years): mean 80.4 (SD 4.5) Inclusion criteria: low score on PPA test; community-dwelling; ≥ 75 years Exclusion criteria: minimal English language skills; blind; Parkinson's disease; cognitive impairment
Interventions | All participants assessed for risk factors prior to randomisation 1. Extensive intervention comprising individualised exercise intervention (2 x per wk for 12 months), visual intervention, peripheral sensation counselling intervention 2. Minimal intervention. Participants received a report outlining their falls risk, a profile of their test results, and specific recommendations on preventing falls based on their test performances 3. Control: no intervention (received minimal intervention after 12-month follow-up)
Outcomes | 1. Rate of falls 2. Number of people falling Other outcomes reported but not included in this review
Duration of the study | 1 year
Notes |
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Quote: "randomised in matched blocks N = 20 ... using concealed allocation (drawing lots)".
Allocation concealment (selection bias) | Low risk | Quote: "concealed allocation"
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Blinding of participants and treatment personnel not mentioned in report, but unlikely. Insufficient evidence to make judgement on impact of lack of blinding.
Blinding of outcome assessment (detection bias) Falls and fallers | Unclear risk | Falls reported by completion of monthly falls calendar by all participants; if not returned telephone calls were made. Blinding of assessors not described.
Incomplete outcome data (attrition bias) Falls | Low risk | See Supplementary material 9 for method of assessment
Incomplete outcome data (attrition bias) Fallers | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Low risk | Prospective. Monthly fall calendars. Telephoned at end of month if not returned.

Luukinen 2007
Study characteristics
Methods | RCT
Participants | Setting: Oulu, Finland N = 486 Sample: identified from population and geriatric registers of Oulu (78% women) Age (years): mean 88 (SD 3) Inclusion criteria: age ≥ 85; home dwelling; ≥ 1 risk factor for falling (≥ 2 falls in previous year, loneliness, poor self rated health, poor visual acuity/hearing, depression, poor cognition, impaired balance, chair rise, slow walking speed, difficulty with at least 1 ADL, able to walk outdoors, up or down stairs) Exclusion criteria: none described
Interventions | 1. Intervention plans developed by OT and physiotherapist at home visit, based on nurse's assessment pre-randomisation. Feasibility of plan assessed by GP. Plan included home exercise or group exercise, walking exercises, self care exercises (duration and frequency not described). Interventions carried out by OT and/or physiotherapist 2. Control: asked to visit GP without written intervention form
Outcomes | 1. Rate of falls 2. Number of people falling
Duration of the study | 24 months (falls monitored for median 16 months)
Notes |
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Quote: "Randomization was done by the study statistician using a random numbers table".
Allocation concealment (selection bias) | Unclear risk | Insufficient information to permit judgement
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Participants and personnel not blind to allocated group but impact of non-blinding unclear
Blinding of outcome assessment (detection bias) Falls and fallers | Low risk | Quote: "Fall recording was based on regular phone calls to all participants made every second month by a research nurse ... unaware of the randomization and the interventions."
Incomplete outcome data (attrition bias) Falls | Low risk | See Supplementary material 9 for method of assessment
Incomplete outcome data (attrition bias) Fallers | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | High risk | Interval recall. Quote: "Fall recording was based on regular telephone interviews once in 2 months, but did not include diary reporting."

Madureira 2010
Study characteristics
Methods | RCT
Participants | Setting: Sao Paulo, Brazil N = 66 Sample: women attending osteometabolic disease outpatient clinic Age (years): mean 74 (SD 4.7) Inclusion criteria: aged > 65; with osteoporosis Exclusion criteria: secondary osteoporosis, visual deficiency, hearing deficiency, vestibular alteration, unable to walk more than 10 m independently, contraindications for exercise training; planning to be out of town for > 4 wks during study
Interventions | Intervention: balance training programme 1 hour per wk for 40 wks (classes held in an athletics club so probably mostly community-dwelling) preceded by 15 min warm-up. Encouraged to continue same exercises at home, 30 min 3 x per wk. Control: osteoporosis treatment, "instructions to prevent falls", and 3-monthly clinic visits
Outcomes | 1. Mean number of falls per person. No poolable data. Falls a secondary outcome Other outcomes reported but not included in this review
Duration of the study | 1 year
Notes |
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Unclear risk | Quote: "The patients were randomized consecutively into two groups."
Allocation concealment (selection bias) | Unclear risk | Quote: "The patients were randomized consecutively into two groups." Insufficient information to permit judgement.
Blinding of participants and personnel (performance bias) All outcomes | High risk | No blinding of participants and personnel and the control group got "orientation to prevent falls"
Blinding of outcome assessment (detection bias) Falls and fallers | Low risk | Falls self reported but recorded in medical record every 3 months by "the Osteometabolic Outpatient Clinic physician blinded to the group assignment."
Incomplete outcome data (attrition bias) Falls | Unclear risk | See Supplementary material 9 for method of assessment. Insufficient information to permit judgement.
Risk of bias in recall of falls | Unclear risk | Quote: "During the study, patients in both groups received a calendar and were instructed to write down falls, which were included in the same electronic medical record every 3 months by the Osteometabolic Outpatient Clinic physician blinded to the group assignment." No mention of more frequent telephone follow-up.

Mahoney 2007
Study characteristics
Methods | RCT
Participants | Setting: USA N = 349 Sample: recruited from seniors centres, meal sites, senior apartment buildings, other senior congregate sites, by referral (79% women) Age (years): mean 80 (SD 7.5) Inclusion criteria: aged ≥ 65; living independently; ≥ 2 falls in previous year or 1 injurious fall in previous 2 years or gait and balance problems Exclusion criteria: unable to give informed consent and no related caregiver; in hospice or assisted-living facility; expected to move away from area
Interventions | 1. Fall risk assessment by nurse or physiotherapist (2 home visits) followed by recommendations and referrals to primary physician, physiotherapist, OT, ophthalmologist, podiatrist etc. All participants given exercise plan for long-term exercise (walking programme, standing balance exercises in group setting etc), monthly exercise calendar and 11 monthly phone calls to promote adherence to exercises and other recommendations 2. Control: 1 in-home assessment by OT "limited to home safety recommendations and advice to see their doctor about falls"
Outcomes | 1. Rate of falls
Duration of the study | 1 year
Notes |
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Randomised using computer-generated randomisation table
Allocation concealment (selection bias) | Unclear risk | Sealed envelopes used but no mention of numbering or how they were used
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Participants and personnel implementing the intervention not blind to allocated group, but impact of non-blinding unclear
Blinding of outcome assessment (detection bias) Falls and fallers | Low risk | Falls reported by all participants using monthly calendars. Quote: "The study researcher, blinded to treatment assignment, called subjects who did not return calendars. When a fall was reported, the researcher interviewed the subject or caregiver to verify the fall."
Incomplete outcome data (attrition bias) Falls | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Low risk | Falls ascertained using monthly calendars, telephone call if calendar not returned or if fall reported

Markle-Reid 2010
Study characteristics
Methods | RCT
Participants | Setting: Ontario, Canada N = 109 Sample: newly referred to, and eligible for, home support services (72% women) Age: range 75 to 84 Inclusion criteria: aged ≥ 75; community-dwelling (not in nursing home or long-term care facility); "at risk of falls" (fallen in past 12 month, fear of falling, unsteady on feet) Exclusion criteria: not mentally competent; not competent in English or with a translator available
Interventions | 1. Standard home services + home visits by health professionals 2. Control: standard home services
Outcomes | 1. Rate of falls 2. Number of people falling
Duration of the study | 6 months
Notes | Cost analysis reported in primary reference
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Quote: "randomly generated numbers constructed by a biostatistician who was not involved in the recruitment process"
Allocation concealment (selection bias) | Low risk | Quote: "Randomization was achieved using consecutively numbered, sealed, opaque envelopes containing randomly generated numbers constructed by a biostatistician who was not involved in the recruitment process."
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Participants and personnel implementing the intervention not blind to allocated group, but impact of non-blinding unclear
Blinding of outcome assessment (detection bias) Falls and fallers | Low risk | Quote: "Trained interviewers, blinded to the purpose of the study and group assignment, assessed participants at baseline and six months"
Blinding of outcome assessment (detection bias) Fractures | Unclear risk | Insufficient information to permit judgement
Incomplete outcome data (attrition bias) Falls | Low risk | See Supplementary material 9 for method of assessment
Incomplete outcome data (attrition bias) Fallers | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Low risk | Quote: "All participants kept a calendar to record daily any slip, trip, or fall and returned it at the end of each month. Interviewers blinded to treatment assignment telephoned participants monthly to obtain additional information"

McKiernan 2005
Study characteristics
Methods | RCT
Participants | Setting: Wisconsin, USA N = 113 Sample: recruited from fall registry and by single media release (60% women) Age (years): mean 74.2, range 65 to 96 Inclusion criteria: aged ≥ 65 years; community-dwelling; ≥ 1 falls in previous year; independently ambulatory Exclusion criteria: not capable of applying Yaktrax walker correctly or discerning correct outdoor conditions to wear them
Interventions | 1. Yaktrax walker (netting applied over usual footwear with wire coils to increase grip in winter outdoor conditions) 2. Control: usual winter footwear
Outcomes | 1. Rate of falls
Duration of the study | 3 months ("one winter")
Notes |
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Unclear risk | Quote: "randomized"
Allocation concealment (selection bias) | Unclear risk | Insufficient information to permit judgement
Blinding of participants and personnel (performance bias) All outcomes | High risk | Consent to participate included awareness of the intervention, and the absence of intervention. 19% of individuals in control group used the intervention device.
Blinding of outcome assessment (detection bias) Falls and fallers | Unclear risk | Falls reported by participants who were aware of their group allocation, using monthly calendars. Blinding of research staff not described.
Incomplete outcome data (attrition bias) Falls | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Low risk | Prospective. Fall diary returned by post.

McMurdo 1997
Study characteristics
Methods | RCT
Participants | Setting: Dundee, United Kingdom N = 118 Sample: women recruited by advertisement Age (years): mean 64.5, range 60 to 73 Inclusion criteria: community-dwelling; post-menopausal Exclusion criteria: conditions or drug treatment likely to affect bone
Interventions | 1. Exercise programme of weight bearing exercise to music, 45 min, 3 x per wk, 30 wks per year, over 2 years, plus 1000 mg calcium carbonate daily 2. Control: 1000 mg calcium carbonate daily
Outcomes | 1. Rate of falls 2. Number of people falling Other outcomes reported but not included in this review
Duration of the study | 24 months
Notes |
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Unclear risk | Method of randomisation not described
Allocation concealment (selection bias) | Unclear risk | Insufficient information to permit judgement
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Participants and personnel implementing the intervention not blind to allocated group, but impact of non-blinding unclear
Blinding of outcome assessment (detection bias) Falls and fallers | Unclear risk | Falls reported by participants who were aware of their group allocation. Insufficient information to permit judgement.
Blinding of outcome assessment (detection bias) Fractures | Unclear risk | Insufficient information to permit judgement
Incomplete outcome data (attrition bias) Falls | High risk |
Incomplete outcome data (attrition bias) Fallers | High risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Unclear risk | No description about ascertainment

McMurdo 2009
Study characteristics
Methods | RCT (2 centres)
Participants | Setting: Dundee and Glasgow, Scotland, United Kingdom N = 253 Sample: people admitted to hospital with acute illness who appeared undernourished (61% women) Age (years): mean 82 (SD 62) Inclusion criteria: consenting; community-dwelling; aged ≥ 70; admitted to the hospital with an acute illness; BMI < 24.0 kg/m2 and mid-arm muscle circumference below the 10th centile or weight loss of 5% or more during the hospital stay Exclusion criteria: Barthel Index > 8, chronic liver disease or renal failure (serum creatinine 43.39 mg/dL); residence in a care home; cognitive impairment precluding informed consent; dysphagia; metastatic carcinoma or other terminal illness; acute inflammatory arthritis; stroke affecting both hands; major surgery within the preceding month
Interventions | 1. Oral nutritional supplementation (400 mL/day of Fresubin, Fresenius Kabi Ltd, Runcorn, Cheshire, UK: 600 kcal, 2520 kJ, 40 g protein, a nutritionally complete liquid protein and energy supplement) 2. Control: matching control supplement (based on skim milk containing minimal energy: 200 kcal, 840 kJ, 12.4 g protein content) in identical packaging
Outcomes | 1. Number of people falling Falls are a secondary outcome in this study. Other outcomes reported but not included in this review
Duration of the study | 4 months
Notes |
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Quote: "Randomization was stratified according to site, in random permuted blocks of 4. An individual not involved in the study prepared the randomization schedule from computer-generated random number tables."
Allocation concealment (selection bias) | Low risk | Quote: "Participants were allocated to oral nutritional supplementation ... or to a matching control supplement ... Both preparations were packaged in identical 200-mL plain white rectangular cartons and labeled using one of two randomization codes."
Blinding of participants and personnel (performance bias) All outcomes | Low risk | Quote: "Both preparations were packaged in identical 200-mL plain white rectangular cartons and labeled using one of two randomization codes."
Blinding of outcome assessment (detection bias) Falls and fallers | Low risk | Likely to be low given that the participants were blinded to contents of supplement and "... observations were recorded blind to treatment allocation"
Incomplete outcome data (attrition bias) Falls | Unclear risk | See Supplementary material 9 for method of assessment
Incomplete outcome data (attrition bias) Fallers | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Unclear risk | Quote: "Falls were recorded prospectively using the validated daily diary method." But no mention of telephone contact or frequency of return.

Means 2005
Study characteristics
Methods | RCT
Participants | Setting: Arkansaw, USA N = 338 Sample: volunteers from 17 senior citizen's centres (57% women) Age (years): mean 73.5 Inclusion criteria: aged ≥ 65 years; able to walk at least 30 feet without assistance from others; able to follow instructions and give consent Exclusion criteria: resident in a nursing home; acute medical problems; cognitive impairment
Interventions | 1. Balance rehabilitation intervention. Active stretching, postural control, endurance walking, and repetitive muscle co-ordination exercises. Group sessions 90 min, 3 x per wk for 6 wks 2. Control: group seminars on non health-related topics of interest to senior citizens. Same time and frequency as intervention group
Outcomes | 1. Rate of falls 2. Number of people falling
Duration of the study | 6 months
Notes |
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Randomised by coin flip
Allocation concealment (selection bias) | Unclear risk | Insufficient information to permit judgement
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Blinding of participants and treatment personnel not mentioned in report, but unlikely. Insufficient information to make judgement on impact of lack of blinding.
Blinding of outcome assessment (detection bias) Falls and fallers | Low risk | Falls reported by participants who were aware of their group allocation. Assessor blind to group allocation.
Incomplete outcome data (attrition bias) Falls | High risk | See Supplementary material 9 for method of assessment
Incomplete outcome data (attrition bias) Fallers | High risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Low risk | Prospective. Recorded on pre-printed postcards weekly with telephone calls to non correspondents to optimise compliance.

Meredith 2002
Study characteristics
Methods | RCT
Participants | Setting: New York and Los Angeles, USA N = 317 Sample: participants enrolled from home health care agencies client lists if agency office agreed to participate (75% women) Age (years): mean 80 (SD 8) Inclusion criteria: Medicare patients; aged ≥ 65; registered with home health care offices in defined period; having one of 4 study medication problems; having an identifiable physician; expected home health care for at least 4 wks Exclusion criteria: not expected to survive through follow-up; unable to understand spoken English; resident in an unsafe area that requires an escort for visits
Interventions | 1. Medication review by pharmacist and participant's nurse based on reported problems relating to medication use (including falls). Targetted therapeutic duplication, cardiovascular, psychotropic, and NSAID use. A plan to reduce medication problem presented to physician in person by nurse or pharmacist. Nurse assisted participant with the medication changes and monitored effect 2. Control: usual care, which might include review of medications and adverse effects if relevant
Outcomes | 1. Number of people falling
Duration of the study | Follow-up interview as close to 6 wks as possible, but up to 90 days after randomisation
Notes |
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Assigment generated by computer random number generator (SAS v 6.10). Balanced block randomisation, stratified by the 2 areas.
Allocation concealment (selection bias) | Unclear risk | Randomised off site but insufficient information to permit judgement
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Participants and personnel implementing the intervention not blind to allocated group, but impact of non-blinding unclear
Blinding of outcome assessment (detection bias) Falls and fallers | Low risk | Falls data collected at 6 weeks by study research assistants, who "supervised by the data coordinator, collected the data; all were masked as to patient group assignment"
Incomplete outcome data (attrition bias) Fallers | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | High risk | No description of how falls ascertained; presumably retrospectively at follow-up interview

Morgan 2004
Study characteristics
Methods | RCT
Participants | Setting: community and assisted-living facilities Florida, USA N = 294 Sample: recruited from Miami Department of Veterans Affairs Medical Centre, 9 assisted-living facilities, private physical therapy clinic (71% women) Age (years): mean 80.5 (SD 7.5) Inclusion criteria: aged ≥ 60; hospital admission or bedrest for ≥ 2 days in previous month Exclusion criteria: medical conditions precluding exercise programme (angina, severe osteoporosis etc); MMSE < 23 (unable to follow instructions); using oxygen therapy at home; planned inpatient treatment or evaluation in 2 months following recruitment; requiring human assistance, wheelchair or artificial limbs to walk
Interventions | 1. Low-intensity group exercise: seated and standing exercises to improve muscle strength, joint flexibility, balance and gait, 5 people per group. 45 min, 3 x per wk for 8 wks 2. Control: usual activities
Outcomes | 1. Number of people falling
Duration of the study | 1 year
Notes | SAFE-GRIP (Study to Assess Falls among Elderly Geriatric Rehabilitation Intensive Program)
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Unclear risk | Randomisation stratified by sex, age (< 75 and ≥ 75), falls history in previous month (fall/no fall). Method of randomisation not described.
Allocation concealment (selection bias) | Unclear risk | Insufficient information to permit judgement
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Participants and personnel implementing the intervention not blind to allocated group, but impact of non-blinding unclear
Blinding of outcome assessment (detection bias) Falls and fallers | Unclear risk | Blinding not described. Insufficient information to permit judgement.
Incomplete outcome data (attrition bias) Fallers | Unclear risk | See Supplementary material 9 for method of assessment. Insufficient information to permit judgement. Number randomised not stated.
Risk of bias in recall of falls | Low risk | Prospective. Pre-dated postcard diaries returned every 2 weeks.

Newbury 2001
Study characteristics
Methods | RCT
Participants | Setting: Adelaide, Australia N = 100 Sample: every 20th name in an age-sex register of community-dwelling patients registered with 6 general practices (63% women) Age: median (intervention group) 78.5, (control group) 80, range 75-91 Inclusion criteria: aged ≥ 75; independently community-dwelling Exclusion criteria: none
Interventions | 1. Health assessment of people aged 75 years or older by nurse (75+HA). Problems identified were counted and reported to patient's GP. No reminders or other intervention for 12 months 2. No 75+HA until 12 months after randomisation
Outcomes | 1. Number of people falling Other outcomes reported but not included in this review
Duration of the study | 1 year
Notes | 75+HA introduced in Australia November 1999 as part of Enhanced Primary Care package. Similar to "health check" for patients in this age group in the United Kingdom.
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Randomisation by random numbers
Allocation concealment (selection bias) | Low risk | Sequentially numbered sealed envelopes
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Participants and personnel implementing the intervention not blind to allocated group, but impact of non-blinding unclear
Blinding of outcome assessment (detection bias) Falls and fallers | Unclear risk | Blinding not described. Insufficient information to permit judgement.
Incomplete outcome data (attrition bias) Fallers | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | High risk | Falls identified retrospectively at follow-up visit at 1 year

Nikolaus 2003
Study characteristics
Methods | RCT
Participants | Setting: enrolled in hospital but community-based intervention, Germany N = 360 Sample: frail "older people" admitted to a geriatric clinic who normally lived at home (73% women) Age (years): mean 81.5 (SD 6.4) Inclusion criteria: lived at home before admission and able to be discharged home; with at least 2 chronic conditions (e.g. osteoarthritis or chronic cardiac failure, stroke, hip fracture, parkinsonism, chronic pain, urinary incontinence, malnutrition) or functional decline (unable to reach normal range on at least 1 assessment test of ADL or mobility) Exclusion criteria: terminal illness; severe cognitive decline; living > 15 km from clinic
Interventions | 1. At least 2 home visits (from interdisciplinary home intervention team (HIT). 1 home visit prior to discharge to identify home hazards and prescribe technical aids if necessary. At least 1 more visit (mean 2.6, range 1 to 8) to inform about possible fall risks in home, advice on changes to home environment, facilitate changes, and teach use of technical and mobility aids. Comprehensive geriatric assessment in hospital. 2. Control: no home visit until final assessment at 1 year. Comprehensive geriatric assessment as for intervention group. Usual post discharge management by GPs
Outcomes | 1. Rate of falls 2. Number sustaining a fracture
Duration of the study | 1 year
Notes | Home intervention team consisted of 3 nurses, physiotherapist, occupational therapist, social worker, and secretary. Usually 2 members at first home visit (OT + nurse or OT + physiotherapist depending on anticipated needs and functional limitations). Methods paper described a third arm receiving usual hospital and home care.
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Quote: "sealed envelopes containing group assignments using a random number sequence"
Allocation concealment (selection bias) | Unclear risk | Quote: "sealed envelopes containing group assignments"
Blinding of participants and personnel (performance bias) All outcomes | Low risk | Participants and personnel implementing the intervention not blind to allocated group, but as both groups received an intervention performance bias is unlikely
Blinding of outcome assessment (detection bias) Falls and fallers | Low risk | Quote: "the participants were contacted monthly by telephone to obtain information on falls, fall-related injuries, and their circumstances. The interviewer was blinded to group allocation."
Blinding of outcome assessment (detection bias) Fractures | High risk | Self report only and no mention of confirmation by the results of radiological examination or from primary care case records
Incomplete outcome data (attrition bias) Falls | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Low risk | Prospective. Falls recorded in falls diary and by monthly telephone interview.

Nitz 2004
Study characteristics
Methods | RCT
Participants | Setting: Queensland, Australia N = 73 Sample: volunteers recruited through advertising and fliers (92% women) Age (years): mean 75.8 (SD 7.8) Inclusion criteria: aged over 60; living independently in the community; at least 1 fall in previous year Exclusion criteria: unstable cardiac condition, living too far from exercise class site, unable to guarantee regular attendance
Interventions | 1. Balance training in small groups using workstation (circuit training) format, 1 hour per wk for 10 wks. Up to 6 people per group, with physiotherapist instructor 2. Control: gentle exercise and stretching, 1 hour per wk for 10 wks
Outcomes | 1. Rate of falls
Duration of the study | 3 months post intervention
Notes |
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Computer-generated random numbers
Allocation concealment (selection bias) | Unclear risk | Insufficient information to permit judgement
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Participants and personnel implementing the intervention not blind to allocated group, but impact of non-blinding unclear
Blinding of outcome assessment (detection bias) Falls and fallers | Low risk | Quote: "Partipants used a calendar on which each day was marked for a fall ... or incident free day" Quote: "The physiotherapists who undertook all assessments of the participants were blinded to the intervention group allocation"
Incomplete outcome data (attrition bias) Falls | High risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Low risk | Falls ascertained by marked calendar returned monthly

Pardessus 2002
Study characteristics
Methods | RCT
Participants | Setting: France N = 60 Sample: individuals hospitalised for a fall (78% women) Age (years): mean 83.2 (SD 7.7) Inclusion criteria: aged ≥ 65; hospitalised for falling; able to return home; able to give consent Exclusion criteria: cognitive impairment (MMSE < 24); falls due to cardiac, neurologic, vascular or therapeutic problems; without a phone; lived > 30 km from hospital
Interventions | 1. Comprehensive 2-hour home visit prior to discharge with "physical medicine and rehabilitation doctor" and OT. Assessment of ADLs, IADLs, transfers, mobility inside and outside, use of stairs. Environmental hazards identified and modified where possible. If not, advice given. Discussion of social support. Referrals for social assistance 2. Control: usual care
Outcomes | 1. Number of people falling Mean number of falls per person reported but unable to calculate a rate of falls
Duration of the study | 1 year
Notes |
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Randomised using random numbers table
Allocation concealment (selection bias) | Unclear risk | Insufficient information to permit judgement
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Participants and personnel implementing the intervention not blind to allocated group, but impact of non-blinding unclear
Blinding of outcome assessment (detection bias) Falls and fallers | Unclear risk | Blinding not described. Quote: "Follow up was provided by one of us contacting each patient by phone, for the intervention or control group, every month during six month, and at twelve months"
Incomplete outcome data (attrition bias) Fallers | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Unclear risk | Interval recall, but short interval. Falls identified by monthly telephone calls.

Parry 2009
Study characteristics
Methods | RCT (within participants cross-over design)
Participants | Setting: specialist falls and syncope facility, Newcastle upon Tyne, United Kingdom N = 34 Sample: consecutive patients presenting to A&E or syncope service (79% women) Age (years): mean 76.8 (SD 9.0) Inclusion criteria: aged over 55; carotid sinus hypersensitivity as sole attributable cause of ≥ 3 falls in preceding 6 months Exclusion criteria: moderate to severe cognitive impairment; stroke or myocardial infarction within 3 months; any history of syncope
Interventions | 1. Dual chamber permanent pacemaker switched on 2. Control: dual chamber permanent pacemaker switched off
Outcomes | 1. Rate of falls 2. Number of fallers
Duration of the study | 6 months in each mode
Notes |
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Quote: "At 1 month, subjects were randomised (by table of random numbers) in double-blind fashion to either continue in DDD/RDR mode, or for the pacing to be turned off (ODO mode). Six months later, patients crossed over to the opposite mode for the remaining 6 months of the study."
Allocation concealment (selection bias) | Low risk | Quote: "At 1 month, subjects were randomised (by table of random numbers) in double-blind fashion to either continue in DDD/RDR mode, or for the pacing to be turned off (ODO mode)."
Blinding of participants and personnel (performance bias) All outcomes | Low risk | Placebo-controlled. Quote: "Following pacemaker implantation, all subjects' pacemakers were programmed to on (ie, in DDD/RDR mode) for a 1-month run-in period in order to ensure that they were unaware of pacing intervention. At 1 month, subjects were randomised (by table of random numbers) in double-blind fashion to either continue in DDD/RDR mode,or for the pacing to be turned off (ODO mode). Six months later, patients crossed over to the opposite mode for the remaining 6 months of the study."
Blinding of outcome assessment (detection bias) Falls and fallers | Unclear risk | Insufficient information to judge whether person phoning participants was blind to pacemaker status (on or off)
Blinding of outcome assessment (detection bias) Fractures | Unclear risk | Fractures recorded in events diary throughout, but no mention of blinded radiology assessment
Incomplete outcome data (attrition bias) Falls | Low risk | See Supplementary material 9 for method of assessment
Incomplete outcome data (attrition bias) Fallers | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Low risk | Quote: "All subjects completed daily fall diaries returned at weekly intervals using prepaid postage to avoid confounding due to inaccurate recall of falls. Information from the falls diaries was held at a central database; failure of diary return initiated a telephone prompt to keep diary returns contemporaneous"

Pereira 1998
Study characteristics
Methods | RCT in 1982-85. Reporting 10-year follow-up.
Participants | Setting: Pittsburgh, USA N = 229 randomised, 198 available for 10-year follow-up Sample: healthy post-menopausal women (volunteers) Age (years): at randomisation mean 57; at follow-up mean 70 (SD 4) Inclusion criteria: 1 year post menopause; aged 50 and 65 Exclusion criteria: on HRT; unable to walk
Interventions | 1. 8-week training period with organised group walking scheme 2 x per wk. Also encouraged to walk 1 x per wk on their own. Building up to 7 miles per wk total 2. Control: no intervention
Outcomes | 1. Number of people falling Other outcomes reported but not included in this review
Duration of the study | Reporting 10-year follow-up
Notes |
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Unclear risk | Method of randomisation not described
Allocation concealment (selection bias) | Unclear risk | Insufficient information to permit judgement
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Participants and personnel implementing the intervention not blind to allocated group, but impact of non-blinding unclear
Blinding of outcome assessment (detection bias) Falls and fallers | Low risk | Quote: "... telephone interviewers remained masked to the original group assignment of the participants until the end of the interview."
Incomplete outcome data (attrition bias) Fallers | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | High risk | Falls in the previous 12 months ascertained by telephone interview

Perry 2008
Study characteristics
Methods | RCT
Participants | Setting: Ontario, Canada N = 46 Sample: healthy volunteers (19/40 women (48%) completed the study) Age (years): mean 69 (SD 3.4); range 65 to 75 Inclusion criteria: moderate insensitivity of the foot soles, as compared to published norms for young adults Exclusion criteria: a clinical diagnosis of diabetes or peripheral neuropathy
Interventions | 1. Intervention: balance-enhancing insole ("Sole-Sensor") for 12 wks 2. Control: normal insole for 12 wks All participants fitted with standard pattern shoe
Outcomes | 1. Number of people falling Other outcomes reported but not included in this review
Duration of the study | 12 wks
Notes | Falls are a secondary outcome in this study
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Unclear risk | Quote: "Each participant performed the gait-perturbation protocol … with both types of insoles, and was then randomly assigned to either the test or control group". Insufficient information to permit judgement.
Allocation concealment (selection bias) | Unclear risk | Insufficient information to permit judgement
Blinding of participants and personnel (performance bias) All outcomes | Low risk | Participants and researchers were not blinded to which allocated group they were in, facilitatory or conventional insole, however this is unlikely to have introduced performance bias
Blinding of outcome assessment (detection bias) Falls and fallers | Unclear risk | Falls reported by participants who were aware of their group allocation. Does not state whether outcome assessors were blind to allocation.
Incomplete outcome data (attrition bias) Fallers | Unclear risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Low risk | Quote: "During the 12-week period, participants sent in postcards weekly with information pertaining to insole comfort, hours of wear, and falls." "There was 100% compliance in completing the weekly reports."

Pfeifer 2000
Study characteristics
Methods | RCT
Participants | Setting: Germany N = 148 Sample: healthy ambulatory community-living women recruited through advertisement Age (years): ≥ 70 Inclusion criterion: 25-hydroxycholecalciferol serum level below 50 nmol/litre Exclusion criteria: hypercalcaemia, primary hyperparathyroidism, osteoporotic extremity fracture, treatment with bisphosphonate, calcitonin, vitamin D or metabolites, oestrogen, tamoxifen in past 6 months; fluoride in last 2 years; anticonvulsants or medications possibly interfering with postural stability or balance; intolerance to vitamin D or calcium; chronic renal failure; drug, alcohol, caffeine, or nicotine abuse; diabetes mellitus; holiday at different latitude
Interventions | An 8-week supplementation at the end of winter 1. 400 IU vitamin D plus 600 mg elemental calcium (calcium carbonate) 2. Control: 600 mg calcium carbonate
Outcomes | 1. Rate of falls 2. Number of people falling 3. Number sustaining a fracture Other outcomes reported but not included in this review
Duration of the study | 1 year
Notes |
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Unclear risk | Quote: "randomly assigned"
Allocation concealment (selection bias) | Unclear risk | Insufficient information to permit judgement
Blinding of participants and personnel (performance bias) All outcomes | Low risk | Double-blind, controlled trial
Blinding of outcome assessment (detection bias) Falls and fallers | Low risk | Both assessors and participants blinded. Quote: "The number of falls was recorded by questionnaire."
Blinding of outcome assessment (detection bias) Fractures | Low risk | Quote: "All fractures were the result of falls and were verified by X-ray and medical reports."
Incomplete outcome data (attrition bias) Falls | Low risk | See Supplementary material 9 for method of assessment
Incomplete outcome data (attrition bias) Fallers | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | High risk | Retrospective. Falls and fractures monitored retrospectively by questionnaire at 1 year.

Pfeifer 2009
Study characteristics
Methods | RCT (2 centres)
Participants | Setting: Bad Pyrmont, Germany, and Graz, Austria N = 242 Sample: healthy community-dwelling people recruited by advertisements and mailing lists (79% women) Age (years): mean 74 (SD 4) Inclusion criteria: ambulatory; aged ≥ 70; serum 25-hydroxyvitamin D below 78 nmol/litre) Exclusion criteria: hypercalcaemia or primary hyperparathyroidism; fractures of the extremities due to osteoporosis; therapy with a thiazide, bisphosphonate, calcitonin, vitamin D and vitamin D metabolites, oestrogen, or anti-oestrogen in the past 6 months or fluoride treatment in the past 2 years; known intolerance to study medication; chronic renal failure (serum creatinine above 20% of the upper limit of the reference range); history of drug or alcohol abuse; nicotine abuse (more than 20 cigarettes per day); > 7 cups of coffee per day; scheduled holidays along the geographic longitude during the study period; diabetes mellitus; severe cardiovascular disease
Interventions | 1. Intervention: 1000 mg calcium plus 800 IU of cholecalciferol (vitamin D)/day (1 tablet) in 2 divided doses for 12 months 2. Control: 1000 mg calcium/day (1 tablet) in 2 divided doses for 12 months
Outcomes | 1. Number of people falling 2. Number sustaining a fracture
Duration of the study | 12 months (for fallers outcome) 20 months (for fractures)
Notes |
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Unclear risk | Detail of randomisation is not described. Quote: "subjects were randomly assigned to either the calcium mono or the calcium plus vitamin D group."
Allocation concealment (selection bias) | Unclear risk | Insufficient information to permit judgement
Blinding of participants and personnel (performance bias) All outcomes | Low risk | Quote: "Individuals received in a double blinded fashion either 1000 mg of calcium or 1000 mg of calcium plus 800 IU of vitamin D per day over a treatment period of 12 months, which was followed by a treatment-free but still blinded observation period of 8 months"
Blinding of outcome assessment (detection bias) Falls and fallers | Low risk | Blinding of outcome assessors is not specifically described. However, double-blinding throughout the 20 months is asserted.
Blinding of outcome assessment (detection bias) Fractures | Low risk | Blinding of outcome assessors is not specifically described. However, double-blinding throughout the 20 months is asserted. Quote: "All fractures were the result of falls and were verified by x-rays and medical reports."
Incomplete outcome data (attrition bias) Falls | Unclear risk | See Supplementary material 9 for method of assessment
Incomplete outcome data (attrition bias) Fallers | Unclear risk | See Supplementary material 9 for method of assessment. Insufficient information to permit judgement.
Risk of bias in recall of falls | Low risk | Quote: "The number of falls was recorded by fall diaries. Each day the participants had to make a cross depending on whether a fall had occurred or not." However, telephone contact only every 2 months (not monthly or more frequent) but unlikely to seriously affect recall.

Pighills 2011
Study characteristics
Methods | RCT
Participants | Setting: affluent rural and deprived urban areas, Yorkshire, United Kingdom N = 238 Sample: recruited from 13 GP lists in the Airedale NHS Trust (67% women) Age (years): mean 79 (SD 6) Inclusion criteria: community-dwelling; aged ≥ 70; history of ≥ 1 fall in previous 12 months Exclusion criteria: living in nursing or residential care homes; receiving OT services; had fall-specific OT intervention in past year
Interventions | 1. Environmental assessment provided by OT, recommendations sent to participant and referrals made for equipment and other input 2. As above, but provided by a trained non-professionally qualified domiciliary support worker 3. Control: usual care from GP
Outcomes | 1. Rate of falls 2. Number of people falling Other outcomes reported but not included in this review
Duration of the study | 12 months
Notes |
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Quote: "The computer-generated outcome of randomization was automatically e-mailed to an independent person"
Allocation concealment (selection bias) | Low risk | Quote: "The York Trials Unit independently and remotely conducted simple Web-based randomization ... The computer-generated outcome of randomization was automatically e-mailed to an independent person who passed the participant's case notes on to the contact person for the group to which they had been randomized."
Blinding of participants and personnel (performance bias) All outcomes | High risk | Participants and personnel carrying out the intervention were aware of group allocation
Blinding of outcome assessment (detection bias) Falls and fallers | Low risk | Quote: "Calendars that were not returned within 2 weeks of the end of the month prompted a telephone contact from an independent, blinded interviewer to ascertain whether the participant had fallen." "All reported falls were followed up with a blinded, structured telephone interview to investigate the circumstances and consequences." "Staff of the York Trials Unit inputted questionnaire data which was checked twice for accuracy."
Incomplete outcome data (attrition bias) Falls | Unclear risk | See Supplementary material 9 for method of assessment
Incomplete outcome data (attrition bias) Fallers | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Low risk | Used postcard diary, mailed monthly. Followed up in 2 weeks if did not send. Participants also provided with toll-free telephone number so that they could report falls contemporaneously of they sustained multiple falls or had difficulty recalling falls.

Pit 2007
Study characteristics
Methods | RCT (cluster-randomised by general practice)
Participants | Setting: general practices in Hunter Region, New South Wales, Australia N = 849 participants (17 practices, 23 GPs) Sample: attending general practices and invited by practice staff (59% women) Age (years): ≥ 65 Inclusion criteria: GPs: based at their current practice for at least 12 months; working ≥ 10 hours per wk; member of a randomly selected network of practices. Patients: aged ≥ 65; community-dwelling Exclusion criterion: confused patients not accompanied by a caregiver
Interventions | 1. GPs: education (academic detailing (2 visits from pharmacist), provision of prescribing information and feedback); completion of medication review checklist; financial rewards. Patients: completed medication risk assessment form 2. Control: GPs: no academic detailing but received feedback on number of medication reviews completed and medication risk factors. Patients: completed medication risk assessment form but not passed on to GP for action
Outcomes | 1. Number of people falling
Duration of the study | 1 year
Notes |
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Assignment undertaken "using computer-generated random number allocation in SAS software"
Allocation concealment (selection bias) | Low risk | Randomisation carried out by off-site statistician
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Quote: "The sequence was not concealed from ... the doctors who needed to conduct the intervention. However, participants, practice staff, data collectors, outcome assessors and data managers were unaware of the treatment allocation."
Blinding of outcome assessment (detection bias) Falls and fallers | Low risk | Falls reported by participants who were unaware of their group allocation. Data collectors also blind to allocation.
Incomplete outcome data (attrition bias) Fallers | High risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | High risk | Retrospective interval recall. Falls ascertained by phone at 4 and 12 months.

Porthouse 2005
Study characteristics
Methods | RCT (multicentre)
Participants | Setting: United Kingdom N = 3314 Sample: community-dwelling women registered with 107 general practices in England Age (years): mean 76.9 (SD 5.1) Inclusion criteria: age ≥ 70; female; community-dwelling; ≥ 1 risk factors for fracture Exclusion criteria: cognitive impairment; life expectancy < 6 months; unable to give written consent; taking more than 500 mg calcium supplementation per day; history of kidney or bladder stones, renal failure or hypercalcaemia
Interventions | 1. Oral vitamin D3 800 IU (Calcichew D3 Forte) + oral 1000 mg calcium (calcium carbonate) daily for 6 months plus session with practice nurse, life-style advice on how to reduce risk of fracture + leaflet on dietary sources of vitamin D 2. Control: no supplementation. Sent same leaflet as intervention group received
Outcomes | 1. Rate of falls 2. Number of people falling 3. Number sustaining a fracture Falls are a secondary outcome in this study. Other outcomes reported but not included in this review
Duration of the study | 1 year
Notes |
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Randomised (stratified by GP practice), by computer. Initially 2:1 ratio in favour of the control group to achieve most statistical power within budget. Changed to 1:1 towards end of study after re-analysis of trial's cost profile.
Allocation concealment (selection bias) | Low risk | Quote: "Randomised at the York Trials Unit, by an independent person who had no knowledge of the baseline characteristics of participants."
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Pharmaceutical open randomised trial. Quote: "Fewer than 6% of control participants had started calcium and vitamin D by 18 months".
Blinding of outcome assessment (detection bias) Falls and fallers | High risk | Outcome data collected by 6-monthly postal questionnaires. Neither participants nor research staff blinded.
Blinding of outcome assessment (detection bias) Fractures | Low risk | Quote: "GPs of women who reported having a fracture were asked to confirm a fracture ... where participants had not completed the final follow-up questionnaire, but had not withdrawn from the study, fracture information was collected from their GP."
Incomplete outcome data (attrition bias) Falls | Low risk | See Supplementary material 9 for method of assessment
Incomplete outcome data (attrition bias) Fallers | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | High risk | Retrospective. Falls reported in 6-monthly postal questionnaires.

Prince 2008
Study characteristics
Methods | RCT
Participants | Setting: Perth, Australia N = 302 Sample: women attending A&E; receiving home nursing management of falls; from electoral roll Age (years): mean 77.2 (SD 3.6) Inclusion criteria: aged 70 to 90 years; history of falling in last 12 months; plasma 25OHD < 24 ng/ml Exclusion criteria: current consumption of vitamin D or bone or mineral active agents other than calcium; BMD z score at total hip site <-2.0; medical conditions or disorders affecting bone metabolism; fracture in last 6 months; MMSE < 24; neurological conditions affecting balance, e.g. stroke or Parkinson's disease
Interventions | 1. 1000 IU/day ergocalciferol (vitamin D2) with evening meal + 1000 mg/day calcium citrate (two 250 mg tablets with breakfast and evening meal) for 1 year 2. Control: placebo + 1000 mg/day calcium citrate (two 250 mg tablets with breakfast and evening meal) for 1 year
Outcomes | 1. Number of people falling 2. Proportion of people with adverse effects
Duration of the study | 1 year
Notes |
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Used random number generator with block size of 10 to randomise in a ratio of 1:1
Allocation concealment (selection bias) | Low risk | Randomisation schedule generated by "independent research scientist". Schedule kept in pharmacy department of hospital where bottles were labelled and dispensed to participants.
Blinding of participants and personnel (performance bias) All outcomes | Low risk | Double-blind, placebo-controlled study
Blinding of outcome assessment (detection bias) Falls and fallers | Low risk | Falls reported by participants who were blind to their group allocation (placebo-controlled trial)
Blinding of outcome assessment (detection bias) Fractures | Unclear risk | Self reported adverse events (including fractures) requiring contact with physician. Participants blind to allocated group but fractures not confirmed from records.
Incomplete outcome data (attrition bias) Fallers | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | High risk | Retrospective. Interviewed by study staff every 6 weeks by phone or at a clinic visit.

Ralston 2011
Study characteristics
Methods | RCT (international multicentre)
Participants | Setting: 24 countries N = 515 Sample: women with postmenopausal osteoporosis recruited from 77 centres Age (years): mean 73 Inclusion criteria: aged ≥ 65; osteoporotic (low BMD T scores or previous fragility fracture); vitamin D insufficiency (serum 25[OH]D 8 to 20 ng/ml); increased risk of falls (≥ 1 fall in previous 12 months + reduced lower extremity physical function) Exclusion criteria: using specified drugs affecting bone metabolism; receiving chemotherapy or heparin; unable to stand or walk independently; abnormal electrocardiogram or laboratory safety screening tests; malignancy within previous 5 years; malabsorption syndrome; uncontrolled upper gastrointestinal or cardiovascular disorders; hyperparathyroidism; renal disease
Interventions | 1. Intervention: weekly alendronate 70 mg + vitamin D3 5600 IU in 1 tablet 2. Control: referred for standard care for osteoporosis from personal physician
Outcomes | 1. Risk of falling (based on time to first fall)
Duration of the study | 1 year
Notes |
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Quote: "Participants were randomized—using a computer-generated allocation schedule generated by the study sponsor"
Allocation concealment (selection bias) | Unclear risk | Allocation is not clearly reported. Quote: "Participants were randomized—using a computer-generated allocation schedule generated by the study sponsor" "Due to the referred-care nature of the trial, it was an open-label design. However, participants, investigators, site staff, and the sponsor's clinical team were blinded to postbaseline concentrations of serum 25(OH)D and BTMs…"
Blinding of participants and personnel (performance bias) All outcomes | High risk | Open label study. Quote: "Due to the referred-care nature of the trial, it was an open-label design. However, participants, investigators, site staff, and the sponsor's clinical team were blinded to postbaseline concentrations of serum 25(OH)D and BTMs…".
Blinding of outcome assessment (detection bias) Falls and fallers | High risk | Self reported falls and likely the study personnel ascertaining falls were aware of allocated group as only blinding to "postbaseline concentrations of serum 25(OH)D and BTMs…" is mentioned. Fall events were also reviewed at office visits where staff were not blind to allocated groups.
Incomplete outcome data (attrition bias) Fallers | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Low risk | Quote: "Participants were asked to record falls on a study calendar and to notify the study site of falls by telephone or prestamped postcard. After notification, study-site personnel telephoned women reporting falls to obtain details about the event, including a description of the fall, the location, contributing factors (e.g., tripping, poor vision), the immediate aftermath, longer-term consequences, and the medical attention that was required. All participants were also routinely contacted on a monthly basis to survey fall incidences (except when an office visit was scheduled in the same month, where fall events were reviewed). Falls were adjudicated by an independent committee".

Reid 2006
Study characteristics
Methods | RCT
Participants | Setting: Auckland, New Zealand N = 1471 Sample: women recruited by advertisement and mail-outs using electoral rolls Age (years): mean 74.2 (SD 4.3) Inclusion criteria: consenting; aged > 55; more than 5 yr postmenopausal Exclusion criteria: free of major ongoing disease including serum creatinine > 1.8 mg/dl (0.2 mmol/litre), untreated hypo- or hyperthyroidism, liver disease, serum 25-hydroxyvitamin D < 10 µg /litre (25 nmol/litre), malignancy, or metabolic bone disease; regular user in the previous year of hormone replacement therapy, anabolic steroids, glucocorticoids, or bisphosphonates; lumbar spine bone density below the age-appropriate normal range (i.e. z-score greater than -2)
Interventions | 1. Intervention: calcium citrate 1 g/day in 2 divided doses 2. Control: identical placebo
Outcomes | 1. Falls per person year reported 2. Number sustaining a fracture Other outcomes reported but not included in this review. Falls are a secondary outcome in this study
Duration of the study | 5 years
Notes |
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Quote: "Treatments were allocated randomly using a minimization algorithm balancing for current thiazide use, age, and the occurrence of fractures resulting from minimal trauma after the age of 40 yr."
Allocation concealment (selection bias) | Low risk | Quote: "Subject numbers were allocated and medication was dispensed by staff who had no direct contact with the other study staff or the subjects."
Blinding of participants and personnel (performance bias) All outcomes | Low risk | States "double blind" and "medication was dispensed by staff who had no direct contact with the other study staff or the subjects"
Blinding of outcome assessment (detection bias) Falls and fallers | Unclear risk | Insufficient information about ascertainment of falls to permit judgement
Blinding of outcome assessment (detection bias) Fractures | Low risk | States "double blind" and "medication was dispensed by staff who had no direct contact with the other study staff or the subjects". Subjects were asked at each 6-month visit about fractures. If reported, the relevant radiograph or report was obtained.
Incomplete outcome data (attrition bias) Falls | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Unclear risk | "Subjects kept a diary of falls." Details unclear.

Reinsch 1992
Study characteristics
Methods | RCT (cluster-randomised by senior centre. 2 x 2 factorial design)
Participants | Setting: Los Angeles County and Orange County, California, USA N = 230 Sample: recruited from 16 senior centres (80% women) Age (years): mean 74.2 (SD 6.0) Inclusion criteria: aged over 60 Exclusion criteria: none listed
Interventions | 1. "Stand up/step up" exercise programme, with preliminary stretching exercise (1 hour, 3 x per wk for 52 wks) 2. Cognitive-behavioural intervention consisting of relaxation training, reaction time training and health and safety curriculum (1 hour, 1 x per wk for 52 wks) 3. Exercise (2 x per wk) and cognitive intervention (1 x per wk) for 52 wks 4. Discussion control group (1 hour, 1 x per wk for 52 wks)
Outcomes | 1. Number of people falling
Duration of the study | 1 year
Notes | MacRae paper includes a subset of results for only 2 arms of the study, in Los Angeles county only
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Unclear risk | Quote: "randomly assigned to treatments"
Allocation concealment (selection bias) | High risk | Cluster-randomised
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Participants and personnel implementing the intervention not blind to allocated group, but impact of non-blinding unclear
Blinding of outcome assessment (detection bias) Falls and fallers | Unclear risk | Falls reported by participants who were aware of their group allocation. Blinding of research assistant not described.
Incomplete outcome data (attrition bias) Fallers | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Low risk | Prospective. Monthly diaries plus weekly phone calls or visits.

Resnick 2002
Study characteristics
Methods | RCT
Participants | Setting: Baltimore, Maryland, USA N = 20 Sample: women in a continuing care retirement community Age (years): mean 88 (SD 3.7) Inclusion criteria: able to walk 50 feet with or without assistive device; sedentary lifestyle Exclusion criteria: cognitive impairment (MMSE > 20); terminal illness; medical condition precluding participation in aerobic exercise
Interventions | 1. WALK intervention: walk (join group or walk alone 20 min per wk); address pain fear fatigue during exercise; learn about exercise; cue by self modelling 2. Control: no intervention
Outcomes | 1. Number of falls (mean), but not rate. Insufficient data to include in analysis
Duration of the study | 6 months (during intervention only)
Notes | Participants lived independently in apartments, and could ambulate independently. (Personal correspondence). Pilot study with no usable data
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Randomised by coin flip (personal communication)
Allocation concealment (selection bias) | Unclear risk | Insufficient information to permit judgement
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Participants and personnel implementing the intervention not blind to allocated group, but impact of non-blinding unclear
Blinding of outcome assessment (detection bias) Falls and fallers | Unclear risk | Falls reported by participants who were aware of their group allocation. Blinding of research assistant not described.
Incomplete outcome data (attrition bias) Falls | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Unclear risk | Quote: "based on self-report". No additional information.

Robertson 2001a
Study characteristics
Methods | RCT
Participants | Setting: West Auckland, New Zealand N = 240 Sample: identified from computerised registers at 17 general practices (68% women) Age (years): mean 80.9 (SD 4.2), range 75 to 95 Inclusion criteria: aged ≥ 75; living at home Exclusion criteria: unable to walk around own residence; already receiving physiotherapy; unable to understand trial requirements
Interventions | 1. Home exercise programme, individually prescribed by district nurse in conjunction with her district nursing duties (see Notes) Visit from nurse at 1 wk (1 hour) and at 2, 4, 8 wks, and 6 months (half hour) plus monthly telephone call to maintain motivation Progressively difficult strength and balance retraining exercises plus walking plan. Participants expected to exercise 3 x per wk and walk 2 x per wk for 1 year 2. Control: usual care
Outcomes | 1. Rate of falls 2. Number of people falling 3. Number sustaining a fracture
Duration of the study | 1 year
Notes | District nurse had no previous experience in exercise prescription. Received 1 weeks' training from research group's physiotherapist, who also made site visits and phone calls to monitor quality. Otago Exercise Programme manual can be obtained from www.cdc.gov/HomeandRecreationalSafety/Falls/compendium/1.2_otago.html. Cost-effectiveness analysis reported in primary reference.
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Randomised using allocation schedule developed using computer-generated numbers
Allocation concealment (selection bias) | Low risk | Assignment by independent person off site
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Participants and personnel implementing the intervention not blind to allocated group, but impact of non-blinding unclear
Blinding of outcome assessment (detection bias) Falls and fallers | Low risk | Falls reported by participants who were aware of their group allocation. Phoned by independent assessor blind to allocation. Person classifying fall events also blind to allocation.
Blinding of outcome assessment (detection bias) Fractures | Low risk | Quote: "... “serious” injuries [including fractures] were confirmed from hospital and general practice records. The investigator classifying fall events remained blind to group allocation."
Incomplete outcome data (attrition bias) Falls | Low risk | See Supplementary material 9 for method of assessment
Incomplete outcome data (attrition bias) Fallers | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Low risk | Active fall registration with daily postcard calendars returned monthly + telephone calls

Robson 2003
Study characteristics
Methods | RCT
Participants | Setting: Edmonton area and 2 rural communities in Alberta, Canada N = 660 Sample: healthy volunteers (81% women) Age (years): mean 73.0 (SD 6.7) Inclusion criteria: able to walk unassisted for 20 min; to get down and up off the floor unassisted Exclusion criteria: dizzy spells or "other health problems that made it difficult for them to function"
Interventions | 1. Two 90-minute group sessions 1 month apart taken by lay senior facilitators. Session 1) Given Client Handbook (self assessed risk and risk reduction strategies relating to balance, strength, shoes, vision, medications, environmental hazards, paying attention). Instructed to complete assessment and implement strategies to reduce risk by session 2. Given fitness video (Tai Chi movements for balance and leg strength). Used video in Session 1 and instructed to use daily for 20 min or get involved in community exercise programme for 45 min 3 x per wk. Asked to identify and report community hazards. Session 2) no details of this session provided in paper. 2. Control: received no intervention until after 4 months
Outcomes | 1. Number of people falling
Duration of the study | 4 months
Notes | SAYGO (Steady As You Go) program
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Unclear risk | Quote: "Randomly assigned by phone". Insufficient information to permit judgement.
Allocation concealment (selection bias) | Unclear risk | Quote: "Randomly assigned by phone". Insufficient information to permit judgement.
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Participants and personnel implementing the intervention not blind to allocated group, but impact of non-blinding unclear
Blinding of outcome assessment (detection bias) Falls and fallers | Unclear risk | Falls reported by participants who were aware of their group allocation. Unclear whether people phoning were blind to allocation.
Incomplete outcome data (attrition bias) Fallers | Unclear risk | See Supplementary material 9 for method of assessment. Insufficient information to permit judgement (number randomised to each group not stated).
Risk of bias in recall of falls | Low risk | Falls ascertained by mail-in calendars returned monthly with telephone follow-up

Rubenstein 2000
Study characteristics
Methods | RCT
Participants | Setting: California, USA N = 59 Sample: men recruited from Veterans Administration ambulatory care centre (volunteers) Age (years): mean 74 Inclusion criteria: aged ≥ 70; ambulatory; ≥ 1 fall risk factor: lower limb weakness, impaired gait, impaired balance, more than 1 fall in previous 6 months Exclusion criteria: exercised regularly; severe cardiac or pulmonary disease; terminal illness; severe joint pain; dementia; medically unresponsive depression; progressive neurological disease
Interventions | 1. Exercise sessions (strength, endurance, and balance training) in groups of 16 to 20, 90 min, 3 x per wk for 12 wks 2. Control: usual activities
Outcomes | 1. Rate of falls 2. Number of people falling
Duration of the study | 3 months
Notes |
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Randomised in blocks of 16 to 20 at 3 to 6-month intervals, using randomly generated sequence cards in sealed envelopes
Allocation concealment (selection bias) | Unclear risk | Cards in sealed envelopes
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Participants and personnel implementing the intervention not blind to allocated group, but impact of non-blinding unclear
Blinding of outcome assessment (detection bias) Falls and fallers | High risk | Falls reported by participants who were aware of their group allocation. Person ascertaining falls was aware of group allocation.
Incomplete outcome data (attrition bias) Falls | Low risk | See Supplementary material 9 for method of assessment
Incomplete outcome data (attrition bias) Fallers | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | High risk | No active fall registration. Fall ascertainment for intervention group at weekly classes. Controls phoned every 2 weeks.

Rubenstein 2007
Study characteristics
Methods | CCT (cluster-randomised)
Participants | Setting: Sepulveda Ambulatory Care Center, California (USA) N = 792 Sample: patients receiving care at ambulatory care centre (only 3% women) Age (years): mean 74.5 (SD 6) Inclusion criteria: aged ≥ 65; previously randomised to either of the 2 practice groups involved in the trial; ≥ 1 clinic visit in previous 18 months; scoring ≥ 4 on GPSS Exclusion criteria: living over 30 miles from care centre; already enrolled in outpatient geriatric services at care centre; living in long-term care facility; scoring less than 4 GPSS
Interventions | 1. Structured risk and needs assessment and referral algorithm implemented by case manager (physician assistant). Targetting 5 geriatric conditions including falls. Assessment followed by referrals and recommendations for further assessment or treatment. 3-monthly telephone contact with case manager 2. Control: usual care
Outcomes | 1. Rate of falls 2. Number of people falling
Duration of the study | 3 years
Notes |
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | High risk | Participants "previously" randomised to one of 3 primary care practice groups using last 2 digits of Social Security number. 2 practice groups then randomised to intervention or control. Third group not included as used in prior pilot study. (personal communication)
Allocation concealment (selection bias) | High risk | 2 groups therefore alternation
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Participants and personnel implementing the intervention not blind to allocated group, but impact of non-blinding unclear
Blinding of outcome assessment (detection bias) Falls and fallers | Low risk | Falls reported by participants who were aware of their group allocation. Assessment research staff blind to allocation.
Incomplete outcome data (attrition bias) Falls | Low risk | See Supplementary material 9 for method of assessment
Incomplete outcome data (attrition bias) Fallers | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | High risk | Retrospective recall. Annual telephone follow-up each year for 3 years. Text states participants asked "about incidence of falls in the previous year" but table 2 reports one or more falls in the preceding 3 months.

Russell 2010
Study characteristics
Methods | RCT
Participants | Setting: 7 emergency departments, Melbourne, Australia N = 712 Sample: people presenting to ED after a fall (70% women) Age (years): 13% 60 to 64; 17% 65 to 70; 19% 70 to 74; 19% 75 to 79; 32% ≥ 80 Inclusion criteria: age ≥ 60; community-dwelling; presenting to ED after a fall and discharged straight home Exclusion criteria: unable to comply with simple instructions; unable to walk independently indoors (with or without a walking aids)
Interventions | 1. Intervention: standard care in ED + assessed (FROP-Com) and offered multifactorial falls prevention programme consisting of referrals to existing community services and health promotion recommendations. Participants at high risk of falls (FROP-Com score ≥ 25) referred to falls clinic for comprehensive multidisciplinary assessment 2. Control: standard care in ED + letter to participants informing them of level of falls risk (FROP-Com), recommendation to speak to GP about this
Outcomes | 1. Rate of falls 2. Number of people falling 3. Number sustaining a fracture Other outcomes reported but not included in this review
Duration of the study | 1 year
Notes |
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Quote: "Randomization was performed using a computer-generated randomization list."
Allocation concealment (selection bias) | Low risk | Quote: "A researcher otherwise not involved in the project generated and held the randomization sequence."
Blinding of participants and personnel (performance bias) All outcomes | High risk | Participants and personnel aware of group intervention. Quote: "Participants allocated to the standard care group received standard care arranged by ED staff and a letter informing them of their FROP-Com falls risk (low, moderate, or high). The letter advised participants to speak to their family physician about their risk of falling". The control group could have received fall prevention interventions which were not part of the study.
Blinding of outcome assessment (detection bias) Falls and fallers | Low risk | Quote: "The intervention and standard care groups received the same contact with the research team over the 12-month monitoring period". Quote: "A research staff member unaware of group allocation telephoned participants who did not return their falls calendars"
Blinding of outcome assessment (detection bias) Fractures | Unclear risk | Falls and injuries self reported in falls diaries. Quote: "After each participant's 12-month follow-up period, his or her hospital medical record was reviewed to verify ED presentations, days in the hospital, and when available, falls and fall injuries." Not clear who extracted data from medical record and whether they were blind to treatment allocation.
Incomplete outcome data (attrition bias) Falls | Low risk | See Supplementary material 9 for method of assessment
Incomplete outcome data (attrition bias) Fallers | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Low risk | Quote: "Participants recorded falls and injuries on a falls calendar, which they were asked to return monthly using a postage-paid mail."

Ryan 1996
Study characteristics
Methods | RCT
Participants | Setting: Baltimore, Maryland, USA N = 45 Sample: rural and urban dwelling women. Volunteers from senior meal sites Age (years): mean 78; range 67 to 90 Inclusion criteria: aged ≥ 65; living alone in own home; ambulatory with or without assistive devices; with telephone for follow-up
Interventions | Interview and physical assessment by nurse prior to randomisation 1. 1-hour fall prevention education programme discussing personal (intrinsic) and environmental (extrinsic) risk modification in small groups of 7 to 8 women (nurse led) 2. Same educational programme but individual sessions with nurse 3. Controls received health promotion presentation (no fall prevention component) in small groups of 7 to 8
Outcomes | 1. Rate of falls 2. Number of people falling
Duration of the study | 3 months
Notes | Pilot research. Primarily to test methodology of a fall prevention education programme and resulting changes in fall prevention behaviour. 2 intervention arms combined in analysis in the review
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Unclear risk | Method of randomisation not described
Allocation concealment (selection bias) | Unclear risk | Insufficient information to permit judgement
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Participants and personnel implementing the intervention not blind to allocated group, but impact of non-blinding unclear
Blinding of outcome assessment (detection bias) Falls and fallers | High risk | Falls reported by participants who were aware of their group allocation. Telephone contact (only method of ascertaining falls) was not blinded (both groups asked about falls but intervention groups asked about recollection of intervention).
Incomplete outcome data (attrition bias) Falls | Low risk | See Supplementary material 9 for method of assessment
Incomplete outcome data (attrition bias) Fallers | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | High risk | Retrospective recall by monthly phone call for 3 months

Ryan 2010
Study characteristics
Methods | RCT (multicentre)
Participants | Setting: 22 centres across the United Kingdom, Europe and North America (5 countries) N = 141 Sample: patients with cardioinhibitory CSH identified in A&E, geriatric medicine, general medicine, and orthopaedic facilities (62% women) Age (years): mean 78 (SD 7) Inclusion criteria: aged > 50 years, ≥ 2 unexplained falls and/or 1 unexplained syncopal event in previous 12 months, cardioinhibitory response (> 3 seconds asystole) to carotid sinus massage Exclusion criteria: cognitive impairment (MMSE < 20), atrial fibrillation
Interventions | 1. Pacemaker: Medtronic Kappa 700 (Europe) or Kappa 400 (North America) pacemaker 2. Control: implantable loop recorder (Medtronic Reveal)
Outcomes | 1. Rate of falls 2. Number of people falling
Duration of the study | Mean 24 months
Notes |
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Quote: "Participants were randomised to receive an implantable loop recorder or dual-chamber pacemaker according to a computer-generated randomisation. The sample was stratified by centre."
Allocation concealment (selection bias) | Unclear risk | Insufficient information to permit judgement. Quote: "Randomisation, data collation and diary card interpretation were carried out by researchers blind to the number of diaries returned by each subject."
Blinding of participants and personnel (performance bias) All outcomes | Low risk | Pacemaker or loop recorder – patients unaware of allocation and unlikely to introduce performance bias in personnel
Blinding of outcome assessment (detection bias) Falls and fallers | Unclear risk | Self reported falls. Quote: "Randomisation, data collation and diary card interpretation were carried out by researchers blind to the number of diaries returned by each subject." Unclear whether people collating data or interpreting diary cards were blind to allocated group.
Incomplete outcome data (attrition bias) Falls | Low risk | See Supplementary material 9 for method of assessment
Incomplete outcome data (attrition bias) Fallers | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Low risk | Quote: "participants completed falls diaries at the end of each week and received monthly telephone interviews, a process that had already been piloted with compliance rates >80%"

Salminen 2009
Study characteristics
Methods | RCT
Participants | Setting: Pori, Finland N = 591 Sample: volunteers identified through advertising etc. (84% women) Age (years): 62% aged 65 to 74, 38% aged ≥ 75 Inclusion criteria: aged ≥ 65 years; fallen in last year; MMSE ≥ 17; able to walk 10 m independently; living at home or sheltered housing Exclusion criteria: none described
Interventions | 1. Intervention: geriatric assessment, individually tailored intervention targeting muscle strength and balance (advised to carry out physical exercises 3 x per wk at home), exercise in groups (3 levels according to physical performance), vision (referral), nutritional guidance or referral, medications, depression, treatment and prevention of osteoporosis, home hazard modification. All received calcium and vitamin D 2. Control: counselling and guidance after comprehensive assessments
Outcomes | 1. Rate of falls 2. Number of fallers Number of fractures (not number sustaining a fracture)
Duration of the study | 1 year
Notes |
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Unclear risk | Quote: "Randomized". No description of sequence generation.
Allocation concealment (selection bias) | Low risk | Quote: "using consecutively numbered, sealed envelopes"
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Quote: "Participants and those administering the intervention were not blinded to group assignment." Insufficient evidence to make judgement on impact of lack of blinding.
Blinding of outcome assessment (detection bias) Falls and fallers | Low risk | Quote: "The research assistants who interviewed the participants by telephone during the follow-up period were blinded to group assignment."
Incomplete outcome data (attrition bias) Falls | Low risk | See Supplementary material 9 for method of assessment
Incomplete outcome data (attrition bias) Fallers | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Low risk | Quote: "recorded by fall diaries that subjects were asked to mail to the research assistants monthly."

Sanders 2010
Study characteristics
Methods | RCT
Participants | Setting: South Victoria, Australia N = 2258 Sample: mail outs to age-eligible women on electoral roles and other strategies Age (years): median (IQR) 76.0 (70.0 to 93.9) Inclusion criteria: aged ≥ 70; community-dwelling; high risk of hip fracture, e.g. maternal hip fracture, past hip fracture, self reported faller Exclusion criteria: resident in high-level care facility; unable to give informed consent or information about falls or fracture history; hypercalcaemia; vit D supplement > 400 IU/day; antifracture therapy; calcitriol; renal disease (creatinine > 150 umol/L); sarcoidosis, TB or lymphoma
Interventions | 1. Intervention: annual oral dose of 500,000 IU cholecalciferol every autumn for 5 years 2. Control: annual oral placebo dose
Outcomes | 1. Rate of falls 2. Number of people falling 3. Number sustaining a fracture 4. Adverse effects Other outcomes reported but not included in this review
Duration of the study | 5 years
Notes | Vital D Study
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Quote: "An independent statistician carried out computer randomisation of participants using their unique study identification numbers and the statistical software Minitab™ (version 13)."
Allocation concealment (selection bias) | Low risk | Quote: "The randomization lists of 'active' and 'placebo' status were then directly emailed to the hospital's clinical trials pharmacist who was responsible for all dispensing of study medication throughout the trial."
Blinding of participants and personnel (performance bias) All outcomes | Low risk | Quote: "The Vital D Study was designed as a double blind, placebo-controlled trial" "The participants and study staff were blinded to intervention group"
Blinding of outcome assessment (detection bias) Falls and fallers | Low risk | Quote: "When a fall or fracture was indicated, a standardized questionnaire recording details was administered by telephone." "The participants and study staff were blinded to intervention group"
Blinding of outcome assessment (detection bias) Fractures | Low risk | Quote: "When a fall or fracture was indicated, a standardized questionnaire recording details was administered by telephone. Only fractures radiologically confirmed were included in the analyses"
Incomplete outcome data (attrition bias) Falls | Low risk | See Supplementary material 9 for method of assessment
Incomplete outcome data (attrition bias) Fallers | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Low risk | Quote: "Falls and fractures were recorded using postcard calendars completed daily by writing F if they had a fall, fracture, or both and N if they did not and were returned monthly by prepaid post. Participants unable to send postcards were telephoned monthly. When a fall or fracture was indicated, a standardized questionnaire recording details was administered by telephone."

Sato 2005a (Retracted)
Study characteristics
Methods | RCT
Participants | Setting: Iizuka, Japan N = 200 Sample: women recruited from hospital outpatient clinic Age (years): mean 78.1 (SD 5.6) Inclusion criteria: aged > 70; ambulatory; with "probable Alzheimer's Disease" Exclusion criteria: impaired renal, cardiac, or thyroid function; known cause for osteoporosis, e.g. hyperparathyroidism, renal osteodystrophy; history of treatment with corticosteroids, oestrogens, calcitonin, bisphosphonate, calcium or vitamins D or K for ≥ 3 months in past 12 months, at all in 3 months prior to study; history of nonvertebral fracture
Interventions | Intervention: menatetrenone (vitamin K2) and vitamin D2 and calcium Control: no treatment
Outcomes | 1. Mean number of falls 2. Number sustaining a fracture
Duration of the study | 2 years
Notes | Published feedback from Alison Avenell notified of the retraction of this study in September 2020. Excerpt from the retraction notice published in 2018: "This article was retracted at the request of the Corresponding Author, Yoshihiro Sato, and the co-authors have been informed. Dr. Sato wishes to retract this article on the grounds that it contains fabricated clinical trial data, which he was responsible for producing. In addition, Dr. Sato claims he listed all of the named co-authors without their consent. The co-authors were therefore unaware of the presence of fabricated data in this publication and their participation in the publication. This retraction was initiated by Dr. Sato, and the Editor-in-Chief of Bone was informed by the author directly."
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Quote: "Computer assisted random numbering"
Allocation concealment (selection bias) | Unclear risk | Insufficient information to permit judgement
Blinding of participants and personnel (performance bias) All outcomes | High risk | No placebo control – blinding not mentioned but presumably there was none
Blinding of outcome assessment (detection bias) Falls and fallers | Unclear risk | Insufficient information to permit judgement
Blinding of outcome assessment (detection bias) Fractures | Unclear risk | Quote: "Follow-up assessment of patients' condition was performed by physicians who did not participate in the initial randomization." – not clear from this that outcome assessment was blinded, though this is probably what it means. "... all of them were followed up every 4 weeks in the outpatient clinic; and nonvertebral fractures, if any, were recorded. " Not clear whether they were confirmed from medical records or X-ray.
Incomplete outcome data (attrition bias) Falls | Unclear risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Unclear risk | Quote: "The number of falls per a subject was also recorded during the 2-year follow-up period". No information on method of recording falls given. Fractures were recorded by follow-up every 4 weeks in outpatient clinic but it doesn't say falls were recorded in the same way.

Schrijnemaekers 1995
Study characteristics
Methods | RCT
Participants | Setting: Sittard, The Netherlands N = 222 Sample: people living at home (N = 146) or in residential homes (N = 76) (70% women) Age (years): 70% aged 77 to 84, 30% ≥ 85 Inclusion criteria: aged ≥ 75; living at home or in one of 2 residential homes; having problems with ≥ 1 of the following: IADL, ADL, toileting, mobility or fallen in last 6 months, serious agitation or confusion; informed consent from participant and their GP Exclusion criteria: living in nursing home; received outpatient or inpatient care from geriatric unit in previous 2 years
Interventions | 1. Comprehensive assessment in outpatient geriatric unit (geriatrician, psychologist, social worker); advice to participant and GP about treatment and support 2. Control: usual care
Outcomes | 1. Number of people falling Other outcomes reported but not included in this review
Duration of the study | Follow-up for 3 years but this paper reports results at 6 months
Notes | Included in this review as the majority of participants were living at home (N = 146)
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Unclear risk | Stratified by living condition (home versus home for the elderly) then "randomly allocated" by researcher in blocks of 10
Allocation concealment (selection bias) | Unclear risk | Insufficient information to permit judgement
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Participants and personnel implementing the intervention not blind to allocated group, but impact of non-blinding unclear
Blinding of outcome assessment (detection bias) Falls and fallers | Unclear risk | Falls reported by participants who were aware of their group allocation. Unclear whether data collectors were blind to allocation.
Incomplete outcome data (attrition bias) Fallers | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | High risk | Retrospective recall. Falls ascertained retrospectively at interview. Presume asked about falls in previous 6 months.

Sherrington 2004
Study characteristics
Methods | RCT
Participants | Setting: Sydney, Australia N = 120 Sample: identified through 6 hospitals in Sydney following hip fracture (79% women) Age (years): mean 79 (SD 9), range 57 to 95 Inclusion criteria: community-dwelling; recent hip fracture Exclusion criteria: severe cognitive impairment; medical conditions; complications from fracture resulting in delayed healing
Interventions | 1. Weight-bearing home exercise group 2. Non weight-bearing home exercise group 3. Control: no intervention
Outcomes | 1. Number of people falling
Duration of the study | 4 months
Notes | Data obtained from authors
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Quote: "the randomisation schedule was produced with a random numbers table in blocks of six"
Allocation concealment (selection bias) | Low risk | Quote: "Sealed in opaque envelopes" Comment: probably done as research group has described "concealed allocation" in previous study
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Participants and personnel implementing the intervention not blind to allocated group, but impact of non-blinding unclear
Blinding of outcome assessment (detection bias) Falls and fallers | High risk | Falls reported by participants who were aware of their group allocation. Assessors not blind to group allocation.
Incomplete outcome data (attrition bias) Fallers | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | High risk | Retrospective recall. Falls data collected at home visits at 1 and 4 months.

Shigematsu 2008
Study characteristics
Methods | RCT
Participants | Setting: Kawage, Mie, Japan N = 68 Sample: randomly selected people meeting inclusion criteria (63% women) Age (years): mean 69 (SD 3) Inclusion criteria: 65 to 74 years old; community-dwelling Exclusion criteria: severe neurological or cardiovascular disease; mobility-limiting orthopaedic conditions
Interventions | 1. Exercise intervention: square-stepping exercises (forward, backward, lateral and oblique steps on a marked mat 250 cm long); supervised group sessions 70 min (30 warm up and cool down) 2 x per wk for 12 wks. Group "further divided" at end of 12 wks, and half (N = 16) continued with sessions "from December 2004 through February 2005", i.e. a further 12 wks 2. Exercise intervention: outdoor supervised walking session 40 min, 1 x per wk for 12 wks. As above, half (N = 18) continued walking for a further 12 wks
Outcomes | 1. Rate of falls 2. Number of people falling 3. Number of people with adverse effects Other outcomes reported but not included in this review
Duration of the study | 1 year with 8 months follow-up after the intervention
Notes |
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Quote: "Randomly allocated.. by a public health nurse who used a computerized random number generation program in which the numbers 0 and 1 corresponded to the two groups, respectively".
Allocation concealment (selection bias) | Unclear risk | Insufficient information to permit judgement
Blinding of participants and personnel (performance bias) All outcomes | Low risk | Study described as "single-blind", presumably meaning that participants were blind to whether they were in the intervention or control groups as both groups received an exercise intervention. Treatment personnel presumably unblinded but judge that lack of blinding unlikely to introduce bias.
Blinding of outcome assessment (detection bias) Falls and fallers | High risk | Study described as "single-blind" because both groups received an exercise intervention. Assessors presumably unblinded.
Incomplete outcome data (attrition bias) Falls | Low risk | See Supplementary material 9 for method of assessment
Incomplete outcome data (attrition bias) Fallers | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Low risk | Quote: "All the persons received a pre-paid postcard at the beginning of each month, which they returned at the beginning of the next month". Instructed to record falls on a daily basis. Phoned or face-to-face interview if falls reported.

Shumway-Cook 2007
Study characteristics
Methods | RCT
Participants | Setting: USA N = 453 Sample: volunteers recruited by advertising etc (77% women) Age (years): mean 75.6 (SD 6.3), range 65 to 96 Inclusion criteria: aged ≥ 65, community-dwelling, able to speak English, have a primary care physician they had seen in last 3 years, able to ambulate independently (with or without cane or walker), willing to attend exercise classes for at least 6 months, have access to transportation. Exclusion criteria: more than minimal hearing or visual problems, regular exercise in previous 3 months, unable to complete 10 ft 'Timed up and Go' test in < 30 seconds, 5 or more errors on Pfeiffer Short Portable Mental Status Questionnaire
Interventions | Both groups completed health history questionnaire at randomisation 1. Intervention: group exercise class (1 hour, 3 x per wk for up to 52 wks), 6 hours of fall prevention classes, fall assessment summary (based on initial questionnaire) sent to participants' primary care physician plus copy of fall prevention guideline (AGS/BGS 2001) 2. Control: usual care plus 2 fall prevention brochures
Outcomes | 1. Rate of falls 2. Number of people falling Other outcomes reported but not included in this review
Duration of the study | 1 year
Notes |
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Computer random number generator used to generate sequence
Allocation concealment (selection bias) | Low risk | Randomised using centralised randomisation scheme, accessed by telephone
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Participants and personnel implementing the intervention not blind to allocated group, but impact of non-blinding unclear
Blinding of outcome assessment (detection bias) Falls and fallers | Unclear risk | Falls reported by participants who were aware of their group allocation. Unclear whether staff who confirmed falls by telephone were blinded.
Incomplete outcome data (attrition bias) Falls | Low risk | See Supplementary material 9 for method of assessment
Incomplete outcome data (attrition bias) Fallers | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Low risk | Prospective. Falling ascertained by 12-monthly calendars with telephone follow-up.

Shyu 2010
Study characteristics
Methods | RCT
Participants | Setting: medical centre, northern Taiwan N = 162 Sample: admitted to hospital for an accidental single side hip fracture (69% women) Age (years): mean 78.2 (SD 7.8) Inclusion criteria: aged ≥ 60; received hip arthroplasty or internal fixation; able to perform full range of motion; prefracture Chinese Barthel Index > 70 Exclusion criteria: severely cognitively impaired; terminally ill
Interventions | 1. Multidisciplinary programme (geriatric consultation services, a continuous rehabilitation programme, discharge planning services) 2. Control: usual care
Outcomes | 1. Number of fallers
Duration of the study | 2 years
Notes |
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Quote: "The randomization was conducted using flip of coin by a neutral third party who was not involved in delivering the intervention or assessing outcomes".
Allocation concealment (selection bias) | Unclear risk | Insufficient detail to allow a definite judgement. Quote: "Those persons who agreed to participate were randomly assigned to an experimental or control group at the time of admission. The randomization was conducted using flip of coin by a neutral third party who was not involved in delivering the intervention or assessing outcomes".
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Insufficient information to permit judgement
Blinding of outcome assessment (detection bias) Falls and fallers | High risk | Ascertained by self report from the participant to an unblinded evaluator
Incomplete outcome data (attrition bias) Fallers | Unclear risk | See Supplementary material 9 for method of assessment. Insufficient information to permit judgement.
Risk of bias in recall of falls | High risk | Quote: "Occurrence of falls and mortality were assessed by self report of patients and family caregivers." "All subjects were assessed at 1, 3, 6, 12, 18, and 24 months after discharge". No mention of concurrent collection of data and recall appears to be over periods longer than 1 month.

Skelton 2005
Study characteristics
Methods | RCT
Participants | Setting: United Kingdom N = 100 Sample: women recruited using posters, newspapers and radio stations Age (years): mean 72.8 (SD 5.9) Inclusion criteria: aged ≥ 65; living independently in own home; ≥ 3 falls in previous year Exclusion criteria: acute rheumatoid arthritis; uncontrolled heart failure or hypertension; significant cognitive impairment; significant neurological disease or impairment; previously diagnosed osteoporosis
Interventions | 1. FAME exercise class 1 hour, 1 x per wk for 36 wks plus home exercises 30 min 2 x per wk 2. Control: no exercise class. Home-based seated exercises 2 x per wk
Outcomes | 1. Rate of falls 2. Number of people falling
Duration of the study | 36 wks
Notes |
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Unclear risk | Quote: "randomly allocated (blind)"
Allocation concealment (selection bias) | Unclear risk | Insufficient information to permit judgement
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Participants and personnel implementing the intervention not blind to allocated group, but impact of non-blinding unclear
Blinding of outcome assessment (detection bias) Falls and fallers | Low risk | Falls reported by participants who were aware of their group allocation. Quote: "The information from the diaries was recorded by an observer blinded to the subject’s group who also contacted subjects if diaries had not been returned for two weeks or more."
Incomplete outcome data (attrition bias) Falls | Unclear risk | See Supplementary material 9 for method of assessment. Insufficient information to permit judgement.
Incomplete outcome data (attrition bias) Fallers | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Low risk | Quote: "Both groups completed daily falls diaries... Diaries were returned every 2 weeks by post to the investigator..." Telephone contact if dairies not returned for 2 weeks or more.

Smith 2007
Study characteristics
Methods | RCT
Participants | Setting: Wessex, United Kingdom N = 9440 Sample: recruited from 111 general practice registers (54% women). Mainly community-dwelling (98%) Age (years): mean (IQR) 79.1 (76.9 to 82.6) Inclusion criteria: aged ≥ 75 Exclusion criteria: current cancer; history of treated osteoporosis; bilateral total hip replacement; renal failure; renal stones; hypercalcaemia; sarcoidosis; taking at least 400 IU of vitamin D supplements already
Interventions | 1. 300,000 IU ergocalciferol (vitamin D2) by intramuscular injection every autumn for 3 years 2. Placebo
Outcomes | 1. Number of people falling 2. Number sustaining a fracture Falls a secondary outcome of the study. Other outcomes reported but not included in this review
Duration of the study | 3 years
Notes |
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Individual randomisation within blocks at each practice by allocation of consecutively numbered ampoules
Allocation concealment (selection bias) | Low risk | Individual randomisation within blocks at each practice by allocation of consecutively numbered ampoules
Blinding of participants and personnel (performance bias) All outcomes | Low risk | Placebo-controlled randomised trial
Blinding of outcome assessment (detection bias) Falls and fallers | Low risk | Falls reported by participants who were blind to their group allocation (placebo-controlled trial)
Blinding of outcome assessment (detection bias) Fractures | Low risk | Fractures reported by participants who were blind to their group allocation (placebo-controlled trial). Quote: "A fracture was treated as confirmed if it met two of the three criteria: report by study subject; report by practice; and confirmation from hospital records."
Incomplete outcome data (attrition bias) Fallers | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | High risk | Retrospective. Quote: "Information on falls ... was obtained at annual review (12, 24 and 36 months) by the practice nurse and on incident fractures by postal questionnaire at 6, 12, 18, 24, 30 and 36 months."

Smulders 2010
Study characteristics
Methods | RCT
Participants | Setting: Nijmegan, Netherlands N = 96 Sample: identified from databases of DXA scans, mail out to members of Dutch Osteoporosis Patient Council; advertising (94% women) Age (years): mean 71.0 (SD 4.7) Inclusion criteria: community-dwelling; aged > 65; osteoporosis (DXA; femoral neck or lower back T score ≤ -2.5); ≥ 1 falls in previous year; able to walk 15 min without walking device Exclusion criteria: severe cardiac, pulmonary, or musculoskeletal disorders or disorders associated with higher fall risk (e.g. neurologic disorders)
Interventions | 1. Nijmegen Falls Prevention Program (NFPP): 1 education session then 10 exercise sessions during 5.5 wks (obstacle course, walking exercises, weight-bearing exercises, correction of gait abnormalities, and training in fall techniques). Delivered by PTs and OTs 2. Control: usual care
Outcomes | 1. Rate of falls 2. Number of people falling 3. Number sustaining a fracture Other outcomes not included in this review
Duration of the study | 1 year
Notes |
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Unclear risk | Quote: "After a baseline assessment M1, the researcher performed block randomization using non–see-through envelopes. The probability of allocation to the exercise group was independent of recruitment method."
Allocation concealment (selection bias) | Unclear risk | Non-see-through envelopes but not sequentially numbered
Blinding of participants and personnel (performance bias) All outcomes | High risk | Participants and personnel aware of allocated groups
Blinding of outcome assessment (detection bias) Falls and fallers | Low risk | Quote: "Fall calendars were scored by an independent researcher who was blinded to group allocation."
Blinding of outcome assessment (detection bias) Fractures | High risk | Fractures self reported and no mention of confirmation by radiological examination or from primary care case records
Incomplete outcome data (attrition bias) Falls | Low risk | See Supplementary material 9 for method of assessment
Incomplete outcome data (attrition bias) Fallers | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Low risk | Quote: "After the intervention had ended, participants registered their falls for 1 year on fall calendars that had to be returned every month… When no fall calendar was received within 2 weeks after the start of the month, the participant was reminded by telephone."

Spice 2009
Study characteristics
Methods | RCT (cluster-randomised, 18 general practices)
Participants | Setting: Winchester, United Kingdom N = 516 Sample: patients in 18 general practices (proportion of women not stated) Age (years): mean 82 Inclusion criteria: aged ≥ 65; community-dwelling; history of at least 2 falls in previous year; not presenting to A&E with index fall Exclusion criteria: none described
Interventions | 1. Secondary care intervention: multidisciplinary day hospital assessment by physician, OT, and physiotherapist 2. Primary care intervention: health visitor/practice nurse falls risk assessment/referral 3. Control: usual care
Outcomes | 1. Number of fallers
Duration of the study | 1 year
Notes |
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Cluster-randomised. Quote: "Practices were stratified into urban (three) and rural (fifteen) and randomly allocated to the three arms, in blocks of three, using a random number generator on a Hewlett Packard 21S pocket calculator".
Allocation concealment (selection bias) | Unclear risk | Insufficient information to permit judgement
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Participants and personnel not blind to allocated group but impact of non-blinding unclear
Blinding of outcome assessment (detection bias) Falls and fallers | High risk | Participants and personnel not blind to group allocation. Quote: "Blinding to the intervention group of those collecting and analysing data was impractical."
Incomplete outcome data (attrition bias) Fallers | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Low risk | Follow-up monthly using postcards, with a phone call if a card not returned

Spink 2011
Study characteristics
Methods | RCT
Participants | Setting: La Trobe University Health Sciences Clinic, Bundoora, Victoria, Australia N = 305 Sample: podiatry services patient database, and advertising (69% women) Age (years): mean 73.9 (SD 5.9) Inclusion criteria: aged ≥ 65; community-dwelling; ≥ 1 falls in past year or score > 1 on physiological profile assessment tool; disabling foot pain Exclusion criteria: lower limb amputation; Parkinson's disease; active plantar ulceration; cognitive impairment; unable to walk 10 m without a walking aid; limited English language skills; leg surgery or planned leg surgery within 3 months of initial assessment
Interventions | 1. Intervention: "multifaceted podiatry": outdoor footwear assessment and advice (AUD 100 voucher towards purchasing more appropriate footwear); orthoses (customised insoles to accommodate plantar lesions) if not already wearing customised orthoses; home-based foot and ankle exercises (30 min 3 x per wk for 6 months); a falls prevention education booklet; plus "routine podiatry care" (see below) 2. Control: "routine podiatry care" (see below) Both groups continued with any podiatry treatment they were already receiving, and were offered free routine podiatry care, i.e. nail trimming, callus, and corn reduction for 1 year
Outcomes | 1. Rate of falls 2. Number of people falling 3. Number sustaining a fracture Other outcomes not reported in this review
Duration of the study | 1 year
Notes |
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Quote: "Permuted block randomisation will be undertaken" using an interactive voice response telephone service provided by the National Health and Medical Research Council Clinical Trials Centre at the University of Sydney
Allocation concealment (selection bias) | Unclear risk | Quote: "One investigator (MJS, who administered the intervention) used an interactive voice response telephone service provided by the National Health and Medical Research Council Clinical Trials Centre at the University of Sydney to carry out permuted block randomisation with mixed block lengths of four and six participants."
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Neither participants nor personnel were blind to intervention group. Unclear whether this would have introduced bias.
Blinding of outcome assessment (detection bias) Falls and fallers | Low risk | Quote: "When a fall occurs, specific details about fall injuries will be obtained through structured telephone interviews. If falls calendars are not returned at the end of each month, research staff will contact the participants by telephone to obtain the missing data." For secondary outcomes "All participants will be assessed at baseline and at six months by an assessor blinded to group allocation." So presume also true for falls (primary outcome).
Blinding of outcome assessment (detection bias) Fractures | Unclear risk | Quote: "When a fall occurs, specific details about fall injuries will be obtained through structured telephone interviews." Assessors might have been blinded to group allocation (see above) but no mention of confirmation of fractures.
Incomplete outcome data (attrition bias) Falls | Low risk |
Incomplete outcome data (attrition bias) Fallers | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Low risk | Quote: "Falls … will be monitored using monthly mail-out calendars. When a fall occurs, specific details about fall injuries will be obtained through structured telephone interviews. If falls calendars are not returned at the end of each month, research staff will contact the participants by telephone to obtain the missing data."

Steadman 2003
Study characteristics
Methods | RCT.
Participants | Setting: London, United Kingdom N = 198 Sample: attendees at a hospital multidisciplinary falls clinic (80% women) Age (years): mean 82.7 (SD 5.6) Inclusion criteria: ≥ 60 years; Berg Balance Scale < 45 after "adequate management of potential risk factors" Exclusion criteria: amputation; unable to walk 10 metres; recent stroke; progressive neurological disorder; unstable medical condition; severe cognitive impairment
Interventions | 1. Enhanced balance training. Conventional physiotherapy plus balance training 45 min, 2 x per wk for 6 wks 1. Control: conventional physiotherapy alone
Outcomes | 1. Rate of falls Other outcomes reported but not included in this review
Duration of the study | 24 wks, but falls data collected for previous month at 6, 12 and 24 wks after randomisation. Data from 24 wks used in analysis in the review.
Notes |
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Quote: "computer generated random numbers"
Allocation concealment (selection bias) | Unclear risk | Insufficient information to permit judgement
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Participants and personnel not blind to allocated group but impact of non-blinding unclear
Blinding of outcome assessment (detection bias) Falls and fallers | Low risk | Study described as "single-blind" - both groups received an intervention. Quote: "A therapist who was not involved with randomization or delivering the interventions completed baseline and outcome assessments"
Incomplete outcome data (attrition bias) Falls | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | High risk | Interval recall. Falls data collected for previous month at 6 weeks, 12 weeks and 24 weeks.

Steinberg 2000
Study characteristics
Methods | RCT (cluster-randomised). 4 groups with approximately equal numbers formed from 2 or 3 National Seniors Branches. Groups randomly allocated to 1 of 4 interventions
Participants | Setting: Brisbane, Queensland, Australia N = 252 Sample: volunteers from branches of National Seniors Association clubs (79% women) Age (years): mean 69; range 51 to 87 Inclusion criteria: aged ≥ 50; National Seniors Club member; with capacity to understand and comply with the project Exclusion criteria: none stated
Interventions | Cumulative intervention 1. Control: oral presentation; video on home safety; pamphlet on fall risk factors and prevention 2. Intervention 1. plus exercise classes designed to improve strength and balance, 1 hour per month, for 17 months; exercise handouts; gentle exercise video to encourage exercise between classes 3. Intervention 2. plus home safety assessment and financial and practical assistance to make modifications 4. Intervention 3. plus clinical assessment and advice on medical risk factors for falls
Outcomes | 1. Rate of falls 2. Number of people falling
Duration of the study | Follow-up commenced after start of all components for each intervention. 17 months but varied between groups
Notes | Younger, healthier and more active sample than elderly population as a whole
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Unclear risk | Quote: "Groups were randomly allocated to receive the four interventions"
Allocation concealment (selection bias) | High risk | Cluster-randomised. Possibility of participants joining group after randomisation.
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | 4 intervention groups. Blinding of participants and treatment personnel not mentioned in report, but unlikely. Insufficient evidence to make judgement on impact of lack of blinding.
Blinding of outcome assessment (detection bias) Falls and fallers | Unclear risk | Falls reported by participants who were aware of their group allocation. Blinding of assessors analysing data and making telephone contact not described.
Incomplete outcome data (attrition bias) Falls | Low risk | See Supplementary material 9 for method of assessment
Incomplete outcome data (attrition bias) Fallers | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Low risk | Quote: "Falls were monitored prospectively using a daily calendar diary to minimise bias." Diary returned monthly. Telephone follow-up of reported falls and no monthly returns.

Stevens 2001
Study characteristics
Methods | RCT. Some clusters. Study population stratified by age (< 80 years and > 80 years) and sex. Within strata index recruits allocated in 2:1 ratio to control or intervention. Coinhabitants assigned to same group as index recruit.
Participants | Setting: Perth, Australia N = 1737 Sample: randomly selected from State Electoral Roll and telephone directory (52% women) Age (years): mean 76 Inclusion criteria: aged ≥ 70; living independently; cognitively intact and able to speak and write in English; anticipated living at home for 10/12 coming months; could make environmental changes inside the home; had not fitting of ramps and grab rails etc Exclusion criteria: if living with more than 2 other older people
Interventions | 1. Intervention: 1 home visit by nurse to confirm consent, educate about how to recognise a fall, and complete the daily calendar. Sent information on the intervention and fall reduction strategies to be offered. Intervention: home hazard assessment, installation of free safety devices, and an educational strategy to empower seniors to remove and modify home hazards (see 'Notes'). 2. Control: 1 home visit by nurse to confirm consent, educate about how to recognise a fall, and complete the daily calendar
Outcomes | 1. Rate of falls 2. Number of people falling
Duration of the study | 1 year
Notes | Hazard list designed with OT input to include factors identified from literature and existing check lists. 11 hazards included. All identified hazards discussed with subjects but only the 3 most conspicuous or remediable selected to give specific advice on their removal or modification. Safety devices offered at no cost and installed by tradesman within 2 wks of visit.
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Unclear risk | Study population divided into 4 strata defined by age (< 80 years and > 80 years) and sex. Within these strata index recruits allocated in 2:1 ratio to control or intervention. Coinhabitants assigned to same group as index recruit.
Allocation concealment (selection bias) | Unclear risk | Insufficient information to permit judgement
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Participants and personnel not blind to allocated group but impact of non-blinding unclear
Blinding of outcome assessment (detection bias) Falls and fallers | Unclear risk | Falls reported by participants who were aware of their group allocation. Blinding of assessors analysing data and making telephone contact not described.
Incomplete outcome data (attrition bias) Falls | Low risk | See Supplementary material 9 for method of assessment
Incomplete outcome data (attrition bias) Fallers | Unclear risk | See Supplementary material 9 for method of assessment. Insufficient information to permit judgement.
Risk of bias in recall of falls | Low risk | Falls recorded on daily calendar

Suman 2011
Study characteristics
Methods | RCT
Participants | Setting: rural Suffolk, United Kingdom N = 369 Sample: recruited by post using GP's age and sex register (62% women) Age (years): mean 75.8 Inclusion criteria: community-dwelling; aged ≥ 65 years; high risk of falling (based on 5-item screening tool) Exclusion criteria: none described
Interventions | 1. Intervention: community-based assessment (20 to 25 min) at GP surgery using tool developed for study plus referral to community PT or OT, own GP, or hospital-based specialist fall service as appropriate 2. Control: comprehensive hospital-based assessment (30 to 45 min) at "falls clinic" by consultant geriatrician with special interest in falls. Some advice plus referred to PT or OT and seen that day
Outcomes | 1. Rate of falls 2. Number of people falling 3. Number sustaining a fracture
Duration of the study | 1 year
Notes |
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Unclear risk | Insufficient information to allow judgement. Quote: "randomly allocated"
Allocation concealment (selection bias) | Unclear risk | Insufficient information to allow judgement. Quote: "The randomisation process was carried out by asking an independent third party to open the returned sealed envelopes in a numbered sequence"
Blinding of participants and personnel (performance bias) All outcomes | High risk | Participants and personnel aware of the intervention and that it was a fall prevention intervention
Blinding of outcome assessment (detection bias) Falls and fallers | Unclear risk | Falls diaries and telephone follow-up but unclear who made the phone calls and whether they were blind to allocated groups
Blinding of outcome assessment (detection bias) Fractures | High risk | Self reported via telephone to personnel who may or may not have been blinded, and no mention of confirmation from X-ray or medical notes
Incomplete outcome data (attrition bias) Falls | Unclear risk | See Supplementary material 9 for method of assessment
Incomplete outcome data (attrition bias) Fallers | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Unclear risk | Quote: "… both arms … were provided with a "falls diary" and asked to record any falls, injury related to a fall.." Only 3-monthly telephone follow-up and does not state how often diaries were returned to researchers.

Suzuki 2004
Study characteristics
Methods | RCT
Participants | Setting: Tokyo, Japan N = 52 Age (years): mean 78 (SD 3.9), range 73 to 90 Sample and inclusion criteria: women in the Tokyo Metropolitan Institute of Gerontology Longitudinal Interdisciplinary Study on Aging attending a comprehensive geriatric health examination; living at home Exclusion criteria: unable to measure muscle strength, poor mobility due to hemiplegia, poorly controlled blood pressure, communication difficulties due to impaired hearing
Interventions | 1. Intervention: exercise-centred fall prevention programme + home-based exercise programme aimed at enhancing muscle strength, balance, and walking ability. 10 1-hour classes (every 2 wks for 6 months) plus individual home-based exercises for 30 min 3 x per wk 2. Control: pamphlet and advice on prevention of falls
Outcomes | 1. Rate of falls 2. Number of people falling Other outcomes reported but not included in this review
Duration of the study | 20 months
Notes |
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Unclear risk | States "randomized" but method of randomisation not described
Allocation concealment (selection bias) | Unclear risk | Insufficient information to permit judgement
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Participants and personnel not blind to allocated group but impact of non-blinding unclear
Blinding of outcome assessment (detection bias) Falls and fallers | Unclear risk | Falls reported by participants who were aware of their group allocation. Does not state whether outcome assessors were blind to allocation.
Incomplete outcome data (attrition bias) Falls | High risk | See Supplementary material 9 for method of assessment
Incomplete outcome data (attrition bias) Fallers | High risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | High risk | Retrospective recall. Falls and fractures recorded retrospectively at interview at 8 months and 20 months after intervention.

Swanenburg 2007
Study characteristics
Methods | RCT
Participants | Setting: Zurich, Switzerland N = 24 Sample: probably female patients in Center for Osteoporosis of the Department of Rheumatology Age (years): mean 71.2 (SD 6.8) Inclusion criteria: aged ≥ 65; living independently; with osteoporosis or osteopenia Exclusion criteria: severe peripheral or central neurological disease known to influence gait, balance or muscle strength; medical contraindications for exercise
Interventions | 1. Intervention: vitamin 400 to 800 IU cholecalciferol and calcium 500 to 1000 mg/day according to physician assessment at baseline plus 12 wk training programme to improve balance, and a daily nutritional supplement enriched with proteins for 3 months 2. Control: vitamin 400 to 800 IU cholecalciferol and calcium 500 to 1000 mg/day according to physician assessment at baseline plus leaflet on home exercises
Outcomes | 1. Rate of falls Other outcomes reported but not included in this review
Duration of the study | 1 year
Notes | Pilot study
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Unclear risk | Quote: "Random assignment ... with a stratified randomisation procedure."
Allocation concealment (selection bias) | Unclear risk | Insufficient information to permit judgement
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Blinding of participants and treatment personnel not mentioned in report, but unlikely. Insufficient evidence to make judgement on impact of lack of blinding.
Blinding of outcome assessment (detection bias) Falls and fallers | Low risk | Falls reported by participants who were aware of their group allocation. Outcome assessors were blind to allocation.
Incomplete outcome data (attrition bias) Falls | Unclear risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | High risk | Quote: "Falls were assessed by interview at each assessment" post intervention, 6, 9, and 12 months. Interval recall of 3-month period.

Tinetti 1994
Study characteristics
Methods | RCT (cluster-randomised). 16 treating physicians, matched in 4 groups of 4, into 2 control and 2 intervention in each group; enrolled subjects assigned to same group as their physician
Participants | Setting: Southern Connecticut, USA N = 301 Sample: people enrolled with participating physicians (69% women) Age (years): mean 77.9 (SD 5.3) Inclusion criteria: aged > 70; community-dwelling; independently ambulant; at least 1 targeted risk factor for falling (postural hypotension, sedative/hypnotic use, use of > 4 medications, inability to transfer, gait impairment, strength or range of motion loss, domestic environmental hazards) Exclusion criteria: enrolment in another study; MMSE < 20; current (within last month) participation in vigorous activity
Interventions | 1. Interventions targeted to individual risk factors, according to decision rules and priority lists. 3-month programme duration 2. Control: visits by social work students over same period
Outcomes | 1. Rate of falls 2. Number of people falling 3. Number sustaining a fracture
Duration of the study | 1 year
Notes | Yale (New Haven) FICSIT trial. Cost-effectiveness analysis reported in 10.
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Quote: "Computerised randomization program"
Allocation concealment (selection bias) | Unclear risk | Insufficient information to permit judgement
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Blinding of participants and treatment personnel not mentioned in report, but unlikely. Insufficient evidence to make judgement on impact of lack of blinding.
Blinding of outcome assessment (detection bias) Falls and fallers | Low risk | Falls reported by participants who were aware of their group allocation. Outcome assessors blinded to assignment.
Blinding of outcome assessment (detection bias) Fractures | Unclear risk | Fractures reported by participants who were aware of their group allocation. Outcome assessors blinded to assignment. Unclear whether medical records or radiology reports were used to confirm fractures.
Incomplete outcome data (attrition bias) Falls | Low risk | See Supplementary material 9 for method of assessment
Incomplete outcome data (attrition bias) Fallers | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Low risk | Prospective. Falls "recorded on a calendar that subjects mailed to the research staff monthly." Followed by personal or telephone contact if no calendar returned or a fall reported.

Trivedi 2003
Study characteristics
Methods | RCT. Stratified by age and sex
Participants | Setting: Suffolk, United Kingdom N = 2686 Sample: recruited from British doctors study register and 1 GP patient register (24% women) Age (years): mean 75 (SD 5), range 65 to 85 Inclusion criteria: aged 65 to 85 years Exclusion criteria: already taking vitamin D supplements; conditions with contraindications for vitamin D supplementation, e.g. renal stones, sarcoidosis, or malignancy
Interventions | 1. Oral vitamin D3 supplementation (100,000 IU cholecalciferol) 1 capsule every 4 months for 5 years 2. Control: matching placebo 1 capsule every 4 months for 5 years
Outcomes | 1. Number of people falling 2. Number sustaining a fracture 3. Adverse events Other outcomes reported but not included in this review
Duration of the study | 5 years
Notes | Although fracture and major illness data collected every 4 months after capsules sent out, falls data not collected until end of study. Falls not mentioned in statistical analysis section of methods.
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Quote: "randomised after stratification by age and sex" Comment: probably done since earlier reports from the same investigators clearly describe use of random sequences.
Allocation concealment (selection bias) | Low risk | Quote: "Ipswich pharmacy revealed the coding" at the end of the study. So assume randomised centrally.
Blinding of participants and personnel (performance bias) All outcomes | Low risk | Placebo-controlled randomised trial
Blinding of outcome assessment (detection bias) Falls and fallers | Low risk | Falls reported by participants who were blind to their group allocation (placebo-controlled trial)
Blinding of outcome assessment (detection bias) Fractures | Unclear risk | Fractures reported by participants who were blind to their group allocation (placebo-controlled trial). Confirmation of fracture outcomes appears to have occurred only in participants who died, and the fracture was recorded on the death certificate.
Incomplete outcome data (attrition bias) Fallers | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | High risk | Retrospecive recall over 12-month period at the end of 5 years

Trombetti 2011
Study characteristics
Methods | RCT (cross-over at 6 months)
Participants | Setting: Geneva, Switzerland N = 134 Sample: volunteers recruited by advertising etc (96% women) Age (years): 75.5 (SD 6.9) Inclusion criteria: aged ≥ 65; community-dwelling; no previous experience of Jaques-Dalcroze eurhythmics (except during childhood); high risk of falling (≥ 1 falls after the age of 65, impaired balance, or physically frail) Exclusion criteria: neurological or orthopaedic disease seriously affecting gait and balance; progressive or unstable medical conditions limiting participation; dependent on walking aids, e.g. canes and walkers
Interventions | 1. Intervention: music-based multitask exercise programme (Jaques-Dalcroze eurhythmics) 1 h per wk for 6 months. Group exercises performed to improvised piano music (walking to music, responding to changes in rhythmic patterns etc), sometimes with manipulation of objects (e.g. percussion instruments, balls), gradually increasing in difficulty to challenge balance control 2. Control: received intervention after 6 months
Outcomes | 1. Rate of falls 2. Number of people falling Falls a secondary outcome. Other outcomes not included in this review
Duration of the study | 1 year
Notes | Falls data from 6 months (before cross-over) used for analysis in the review
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Quote: "subjects were randomized … according to a computer-generated list … using a permuted block randomization design"
Allocation concealment (selection bias) | Low risk | Quote: "subjects were randomized … according to a computer-generated list prepared by an independent statistician"
Blinding of participants and personnel (performance bias) All outcomes | High risk | Participants and personnel carrying out the intervention were aware of group allocation
Blinding of outcome assessment (detection bias) Falls and fallers | Unclear risk | Participants self reported falls. Quote: "Participants who failed to return the diary or provided incomplete data were contacted by telephone." Not clear whether this assessor was blind to group allocation.
Incomplete outcome data (attrition bias) Falls | High risk | See Supplementary material 9 for method of assessment
Incomplete outcome data (attrition bias) Fallers | High risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Low risk | Quote: "Falls were prospectively monitored for 12 months and recorded daily using a diary mailed monthly to the study coordinator. Participants who failed to return the diary or provided incomplete data were contacted by telephone."

Van Haastregt 2000
Study characteristics
Methods | RCT
Participants | Setting: Hoensbroek, The Netherlands N = 316 Sample: people registered with 6 general medical practices (66% women) Age (years): mean 77.2 (SD 5.1) Inclusion criteria: aged ≥ 70; community-dwelling; 2 or more falls in previous 6 months or score 3 or more on mobility scale of Sickness Impact Profile Exclusion criteria: bed ridden; fully wheelchair dependent; terminally ill; awaiting nursing home placement; receiving regular care from community nurse
Interventions | 1. 5 home visits from community nurse over 1 year. Screened for medical, environmental, and behavioural risk factors for falls and mobility impairment; advice, referrals, and "other actions" 2. Control: usual care
Outcomes | 1. Number of people falling
Duration of the study | 18 months (12-month data used in analyses in the review)
Notes |
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Randomisation by computer-generated random numbers
Allocation concealment (selection bias) | Unclear risk | Insufficient information to permit judgement
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Participants and nurses conducting home visits in intervention group were not blinded. Partial blinding of other health professionals. Quote: "The doctors and healthcare staff dealing with the participants were not told which patients were allocated to the usual care group". Insufficient evidence to make judgement on impact of lack of blinding.
Blinding of outcome assessment (detection bias) Falls and fallers | Unclear risk | Falls reported by participants who were aware of their group allocation. Quote: "During follow up participants recorded falls in a weekly diary." No mention of blinding of study personnel collecting data.
Incomplete outcome data (attrition bias) Fallers | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Low risk | Quote: "During follow up participants recorded falls in a weekly diary."

Van Rossum 1993
Study characteristics
Methods | RCT (some clusters as people living together allocated to same group)
Participants | Setting: Weert, The Netherlands N = 580 Sample: general population sampled, not volunteers (58% women) Age (years): range 75 to 84 Inclusion criteria: aged 75 to 84; living at home Exclusion criteria: subject or partner already receiving regular home nursing care
Interventions | 1. Preventive home visits by public health nurse 4 x per year for 3 years. Extra visits/telephone contact as required. Check list of health topics to discuss. Advice given and referrals to other services 2. Control: no home visits
Outcomes | 1. "Falls" Other outcomes reported but not included in this review
Duration of the study | Follow-up at 1½ years and 3 years
Notes | Cost analysis reported in primary reference
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Stratified by sex, self rated health, composition of household and social class then randomised by computer generated random numbers. Participants in intervention group then randomised to nurses.
Allocation concealment (selection bias) | Unclear risk | Insufficient information to permit judgement
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Participants and nurses conducting home visits in intervention group were not blinded. Insufficient evidence to make judgement on impact of lack of blinding.
Blinding of outcome assessment (detection bias) Falls and fallers | Low risk | Falls reported by participants who were aware of their group allocation. The interviewers who collected data on falls in the previous 6 months at the end of the study were blinded. Quote: "The interviews were conducted by trained interviewers who were unaware of whether a participant had been regularly visited by a nurse or not."
Incomplete outcome data (attrition bias) Falls | Unclear risk | See Supplementary material 9 for method of assessment. Insufficient information to permit judgement.
Risk of bias in recall of falls | High risk | Retrospective. Follow-up at 1½ years and 3 years by postal survey and interview. Falls in previous 6 months recorded.

Vellas 1991
Study characteristics
Methods | RCT
Participants | Setting: Toulouse, France N = 95 Sample: people presenting to their GP after a fall (65% women) Age (years): mean 78 Inclusion criteria: community-dwelling; no biological cause for the fall; fallen less than 7 days previously Exclusion criteria: hospitalised for more than 7 days after the fall; demented; sustaining major trauma, e.g. hip fracture or other fracture; unable to mobilise or be evaluated within 7 days of the fall
Interventions | 1. Iskédyl® (combination of raubasine and dihydroergocristine) 2 droppers morning and evening for 180 days 2. Control: placebo for 180 days
Outcomes | 1. "Falls"
Duration of the study | 180 days
Notes |
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Unclear risk | Quote: "Randomised". Method of randomisation not described.
Allocation concealment (selection bias) | Unclear risk | Insufficient information to permit judgement
Blinding of participants and personnel (performance bias) All outcomes | Low risk | Placebo-controlled randomised trial
Blinding of outcome assessment (detection bias) Falls and fallers | Low risk | Falls reported by participants who were blind to their group allocation (placebo-controlled trial). "Double blind" so assessors also blind to group allocation.
Incomplete outcome data (attrition bias) Falls | Unclear risk | See Supplementary material 9 for method of assessment. Insufficient information to permit judgement.
Risk of bias in recall of falls | Unclear risk | Retrospective recall at 30, 60, 120, 180 days

Vetter 1992
Study characteristics
Methods | RCT (cluster-randomised by household)
Participants | Setting: Wales, United Kingdom N = 674 Sample: people on 1 GP's patient list (% women not described) Age (years): > 70 Inclusion criteria: aged > 70 Exclusion criteria: none listed
Interventions | 1. Health visitor visits, minimum yearly, for 4 years, with advice on nutrition, environmental modification, concomitant medical conditions, and availability of physiotherapy classes if desired 2. Control: usual care
Outcomes | 1. Number of people falling 2. Number sustaining a fracture
Duration of the study | 4 years
Notes |
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Cluster-randomised by household "using random number tables with subjects' study numbers and without direct contact with the subjects"
Allocation concealment (selection bias) | Low risk | Randomised "using random number tables with subjects' study numbers and without direct contact with the subjects". Introduction of bias unlikely.
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Participants and health visitor conducting home visits in intervention group were not blinded. Insufficient evidence to make judgement on impact of lack of blinding.
Blinding of outcome assessment (detection bias) Falls and fallers | Unclear risk | Falls reported by participants who were aware of their group allocation. Research assistant who collected data had interviewed all participants before randomisation; unclear whether she had remained blinded.
Blinding of outcome assessment (detection bias) Fractures | Unclear risk | Fractures reported by participants who were aware of their group allocation. Research assistant who collected data had interviewed all participants before randomisation; unclear whether she had remained blinded. For reported fractures, "the case notes were referred to if clear answers were not obtained."
Incomplete outcome data (attrition bias) Fallers | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | High risk | Falling status and fractures ascertained by interview at end of study period

Vind 2009
Study characteristics
Methods | RCT
Participants | Setting: Glostrup, Denmark N = 392 Sample: contacted by post after ED treatment or hospital discharge (74% women) Age (years): mean 74 (SD 6) Inclusion criteria: aged ≥ 65; treated in ED or admitted to hospital because of a fall Exclusion criteria: fall caused by external force or alcohol intoxication; not living locally; institutionalised; unable to walk; terminally ill; impaired communication; described as suffering from dementia in hospital notes or by staff; having a planned geriatric intervention
Interventions | 1. Intervention: comprehensive multifactorial intervention. Assessed by doctor (1 h), and nurse and PT (1.5 h), during 2 visits to geriatric outpatient clinic. Team discussion with senior geriatrician, interventions planned and offered to participants. Carried out in clinic or referred to specialists. Included progressive, individualised exercise, drug modification, treatment of untreated disease, advice or referral to ophthalmologist, etc. (see Table 1 in Vind 2009 for details) 2. Control: usual care as planned in ED or during admission
Outcomes | 1. Rate of falls 2. Number of people falling 3. Number of fractures (not number of people with fractures therefore no usable data)
Duration of the study | 1 year
Notes |
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Quote: "Participants were randomized by simple method, 1:1, using a computer-generated random list and sealed envelopes; a secretary not involved in the intervention performed randomization."
Allocation concealment (selection bias) | Low risk | Quote: "… using a computer-generated random list and sealed envelopes; a secretary not involved in the intervention performed randomization."
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Participants and/or intervention delivery personnel were not blind to group allocation. There is insufficient information to judge whether participants were blinded, or whether the outcomes were likely to be affected by lack of blinding.
Blinding of outcome assessment (detection bias) Falls and fallers | Low risk | Quote: "Research assistants who were not aware of group allocation followed all participants for 12 months. All participants kept a falls diary and were instructed to record falls daily ... Participants were telephoned monthly for collection of falls data."
Blinding of outcome assessment (detection bias) Fractures | Low risk | Self reported fractures confirmed from hospital records
Incomplete outcome data (attrition bias) Falls | Unclear risk | See Supplementary material 9 for method of assessment
Incomplete outcome data (attrition bias) Fallers | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Low risk | Quote: "All participants kept a falls diary and were instructed to record falls daily and whether falls had caused injury resulting in contact with a general practitioner or emergency department or admission to the hospital. Participants were telephoned monthly for collection of falls data."

Von Stengel 2011
Study characteristics
Methods | RCT
Participants | Setting: Erlangen-Nürnberg, Germany N = 101 (see Notes) Sample: women recruited by mail using health insurance company database Age (years): mean 68.5 (SD 3.1), range 65 to 76 Inclusion criteria: postmenopausal; aged ≥ 65; independently community-dwelling Exclusion criteria: diseases or medication affecting bone metabolism, neuromuscular performance or falls; implants of the lower extremity or spine; eye diseases affecting the retina; low physical capacity (< 50 W)
Interventions | 1. Multifunctional training + whole body vibration: group training sessions (60 min, 2 x per week) + home training sessions (20 min, 2 x per week) for 1 year. Group sessions: dancing aerobics, balance training, functional strength training + leg strength exercises on vibration platform for last 15 min (platforms vibrated at frequencies from 25 to 35 Hz, amplitude 1.7 to 2.0 mm) 2. Control: light physical exercise and relaxation programme 1 x per wk 10 wks with breaks of 10 wks between the blocks Both groups received calcium and vitamin D supplements to ensure 1500 mg calcium and 400 IE vitamin D per day, based on normal intake
Outcomes | 1. Rate of falls 2. Number sustaining a fracture
Duration of the study | 18 months
Notes | Randomised into 3 groups: training group (TG N = 50), training + whole body vibration (TGV N = 50), and control group (CG N = 51). Only TGV and CG included in the analysis as 50 members of the TG group are also included in the larger TG group in Kemmler 2010.
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Randomised by computer-generated age-stratified randomization list
Allocation concealment (selection bias) | Low risk | Quote: "The randomization ... was performed by an independent statistician using a computer-generated age-stratified randomization list." Same procedure as Kemmler 2010 where randomisation was carried out by a University department.
Blinding of participants and personnel (performance bias) All outcomes | Low risk | Quote: "In contrast to other exercise studies, we tried to blind the study on the participant level by the implementation of sham exercise for the control group. Participants were not informed on the hypothesis and were unaware if they were in the real or control group. Groups were trained separately in order to prevent contact between the cohorts."
Blinding of outcome assessment (detection bias) Falls and fallers | Low risk | Falls self reported but "outcome assessors and research assistants were not allowed to ask subjects about their allocated intervention during the measurements."
Blinding of outcome assessment (detection bias) Fractures | Unclear risk | Participants and outcome assessors were blind to treatment group. It is unclear whether in this study radiographic confirmation was conducted. Quote: "Injurious falls, defined as falls associated with a trauma (contusion, sprain, luxation, or fracture) leading to an ailment of more than 2 days, were assessed separately", i.e. not exclusively by diary.
Incomplete outcome data (attrition bias) Falls | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Low risk | Quote: "Fall data were collected according to the PROFANE recommendation ... by a prospective reporting method via calendar."

Voukelatos 2007
Study characteristics
Methods | RCT
Participants | Setting: Sydney, Australia N = 702 Sample: volunteers recruited through advertising (84% women) Age (years): mean 69 (SD 6.5), range 69 to 70 Inclusion criteria: aged over 60; community-dwelling Exclusion criteria: degenerative neurological disease; severely debilitating stroke; metastatic cancer; severe arthritis; unable to walk across a room independently; unable to use English
Interventions | 1. Tai Chi classes 1 hour per wk for 16 wks (8 to 15 participants per class) at 24 community venues. Style of Tai Chi differed between classes: majority (83%) involved Sun style, 2 classes (3%) Yang style, remainder (14%) involved a mixture of styles 2. Control: placed on 24 wk waiting list, then offered Tai Chi programme
Outcomes | 1. Rate of falls 2. Number of people falling
Duration of the study | 24 wks
Notes | Cost-effectiveness analysis reported in 11
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Quote: "Randomization list ... was prepared for each venue using randomly permuted blocks of four or six".
Allocation concealment (selection bias) | Unclear risk | Insufficient information to permit judgement
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Participants and instructors conducting classes in intervention group were not blinded. Control participants were asked not to take classes during the study period, but may have accessed other fall prevention interventions. Insufficient evidence to make judgement on impact of lack of blinding.
Blinding of outcome assessment (detection bias) Falls and fallers | Low risk | Falls reported by participants who were aware of their group allocation. Outcome assessors blinded to assignment.
Incomplete outcome data (attrition bias) Falls | Low risk | See Supplementary material 9 for method of assessment
Incomplete outcome data (attrition bias) Fallers | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Low risk | Quote: "Participants were given falls calendars and were instructed to record on the calendar each day for 24 weeks whether they had had a fall." Pre-paid postage calendars returned at the end of each month, with telephone call if not returned within 2 weeks.

Wagner 1994
Study characteristics
Methods | RCT
Participants | Setting: Seattle, USA N = 1559 Sample: 'healthy elderly' people, HMO enrollees (59% women) Age (years): mean 72 Inclusion criteria: aged ≥ 65; HMO members; ambulatory and independent Exclusion criteria: too ill to participate as defined by primary care physician
Interventions | 1. 60 to 90-minute interview with nurse, including review of risk factors, audiometry and blood pressure measurement, development of tailored intervention, motivation to increase physical and social activity 2. Chronic disease prevention nurse visit 3. Control: usual care
Outcomes | 1. Number of people falling Other outcomes reported but not included in this review
Duration of the study | 2 years (1-year data used in analyses in the review)
Notes | Risk factors identified: inadequate exercise, high-risk alcohol use, environmental hazards if increased fall risk, high-risk prescription drug use, impaired vision, impaired hearing
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Unclear risk | Quote: "Randomized into three groups in a ratio of 2:1:2."
Allocation concealment (selection bias) | Unclear risk | Insufficient information to permit judgement
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Participants and personnel implementing the intervention not blind to allocated group, but impact of non-blinding unclear
Blinding of outcome assessment (detection bias) Falls and fallers | Unclear risk | Falls were self reported at 1 year and 2 years by questionnaire, with telephone interview if questionnaire was not returned. Blinding of interviewers and data assessors not described.
Incomplete outcome data (attrition bias) Falls | Unclear risk | See Supplementary material 9 for method of assessment
Incomplete outcome data (attrition bias) Fallers | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | High risk | Falls retrospectively measured at 1 and 2 years by mailed questionnaire. Interviewed by phone if questionnaire not returned. Data supplemented by computerised hospital discharge files.

Weber 2008
Study characteristics
Methods | RCT (cluster-randomised 15:3 ratio). Clusters were clinics with > 20 patients meeting inclusion criteria
Participants | Setting: rural Pennsylvania, USA N = 620 Sample: patients in EPICCare database for Geisinger Health System (79% women) Age (years): mean 76.8 Inclusion criteria: aged ≥ 70; community-dwelling; ≥ 4 active prescription medicines and ≥ 1 psychoactive medication prescribed within last year Exclusion criteria: none described.
Interventions | 1. Intervention: standardised medication review by pharmacist or geriatrician using electronic medical record (EMR) system focusing on psychoactive medications, polypharmacy, and inappropriate dosages. Recommendations sent to primary physician via EMR (only once). Primary physician could access guidelines via EMR system 2. Control: usual care with no access to EMR
Outcomes | Falls but no useable data and no results that can be reported in the text. Cost analysis reported.
Duration of the study | 15 months
Notes | Cost analysis reported in primary reference
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Unclear risk | Quote: "We then randomized clinic sites to receive either the intervention or usual care." Insufficient information to permit judgement.
Allocation concealment (selection bias) | Unclear risk | Insufficient information to permit judgement
Blinding of participants and personnel (performance bias) All outcomes | High risk | No mention of any blinding; unlikely that participants and study personnel could be blinded
Blinding of outcome assessment (detection bias) Falls and fallers | Unclear risk | Quote: "... patients were contacted by telephone by a study nurse at months 1, 3, 6, 9, 12, and 15, who collected data on self reported falls" Quote: "To identify falls, we obtained data on all medical encounters (inpatient hospitalizations, emergency department encounters, and outpatient visits". No mention of blinding for either of these sources of data.
Incomplete outcome data (attrition bias) Falls | Unclear risk | See Supplementary material 9 for method of assessment
Incomplete outcome data (attrition bias) Fallers | Unclear risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | High risk | Recall at 3-month intervals. Quote: "To obtain direct information from patients regarding self-reported fall rates, patients were contacted by telephone by a study nurse at months 1, 3, 6, 9, 12, and 15, who collected data on self reported falls". These were combined in analysis with falls records from routinely collected data.

Weerdesteyn 2006
Study characteristics
Methods | RCT
Participants | Setting: Nijmegan, The Netherlands N = 58 Sample: recruited using newspaper advertisements (72% women) Age (years): mean 74 (SD 6) Inclusion criteria: ≥ 65 years; community-dwelling; ≥ 1 fall in previous year; able to walk 15 min without a walking aid Exclusion criteria: severe cardiac, pulmonary, or musculoskeletal disorders; pathologies associated with increased falls risk, e.g. Parkinson's disease; osteoporosis; using psychotropic drugs
Interventions | 3 arms described, but 1 not randomised 1. Low-intensity exercise programme: 1.5 hour, 2 x per wk for 5 wks. First weekly session included gait, balance, and co-ordination training including obstacle avoidance. Second session, walking exercises with changes of speed and direction, and practice of fall techniques derived from martial arts 2. Control: no training
Outcomes | 1. Rate of falls 2. Number of people falling Other outcomes reported but not included in this review
Duration of the study | 7 months
Notes |
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Unclear risk | Quote: "Block randomization (3 blocks of 20) with gender stratification with equal probability for either exercise or control group assignment."
Allocation concealment (selection bias) | Unclear risk | Quote: "The group allocation sequence was concealed (to both researchers and participants) until assignment of interventions". "We had participants draw a sealed envelope with group allocation ticket from a box containing all remaining envelopes in the block" (personal communication).
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Participants and personnel implementing the intervention not blind to allocated group, but impact of non-blinding unclear
Blinding of outcome assessment (detection bias) Falls and fallers | High risk | Falls reported by participants who were aware of their group allocation. Outcome assessors were not blinded to assignment (personal communication from Dr Weeredesteyn)
Incomplete outcome data (attrition bias) Falls | Low risk | See Supplementary material 9 for method of assessment
Incomplete outcome data (attrition bias) Fallers | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Low risk | Quote: "Falls were monitored monthly using pre-addressed, reply-paid fall registration cards." Asked asked whether a fall had occurred in the past month. Sent a reminder if no registration card received.

Whitehead 2003
Study characteristics
Methods | RCT
Participants | Setting: community or low care residential care (hostel accommodation), Adelaide, Australia N = 140 Sample: patients presenting with a fall to A&E (71% women) Age (years): mean 77.8 (SD 7.0) Inclusion criteria: aged ≥ 65; fall-related attendance at A&E; community-dwelling or in low care residential care (hostel accommodation) Exclusion criteria: resident in nursing home; presenting fall related to a stroke, seizure, cardiac or respiratory arrest, major infection, haemorrhage, motor vehicle accident, or being knocked to the ground by another person; MMSE < 25; no resident carer; not English speaking; living out of catchment area; terminal illness
Interventions | 1. Home visit and questionnaire. "Fall risk profile" developed and participant given written care plan itemising elements of intervention. Letter to GP informing him of participant's fall, inviting them to review participant, highlighting identified risk factors, suggesting possible strategies (evidence based). GP also given 1-page evidence summary 2. Home visit. No intervention. Standard medical care from GP
Outcomes | 1. Number of people falling Primary outcome was uptake of prevention strategies, rather than falls
Duration of the study | 6 months
Notes | Potential strategies: review of medication use especially psychotropic drugs, home assessment
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Randomisation and allocation schedules created by a researcher external to the trial
Allocation concealment (selection bias) | Low risk | Randomised by a researcher external to the trial using numbered, sealed, opaque envelopes
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Participants and personnel implementing the intervention not blind to allocated group, but impact of non-blinding unclear
Blinding of outcome assessment (detection bias) Falls and fallers | Low risk | Falls reported by participants who were aware of their group allocation. Outcome assessors blinded to assignment.
Incomplete outcome data (attrition bias) Fallers | High risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Low risk | Falls ascertained by falls diary and phone calls monthly to encourage use of the diary

Wilder 2001
Study characteristics
Methods | RCT
Participants | Setting: Wisconsin, USA N = 60 Sample: "frail elderly" (proportion of women not stated) Age (years): no description Inclusion criteria: aged ≥ 75 years, living at home, using home services (i.e. Meals on Wheels, Telecare or Lifeline) Exclusion criteria: none described
Interventions | 1. Home modifications plus home exercise programme monitored by a "trained volunteer buddy" 2. Simple home modifications 3. Control: no intervention
Outcomes | 1. "Falls"
Duration of the study | 1 year
Notes | Abstract only
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Unclear risk | Quote: "randomly assigned" to 3 arms. Method not described.
Allocation concealment (selection bias) | Unclear risk | Insufficient information to permit judgement
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Participants and personnel implementing the intervention not blind to allocated group, but impact of non-blinding unclear
Blinding of outcome assessment (detection bias) Falls and fallers | Unclear risk | Falls reported by participants who were aware of their group allocation. Does not state whether outcome assessors were blind to allocation.
Incomplete outcome data (attrition bias) Falls | Unclear risk | See Supplementary material 9 for method of assessment. Insufficient information to permit judgement.
Risk of bias in recall of falls | Unclear risk | Falls monitored by weekly telephone calls. Interval recall over a short period.

Wolf 1996
Study characteristics
Methods | RCT
Participants | Setting: Atlanta, USA N = 200 Sample: residing in an independent living facility, recruited by advertising and direct contact (81% women) Age (years): mean 76.2 (SD 4.7) Inclusion criteria: aged > 70; ambulatory; living in unsupervised environment; agreeing to participate weekly for 15 wks with 4-month follow-up Exclusion criteria: debilitating conditions, e.g. cognitive impairment, metastatic cancer, crippling arthritis, Parkinson's disease, major stroke, profound visual defects
Interventions | 3 arms: 1. Tai Chi Quan (balance enhancing exercise). Group sessions 2 x per wk for 15 wks. (Individual contact with instructor approximately 45 min per wk) 2. Computerised balance training on force platform. Individual sessions 1 x per wk for 15 wks. (Individual contact with instructor approximately 45 min per wk) 3. Control: group discussions of topics of interest to older people with gerontological nurse, 1 hour per week for 15 wks
Outcomes | Used modified definition of a fall rather than agreed definition for FICSIT trials described in Buchner 1993 1. Rate of falls
Duration of the study | 8 months (range 7 to 20)
Notes | Atlanta FICSIT trial (Province 1995). 1997 paper included under this Study ID reports on a subgroup of the trial, reporting on outcomes other than falls
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Randomised using "computer-generated fixed randomization procedure".
Allocation concealment (selection bias) | Unclear risk | Insufficient information to permit judgement.
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Participants and personnel implementing the intervention not blind to allocated group, but impact of non-blinding unclear
Blinding of outcome assessment (detection bias) Falls and fallers | Unclear risk | Falls reported by participants who were aware of their group allocation. Does not state whether outcome assessors were blind to allocation.
Incomplete outcome data (attrition bias) Falls | Unclear risk | See Supplementary material 9 for method of assessment. Insufficient information to permit judgement.
Risk of bias in recall of falls | Low risk | Falls ascertained by monthly calendar, or by monthly phone call from project staff

Wolf 2003
Study characteristics
Methods | RCT (cluster-randomised by living facility)
Participants | Setting: Atlanta, USA N = 311 (N = 20 clusters) Sample: congregate living facilities (independent living facilities) recruited in pairs by whether Housing and Urban Development (N = 14) or private (N = 6). At least 15 participants recruited per site (94% women) Age (years): mean 80.9 (SD 6.2), range 70 to 97 Inclusion criteria: aged ≥ 70; ≥ 1 fall in previous year; transitioning to frailty Exclusion criteria: frail or vigorous elderly; major cardiopulmonary disease; cognitive impairment (MMSE < 24); contraindications for exercise, e.g. major orthopaedic conditions; mobility restricted to wheelchair; terminal cancer; evidence of other progressive or unstable neurological or medical conditions
Interventions | 1. Intense Tai Chi (TC): 6 out of 24 simplified TC forms. 1 hour progressing to 90 min, 2 x per wk (10 to 50 min of TC) for 48 wks. Progressing from using upright support to 2 min of TC without support 2. Wellness education programme: 1 hour per wk for 48 wks. Instruction on fall prevention, exercise and balance, diet and nutrition, pharmacological management, legal issues, changes in body function, mental health issues. Interactive material provided but no formal instruction in exercise
Outcomes | 1. Rate of falls 2. Number of people falling
Duration of the study | 48 wks of intervention. Methods paper (Wolf SL et al. Controlled Clinical Trials 2001;22:689-704) describes follow-up for 1 year post intervention by weekly phone calls but not reported in Wolf 2003 or subsequently.
Notes | "Transitioning to frailty" if not vigorous or frail; based on age, gait/balance, walking activity for exercise, other physical activity for exercise, depression, use of sedatives, vision, muscle strength, lower extremity disability (Speechley M et al. J Am Geriatr Soc 1991;39:46-52)
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Unclear risk | Facilities stratified by socioeconomic status and randomised in pairs. Quote: "First site in the pair was randomized to an intervention. The second site received the other intervention."
Allocation concealment (selection bias) | Unclear risk | Insufficient information to permit judgement, although allocation of second site in the pair could be predicted after the first site was randomised.
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Participants and personnel implementing the intervention not blind to allocated group, but impact of non-blinding unclear
Blinding of outcome assessment (detection bias) Falls and fallers | Low risk | Falls reported by participants who were aware of their group allocation. Outcome assessors blinded to assignment.
Incomplete outcome data (attrition bias) Falls | Unclear risk | See Supplementary material 9 for method of assessment
Incomplete outcome data (attrition bias) Fallers | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Low risk | Prospective. Falls recorded on forms and submitted to instructor weekly + phone call.

Woo 2007
Study characteristics
Methods | RCT
Participants | Setting: Hong Kong, China N =180 Sample: recruited by notices posted in 4 community centres in Shatin township (50% women) Age (years): mean 69 (SD 2.6), range 65 to 74 Inclusion criteria: able to walk > 8 m without assistance Exclusion criteria: neurological disease which impaired mobility; shortness of breath or angina on walking up 1 flight of stairs; dementia; already performing Tai Chi or resistance training exercise
Interventions | 1. Tai Chi using Hang style with 24 forms 3 x per wk for 52 wks 2. Resistance training exercises 3 x per wk using a Theraband, for 52 wks 3. Control: no exercise prescribed
Outcomes | 1. Number of people falling Falls a secondary outcome of this study. Other outcomes reported but not included in this review
Duration of the study | 1 year
Notes |
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Quote: "Computer generated blocked randomisation."
Allocation concealment (selection bias) | Unclear risk | Insufficient information to permit judgement
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Participants and personnel implementing the intervention not blind to allocated group, but impact of non-blinding unclear
Blinding of outcome assessment (detection bias) Falls and fallers | High risk | Participants and personnel not blind to allocated group. Quote: "Falls were ascertained by diary and reported to the staff running the interventions." (personal communication)
Incomplete outcome data (attrition bias) Fallers | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | High risk | Quote: "Falls were ascertained by diary and reported to the staff running the interventions." (personal communication) but this could not apply to the control group.

Wu 2010
Study characteristics
Methods | RCT
Participants | Setting: Burlington, Vermont, USA N = 64 Sample: volunteers recruited by advertising, referrals, flyers etc (84% women) Age (years): mean 75.4 (SD 7) Inclusion criteria: age ≥ 65; community-dwelling; at risk of falling (≥ 1 fall in past year or ≤ 50% on ABC Scale); able to walk and do weight-bearing exercises with or without assistive devices; no plans to be away > 2 wks during study period; sufficient cognition and attention to follow directions; have a television (TV) and Internet access; sufficient visual acuity to mimic instructor's movements on TV screen; consenting; with primary care physician approval to participate Exclusion criteria: unable to ambulate/exercise independently; unable to travel to community centre; having certain exercise-limiting conditions including musculoskeletal, cardiac, neurological, pulmonary etc
Interventions | 24-form, Yang-style Tai Chi for 1 h/day, 3 days/wk for 15 wks Delivered via 3 methods with same content and same instructor: 1. Telecommunication-based exercise (Tele-ex). Home-based, interactive via TV screen, allowing group and their instructor to "meet" 2. Traditional community centre-based exercise (Comm-ex) 3. Home video-based exercise (Home-ex). DVD with 45 1-hour sessions + written documentation
Outcomes | 1. Falls (mean reduction in falls) No poolable data. Other outcomes not included in this review
Duration of the study | 15 wks
Notes |
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Unclear risk | Quote: "Those who consented were enrolled in the study and were randomly assigned into the Tele-ex, Commex, and Home-ex groups. To ensure balance among the 3 groups on important potential confounders, randomization was stratified by sex, age (65–74y vs 75y), and time expected to be away during the study period (1 wk vs 1–2 wk). Blocked randomization was used within strata."
Allocation concealment (selection bias) | Unclear risk | Insufficient information to permit judgement
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | All 3 groups received a fall prevention intervention (Tai Chi). Unclear whether there is potential for performance bias.
Blinding of outcome assessment (detection bias) Falls and fallers | Unclear risk | Insufficient information to permit judgement
Incomplete outcome data (attrition bias) Falls | Unclear risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | High risk | Quote: "Fall incidents were assessed by a Fall History Form that recorded the number of falls in the past 12 months (at pretest) and the past 15 weeks (at posttest)"

Wyman 2005
Study characteristics
Methods | RCT
Participants | Setting: Minnesota, USA N = 272 Sample: female Medicare beneficiaries in Twin Cities Metropolitan Area Age (years): mean 79 (SD 6), range 70 to 99 Inclusion criteria: > 70 years; community-dwelling; mentally intact; ambulatory; ≥ 2 risk factors for falls; medically stable Exclusion criteria: currently involved in regular exercise
Interventions | 1. Multifactorial intervention: comprehensive fall risk assessment by nurse practitioner, exercise (walking with weighted balance and co-ordination exercises), fall prevention education, provision of 2 night lights, individualised risk reduction counselling. 12-week intervention of alternating home visits and telephone calls, followed by tapered 16-week computerised telephone monitoring and support 2. Control: health education on topics other than fall prevention. 12-week intervention of alternating home visits and telephone calls. 12-week intervention of alternating home visits and telephone calls, followed by tapered 16-week computerised telephone monitoring and support.
Outcomes | 1. Rate of falls 2. Number of people falling
Duration of the study | 2 years (1-year data used for rate of falls in the review analysis, 2-year data for risk of falling as 1-year data unavailable)
Notes | Cost description reported in 12
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Low risk | Quote: "Participants were stratified according to age group ... and randomized using a permutated block design with varying block sizes of four and six to assure that the number of participants was balanced in each treatment group."
Allocation concealment (selection bias) | Unclear risk | Insufficient information to permit judgement
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Participants and personnel implementing the intervention not blind to allocated group, but impact of non-blinding unclear
Blinding of outcome assessment (detection bias) Falls and fallers | Unclear risk | Falls reported by participants who were aware of their group allocation. Does not state whether outcome assessors were blind to allocation.
Incomplete outcome data (attrition bias) Falls | Low risk | See Supplementary material 9 for method of assessment
Incomplete outcome data (attrition bias) Fallers | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Low risk | Quote: "Falls were measured daily on a calendar that was mailed in monthly."

Yamada 2010
Study characteristics
Methods | RCT
Participants | Setting: Kyoto, Japan N = 60 Sample: people recruited using advertising in local press (% women not stated) Age (years): not stated Inclusion criteria: aged ≥ 65; community-dwelling; visited primary care physician in previous 3 yrs; MMSE ≥ 24; able to walk independently (with or without a cane): willing to participate in group exercise classes lasting ≥ 6 months; access to transportation; minimal hearing and visual impairments; no regular exercise in previous 12 months Exclusion criteria: severe cardiac pulmonary, or musculoskeletal disorders; neurological conditions associated with falling (stroke, Parkinson's disease); osteoporosis; use of psychotropic drugs
Interventions | 1. Exercise class + trail-walking exercise: numbered flags at random positions in a 5 m x 5 m area. Participants walk as quickly and correctly from flag 1 to 15 in wk 1 to 8, from flags 15 to 1 in wk 9 to 16. Flag positions changed for each session. 2. Exercise class + indoor walking: instructed to attend supervised indoor walking session (up to 30 min on 300-foot loop) Standardised group exercise class: 20 min moderate-intensity aerobic exercise, 20 min progressive strength training, 10 min flexibility + balance exercises, 10 min cool-down, + "exercises known to decrease fall risk". 90 min, 1 x per wk for 16 wks
Outcomes | 1. Rate of falls 2. Number of people falling Other outcomes not included in this review
Duration of the study | 16 months
Notes |
Risk of bias
Bias | Authors' judgement | Support for judgement
Random sequence generation (selection bias) | Unclear risk | Quote: "Participants were block randomized in blocks of four"
Allocation concealment (selection bias) | Low risk | Quote: "Using this sequence, opaque envelopes bearing group names were numbered and the 60 participants were then randomly as signed to the TWE (n = 30) or walking (W) group (n = 30)"
Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Both groups received an exercise intervention. Unclear whether there was any risk of performance bias.
Blinding of outcome assessment (detection bias) Falls and fallers | Unclear risk | Unclear whether person ascertaining falls was blind to allocated group
Incomplete outcome data (attrition bias) Falls | Unclear risk | See Supplementary material 9 for method of assessment
Incomplete outcome data (attrition bias) Fallers | Low risk | See Supplementary material 9 for method of assessment
Risk of bias in recall of falls | Low risk | Quote: "The participants were asked to record any falls in fall diaries that were mailed to the research assistants every month."

## Footnotes

A&E: hospital accident and emergency department
ABC Scale: Activities-specific Balance Confidence Scale
ADL: activities of daily living
AMT: abbreviated mental test
BMD: bone mineral density
BMI: body mass index
CCT: controlled clinical trial (quasi-randomised)
CSH: carotid sinus hypersensitivity
CSM: carotid sinus massage
DXA: dual-energy X-ray absorptiometry (a means to measure bone density)
ECG: electrocardiogram
ERT: estrogen replacement therapy
ED: emergency department
FAME: Falls Management Exercise
FICSIT: frailty and injuries: co-operative studies of intervention techniques
FROP-Com: Falls Risk for Older People in the Community assessment
GP: general practitioner
GPSS: Geriatric Postal Screening Survey
HMO: health maintenance organisation
HRT: hormone replacement therapy
IADL: instrumental activities of daily living. More complex than ADL, e.g. handling personal finances, preparing meals, shopping etc
IQR: interquartile range
m: metres
µg: microgram
MET: Melbourne Edge Test
MMSE: Mini Mental State Examination
NHS: National Health Service (United Kingdom)
NSAID: nonsteroidal anti-inflammatory drugs
ng: nanogram (multiply by 2.496 to convert to nanomoles/L)
nmol: nanomole
OT: occupational therapist
PT: physical therapist/physiotherapist
RCT: randomised controlled trial
SD: standard deviation
TUG: Timed Up and Go test
wk: week
x: times
25(OH)D: 25-hydroxy-vitamin D
<: less than
>: more than

## References to studies

### Assantachai 2002 {published and unpublished data}

- * Assantachai P , Chatthanawaree W , Thamlikitkul V , Praditsuwan R , Pisalsarakij D . Strategy to prevent falls in the Thai elderly: a controlled study integrated health research program for the Thai elderly. Journal of the Medical Association of Thailand 2002;85(2):215-22. [MEDLINE: 12081122]
- Assantachai P . personal communication June 11 2007.

### Ballard 2004 {published data only}

- Ballard JE , McFarland C , Wallace LS , Holiday DB , Roberson G . The effect of 15 weeks of exercise on balance, leg strength, and reduction in falls in 40 women aged 65 to 89 years. Journal of the American Medical Women's Association 2004;59(4):255-61. [MEDLINE: 16845754]

### Barnett 2003 {published data only}

- Barnett A , Smith B , Lord SR , Williams M , Baumand A . Community-based group exercise improves balance and reduces falls in at-risk older people: a randomised controlled trial. Age and Ageing 2003;32(4):407-14. [MEDLINE: 12851185]

### Beling 2009 {published data only}

- Beling J , Roller M . Multifactorial intervention with balance training as a core component among fall-prone older adults. Journal of Geriatric Physical Therapy 2009;32(3):125-33. [MEDLINE: 20128337]

### Beyer 2007 {published data only}

- Beyer N , Simonsen L , Bulow J , Lorenzen T , Jensen DV , Larsen L , et al. Old women with a recent fall history show improved muscle strength and function sustained for six months after finishing training. Aging-Clinical & Experimental Research 2007;19(4):300-9. [MEDLINE: 17726361]

### Bischoff-Ferrari 2006 {published data only}

- Bischoff-Ferrari HA , Orav EJ , Dawson-Hughes B . Additive benefit of higher testosterone levels and vitamin D plus calcium supplementation in regard to fall risk reduction among older men and women. Osteoporosis International 2008;19(9):1307-14. [MEDLINE: 18348447]
- * Bischoff-Ferrari HA , Orav EJ , Dawson-Hughes B . Effect of cholecalciferol plus calcium on falling in ambulatory older men and women: a 3-year randomized controlled trial. Archives of Internal Medicine 2006;166(4):424-30. [MEDLINE: 16505262]
- Bischoff-Ferrari HA , Orav EJ , Dawson-Hughes B . Effect of vitamin D3 plus calcium on fall risk in older men and women: a 3-year randomized controlled trial [abstract]. Journal of Bone and Mineral Research 2004;19(Suppl 1):S57.
- Dawson-Hughes B , Harris SS , Krall EA , Dallal GE . Effect of calcium and vitamin D supplementation on bone density in men and women 65 years of age or older. New England Journal of Medicine 1997;337(10):670-6. [MEDLINE: 9278463]

### Bischoff-Ferrari 2010 {published data only}

[CTG: NCT00133640]

- Bischoff-Ferrari HA , Dawson-Hughes B , Platz A , Orav EJ , Stahelin HB , Willett WC , et al. Effect of high-dosage cholecalciferol and extended physiotherapy on complications after hip fracture: a randomized controlled trial. Archives of Internal Medicine 2010;170(9):813-20. [MEDLINE: 20458090]
- NCT00133640 . Early rehabilitation after hip fracture. clinicaltrials.gov/show/NCT00133640 (accessed 31 August 2011).

### Blalock 2010 {published data only}

[CTG: NCT00618800]

- * Blalock SJ , Casteel C , Roth MT , Ferreri S , Demby KB , Shankar V . Impact of enhanced pharmacologic care on the prevention of falls: A randomized controlled trial. American Journal of Geriatric Pharmacotherapy 2010;8(5):428-40. [MEDLINE: 21335296]
- Casteel C , Blalock SJ , Ferreri S , Roth MT , Demby KB . Implementation of a community pharmacy-based falls prevention program. American Journal of Geriatric Pharmacotherapy 2011;9(5):310-9.
- Ferreri S , Roth MT , Casteel C , Demby KB , Blalock SJ . Methodology of an ongoing, randomized controlled trial to prevent falls through enhanced pharmaceutical care. American Journal of Geriatric Pharmacotherapy 2008;6(2):61-81. [MEDLINE: 18675765]
- NCT00618800 . Preventing falls through enhanced pharmaceutical care. clinicaltrials.gov/show/NCT00618800 (accessed 23 February 2011).

### Brown 2002 {published data only}

- * Brown AI . Functional Adaptation to Exercise in Elderly Subjects [thesis] http://adt.curtin.edu.au/theses/available/adt-WCU20030423.094914. Perth (Australia): Curtin Univ. of Technology, 2002 (accessed 30 November 2011).
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### Buchner 1997a {published data only}

- * Buchner DM , Cress ME , de Lateur BJ , Esselman PC , Margherita AJ , Price R , et al. The effect of strength and endurance training on gait, balance, fall risk, and health services use in community-living older adults. Journals of Gerontology. Series A, Biological Sciences and Medical Sciences 1997;52(4):M218-24. [MEDLINE: 9224433]
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- Buchner DM , Cress ME , Wagner EH , de Lateur BJ . The role of exercise in fall prevention: Developing targeting criteria for exercise programs. In: Vellas B , Toupet M , Rubenstein L , Albarede JL , Christen Y , editors(s). Falls, balance and gait disorders in the elderly. Amsterdam: Elsevier, 1992:55-68.

### Bunout 2005 {published and unpublished data}

- * Bunout D , Barrera G , Avendano M , de la Maza P , Gattas V , Leiva L , et al. Results of a community-based weight-bearing resistance training programme for healthy Chilean elderly subjects. Age and Ageing 2005;34(1):80-3. [MEDLINE: 15591487]
- Bunout D . personal communication Feb 1 2005.

### Campbell 1997 {published and unpublished data}

- Campbell AJ , Robertson MC , Gardner MM , Norton RN , Buchner DM . Falls prevention over 2 years: a randomized controlled trial in women 80 years and older. Age and Ageing 1999;28:513-8. [MEDLINE: 10604501]
- * Campbell AJ , Robertson MC , Gardner MM , Norton RN , Tilyard MW , Buchner DM . Randomised controlled trial of a general practice programme of home based exercise to prevent falls in elderly women. BMJ 1997;315:1065-9. [MEDLINE: 9366737]
- Gardner M . Home-based exercises to prevent falls in elderly women. New Zealand Journal of Physiotherapy 1998;26(3):6. [CINAHL: 1999044632]
- Gardner MM , Buchner DM , Robertson MC , Campbell AJ . Practical implementation of an exercise-based falls prevention programme. Age and Ageing 2001;30(1):77-83. [MEDLINE: 11322678]
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- Robertson MC , Devlin N , Scuffham P , Gardner MM , Buchner DM , Campbell AJ . Economic evaluation of a community based exercise programme to prevent falls. Journal of Epidemiology and Community Health 2001;55(8):600-6. [MEDLINE: 11449021]
- Robertson MC . Development of a falls prevention programme for elderly people: evaluation of efficacy, effectiveness, and efficiency [thesis]. Dunedin (NZ): Univ. of Otago, 2001.

### Campbell 1999 {published and unpublished data}

- * Campbell AJ , Robertson MC , Gardner MM , Norton RN , Buchner DM . Psychotropic medication withdrawal and a home-based exercise program to prevent falls: a randomized, controlled trial. Journal of the American Geriatrics Society 1999;47(7):850-3. [MEDLINE: 10404930]
- Gardner MM , Buchner DM , Robertson MC , Campbell AJ . Practical implementation of an exercise-based falls prevention programme. Age and Ageing 2001;30(1):77-83. [MEDLINE: 11322678]
- Robertson MC , Campbell AJ , Gardner MM , Devlin N . Preventing injuries in older people by preventing falls: a meta-analysis of individual-level data. Journal of the American Geriatrics Society 2002;50:905-11. [MEDLINE: 12028179]
- Robertson MC . Development of a falls prevention programme for elderly people: evaluation of efficacy, effectiveness, and efficiency [thesis]. Dunedin (NZ): Univ. of Otago, 2001.

### Campbell 2005 {published data only}

- * Campbell AJ , Robertson MC , La Grow SJ , Kerse NM , Sanderson GF , Jacobs RJ , et al. Randomised controlled trial of prevention of falls in people aged > or =75 with severe visual impairment: the VIP trial. BMJ 2005;331(7520):817. [MEDLINE: 16183652]
- Jacobs R , Campbell AJ , Robertson MC . Randomized controlled trial of falls prevention in people 75 years and older with severe visual impairment [abstract]. American Academy of Optometry Meeting 2005 Dec 8-12; San Diego (CA). [CENTRAL: CN-00634854]
- Kiata L , Kerse NM , Hughes WE , Hayman KJ , Robertson MC , La Grow SJ , et al. Agreement and compliance with advice on removing mats or rugs by older people with visual impairments. Journal of Visual Impairment & Blindness 2008;102(3):167-72.
- La Grow SJ , Robertson MC , Campbell AJ , Clarke GA , Kerse NM . Reducing hazard related falls in people 75 years and older with significant visual impairment: how did a successful program work? Injury Prevention 2006;12(5):296-301. [MEDLINE: 17018669]

### Carpenter 1990 {published data only}

- Carpenter GI , Demopoulos GR . Screening the elderly in the community: controlled trial of dependency surveillance using a questionnaire administered by volunteers. BMJ 1990;300(6734):1253-6. [MEDLINE: 2354297]

### Carter 1997 {unpublished data only}

- Carter S , Campbell E , Sanson-Fisher R , Tiller K , Gillespie WJ . Trial data (as supplied 1997). Data on file.

### Carter 2002 {published data only}

- * Carter ND , Khan KM , McKay HA , Petit MA , Waterman C , Heinonen A , et al. Community-based exercise program reduces risk factors for falls in 65- to 75-year-old women with osteoporosis: Randomized controlled trial. CMAJ: Canadian Medical Association Journal 2002;167(9):997-1004. [MEDLINE: 12403738]
- Carter ND , Khan KM , Petit MA , Heinonen A , Waterman C , Donaldson MG , et al. Results of a 10 week community based strength and balance training programme to reduce fall risk factors: a randomised controlled trial in 65-75 year old women with osteoporosis. British Journal of Sports Medicine 2001;35(5):348-51. [MEDLINE: 11579072]

### Cerny 1998 {published and unpublished data}

- * Cerny K , Blanks R , Mohamed O , Schwab D , Robinson B , Russo A , Zizz C . The effect of a multidimensional exercise program on strength, range of motion, balance and gait in the well elderly [abstract]. Gait and Posture 1998;7(2):185-6.
- Cerny K . personal communication October 22 2002.

### Ciaschini 2009 {published data only}

[CTG: NCT00465387]

- * Ciaschini PM , Straus SE , Dolovich LR , Goeree RA , Leung KM , Woods CR , et al. Community-based intervention to optimise falls risk management: a randomised controlled trial. Age and Ageing 2009;38(6):724-30. [MEDLINE: 19767629]
- Ciaschini PM , Straus SE , Dolovich LR , Goeree RA , Leung KM , Woods CR , et al. Community-based randomised controlled trial evaluating falls and osteoporosis risk management strategies. Trials [Electronic Resource] 2008;9:62. [MEDLINE: 18983670]
- NCT00465387 . FORCE (Falls, Fracture, and Osteoporosis Risk Control Evaluation) study. clinicaltrials.gov/show/NCT00465387 (accessed 31 August 2011).

### Clemson 2004 {published data only}

- * Clemson L , Cumming RG , Kendig H , Swann M , Heard R , Taylor K . The effectiveness of a community-based program for reducing the incidence of falls in the elderly: a randomized trial. Journal of the American Geriatrics Society 2004;52(9):1487-94. [MEDLINE: 15341550]
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- Clemson L . Stepping On, reducing falls and building confidence: a practical program that works [abstract]. In: Lord SR , editors(s). Falls prevention in older people: from research to practice. Proceedings of the 1st Australian falls prevention conference; 2004 Nov 21-23; Sydney (AU). Randwick, NSW, Australia: Prince of Wales Medical Research Institute, 2004:68.
- Swann M , Clemson L . Evaluating falls efficacy following a community based falls prevention program for older people [abstract]. In: Lord SR , editors(s). Falls prevention in older people: from research to practice. Proceedings of the 1st Australian falls prevention conference; 2004 Nov 21-23; Sydney (AU). Randwick, NSW, Australia: Prince of Wales Medical Research Institute, 2004:34.

### Clemson 2010 {published data only}

- Clemson L , Singh MF , Bundy A , Cumming RG , Weissel E , Munro J , et al. LiFE Pilot Study: A randomised trial of balance and strength training embedded in daily life activity to reduce falls in older adults. Australian Occupational Therapy Journal 2010;57(1):42-50. [MEDLINE: 20854564]

### Close 1999 {published and unpublished data}

- * Close J , Ellis M , Hooper R , Glucksman E , Jackson S , Swift C . Prevention of falls in the elderly trial (PROFET): a randomised controlled trial. Lancet 1999;353(9147):93-7. [MEDLINE: 10023893]
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- Close J . personal communication Dec 9 2008.
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- Close JCT , Ellis M , Jackson SHD , Glucksman E , Swift CG . Interdisciplinary assessment of elderly people presenting to A&E with a fall [abstract]. Age and Ageing 1998;27(Suppl 1):20.
- Close JCT , Patel A , Hooper R , Glucksman E , Jackson SHD , Swift CG . PROFET - Improved clinical outcomes at no additional cost [abstract]. Age and Ageing 2000;29(Suppl 1):48.
- F0300115 . Can the incidence of falls in the elderly be reduced by a secondary prevention protocol? National Research Register (NRR) Archive. www.nihr.ac.uk/Pages/NRRArchiveSearch.aspx (accessed 23 February 2011). [NRR Publication ID: F0300115]

### Coleman 1999 {published data only}

- Coleman EA , Grothaus LC , Sandhu N , Wagner EH . Chronic care clinics: a randomized controlled trial of a new model of primary care for frail older adults. Journal of the American Geriatrics Society 1999;47(7):775-83. [MEDLINE: 10404919]

### Comans 2010 {published data only}

- ACTRN12605000056695 . Domiciliary versus centre-based rehabilitation of older community dwellers: Randomised trial with economic evaluation. www.anzctr.org.au/trial_view.aspx?ID=52 (accessed 30 November 2011).
- Comans TA , Brauer S , Haines T . Domiciliary vs centre-based rehabilitation of older community dwellers: randomised trial with economic evaluation. Open Geriatric Medicine Journal 2008;1(6):62-7.
- * Comans TA , Brauer SG , Haines TP . Randomized trial of domiciliary versus center-based rehabilitation: which is more effective in reducing falls and improving quality of life in older fallers? Journals of Gerontology Series A-Biological Sciences & Medical Sciences 2010;65(6):672-9.
- Comans TA , Currin ML , Brauer SG , Haines TP . Factors associated with quality of life and caregiver strain amongst frail older adults referred to a community rehabilitation service: implications for service delivery. Disability & Rehabilitation 2011;33(13-14):1215-21.

### Conroy 2010 {published data only}

[ISRCTN: 46584556]

- * Conroy S , Kendrick D , Harwood R , Gladman J , Coupland C , Sach T , et al. A multicentre randomised controlled trial of day hospital-based falls prevention programme for a screened population of community-dwelling older people at high risk of falls. Age and Ageing 2010;39(6):704-10.
- Conroy S , Morris R , Masud T . Multifactorial day hospital intervention to reduce falls in high risk older people in primary care: a multi-centre randomised controlled trial. ProFaNE (Prevention of Falls Network Europe) meeting; 2004 June 11-13; Manchester (UK).
- Irvine L , Conroy SP , Sach T , Gladman JR , Harwood RH , Kendrick D , et al. Cost-effectiveness of a day hospital falls prevention programme for screened community-dwelling older people at high risk of falls. Age and Ageing 2010;39(6):710-6.
- ISRCTN46584556 . Multifactorial day hospital intervention to reduce falls in high risk older people in primary care: a multi-centre randomised controlled trial. controlled-trials.com/ISRCTN46584556 (accessed 14 September 2011).
- Masud T , Coupland C , Drummond A , Gladman J , Kendrick D , Sach T , et al. Multifactorial day hospital intervention to reduce falls in high risk older people in primary care: a multi-centre randomised controlled trial [ISRCTN46584556]. Trials 2006;7:5-10.

### Cornillon 2002 {published data only}

- Cornillon E , Blanchon MA , Ramboatsisetraina P , Braize C , Beauchet O , Dubost V , et al. Effectiveness of falls prevention strategies for elderly subjects who live in the community with performance assessment of physical activities (before-after) [Impact d'un programme de prevention multidisciplinaire de la chute chez le sujet age autonome vivant a domicile, avec analyse avant-apres des performances physiques]. Annales de Readaptation et de Medecine Physique 2002;45(9):493-504. [MEDLINE: 12495822]

### Cumming 1999 {published data only}

- Cumming RG , Thomas M , Szonyi G , Frampton G , Salkeld G , Clemson L . Adherence to occupational therapist recommendations for home modifications for falls prevention. American Journal of Occupational Therapy 2001;55(6):641-8. [MEDLINE: 12959228]
- * Cumming RG , Thomas M , Szonyi G , Salkeld G , O'Neill E , Westbury C , et al. Home visits by an occupational therapist for assessment and modification of environmental hazards: a randomized trial of falls prevention. Journal of the American Geriatrics Society 1999;47(12):1397-1402. [MEDLINE: 10591231]
- Salkeld G , Cumming RG , O'Neill E , Thomas M , Szonyi G , Westbury C . The cost effectiveness of a home hazard reduction program to reduce falls among older persons. Australian and New Zealand Journal of Public Health 2000;24(3):265-71. [MEDLINE: 10937402]

### Cumming 2007 {published data only}

- Cumming RG , Ivers R , Clemson L , Cullen J , Hayes MF , Tanzer M , et al. Improving vision to prevent falls in frail older people: A randomized trial. Journal of the American Geriatrics Society 2007;55(2):175-81. [MEDLINE: 17302652]

### Dangour 2011 {published data only}

[ISRCTN: 48153354]

- Dangour AD , Albala C , Aedo C , Elbourne D , Grundy E , Walker D , et al. A factorial-design cluster randomised controlled trial investigating the cost-effectiveness of a nutrition supplement and an exercise programme on pneumonia incidence, walking capacity and body mass index in older people living in Santiago, Chile: the CENEX study protocol. Nutrition Journal 2007;6:14. [MEDLINE: 17615064]
- * Dangour AD , Albala C , Allen E , Grundy E , Walker DG , Aedo C , et al. Effect of a nutrition supplement and physical activity program on pneumonia and walking capacity in Chilean older people: a factorial cluster randomized trial. PLoS Medicine / Public Library of Science 2011;8(4):e1001023. [MEDLINE: 21526229]
- ISRCTN48153354 . Cost-effectiveness of nutritional supplementation and exercise programme among older people in Santiago, Chile. controlled-trials.com/ISRCTN48153354 (accessed 30 November 2011).
- Walker DG , Aedo C , Albala C , Allen E , Dangour AD , Elbourne D , et al. Methods for economic evaluation of a factorial-design cluster randomised controlled trial of a nutrition supplement and an exercise programme among healthy older people living in Santiago, Chile: the CENEX study. BMC Health Services Research 2009;9:85. [MEDLINE: 19473513]

### Dapp 2011 {published and unpublished data}

- Dapp U , Anders J , von Renteln-Kruse W , Meier-Baumgartner HP . Active health promotion in old age: Methodology of a preventive intervention programme provided by an interdisciplinary health advisory team for independent older people. Journal of Public Health 2005;13(3):122-7. [EMBASE: 2005287059]
- * Dapp U , Anders JA , von Renteln-Kruse W , Minder CE , Meier-Baumgartner HP , Swift CG , et al. A randomized trial of effects of health risk appraisal combined with group sessions or home visits on preventive behaviors in older adults. Journals of Gerontology. Series A, Biological Sciences and Medical Sciences 2011;66(5):591-8. [MEDLINE: 21350242]
- Dapp U . personal communication April 11 2011.
- Stuck AE , Kharicha K , Dapp U , Anders J , von Renteln-Kruse W , Meier-Baumgartner HP , et al. The PRO-AGE study: an international randomised controlled study of health risk appraisal for older persons based in general practice. BMC Medical Research Methodology 2007;7:2.

### Davis 2011a {published data only}

- Davis JC , Marra CA , Beattie BL , Robertson MC , Najafzadeh M , Graf P , et al. Sustained cognitive and economic benefits of resistance training among community-dwelling senior women: a 1-year follow-up study of the Brain Power study. Archives of Internal Medicine 2010;170(22):2036-8.
- Davis JC , Marra CA , Liu-Ambrose TY . Falls-related self-efficacy is independently associated with quality-adjusted life years in older women. Age & Ageing 2011;40(3):340-6.
- * Davis JC , Marra CA , Robertson MC , Khan KM , Najafzadeh M , Ashe MC , et al. Economic evaluation of dose-response resistance training in older women: a cost-effectiveness and cost-utility analysis. Osteoporosis International 2011;22(5):1355-66.
- Davis JC , Marra CA , Robertson MC , Najafzadeh M, Liu-Ambrose T . Sustained economic benefits of resistance training in community-dwelling senior women. Journal of the American Geriatrics Society 2011;59(7):1232-7. [MEDLINE: 21718265]
- Liu-Ambrose T , Davis JC , Nagamatsu LS , Hsu CL , Katarynych LA , Khan KM . Changes in executive functions and self-efficacy are independently associated with improved usual gait speed in older women. BMC Geriatrics 2010;10:25.
- Liu-Ambrose T , Nagamatsu LS , Graf P , Beattie BL , Ashe MC , Handy TC . Resistance training and executive functions: a 12-month randomized controlled trial. Archives of Internal Medicine 2010;170(2):170-8.

### Davison 2005 {published data only}

- * Davison J , Bond J , Dawson P , Steen IN , Kenny RA . Patients with recurrent falls attending Accident & Emergency benefit from multifactorial intervention - a randomised controlled trial. Age and Ageing 2005;34(2):162-8. [MEDLINE: 15716246]
- Kenny R . Syncope and Falls in the Emergency Room (SAFER 2) - A multidisciplinary post-fall assessment and intervention strategy for elderly recurrent fallers attending casualty (RRCC53R). The Research Findings Register. Summary number 1174. www.ReFeR.nhs.uk/ViewRecord.asp?ID=1174 (accessed 24 August 2006).
- N0009027144 . SAFER2 - Syncope and falls in the emergency room - an explanatory randomised controlled trial of a multidisciplinary post-fall assessment and intervention strategy in elderly recurrent fallers attending casualty. National Research Register (NRR) Archive. www.nihr.ac.uk/Pages/NRRArchiveSearch.aspx (accessed 23 February 2011). [NRR Publication ID: N0009027144]
- N0116069489 . Can the incidence of falls in the elderly be reduced by a secondary falls prevention protocol. National Research Register (NRR) Archive. www.nihr.ac.uk/Pages/NRRArchiveSearch.aspx (accessed 23 February 2011). [NRR Publication ID: N0116069489]
- N0145036249 . A post-fall intervention strategy after presentation to casualty. National Research Register (NRR) Archive. www.nihr.ac.uk/Pages/NRRArchiveSearch.aspx (accessed 23 February 2011). [NRR Publication ID: N0145036249]
- N0145049230 . A post-fall intervention strategy after presentation to casualty - Safer 2. National Research Register (NRR) Archive. www.nihr.ac.uk/Pages/NRRArchiveSearch.aspx (accessed 23 February 2011). [NRR Publication ID: N0145049230]
- N0503055776 . SAFER 2 - Syncope and falls in the emergency room - The Tyneside casualty falls intervention project. National Research Register (NRR) Archive. www.nihr.ac.uk/Pages/NRRArchiveSearch.aspx (accessed 23 February 2011). [NRR Publication ID: N0503055776]

### Day 2002 {published and unpublished data}

- Day L , Fildes B , Gordon I , Fitzharris M , Flamer H , Lord S . Randomised factorial trial of falls prevention among older people living in their own homes. BMJ 2002;325(7356):128-31. [MEDLINE: 12130606]
- * Fitzharris MP , Day L , Lord SR , Gordon I , Fildes B . The Whitehorse NoFalls trial: effects on fall rates and injurious fall rates. Age & Ageing 2010;39(6):728-33. [MEDLINE: 20817936]

### De Vries 2010 {published data only}

[ISRCTN: 11546541]

- * De Vries OJ , Peeters GM , Elders PJ , Muller M , Knol DL , Danner SA , et al. Multifactorial intervention to reduce falls in older people at high risk of recurrent falls: a randomized controlled trial. Archives of Internal Medicine 2010;170(13):1110-7. [MEDLINE: 20625015]
- ISRCTN11546541 . Prevention of fall incidents in patients with a high risk of falling; a multidisciplinary study on the effects of transmural health care compared to usual care. controlled-trials.com/ISRCTN11546541 (accessed 14 September 2011).
- Peeters GM , de Vries OJ , Elders PJ , Pluijm SM , Bouter LM , Lips P . Prevention of fall incidents in patients with a high risk of falling: design of a randomised controlled trial with an economic evaluation of the effect of multidisciplinary transmural care. BMC Geriatrics 2007;7:15. [MEDLINE: 17605771]
- Peeters GM , Heymans MW , de Vries OJ , Bouter LM , Lips P , van Tulder MW . Multifactorial evaluation and treatment of persons with a high risk of recurrent falling was not cost-effective. Osteoporosis International 2011;22(7):2187-96.

### Dhesi 2004 {published data only}

- Dhesi JK , Bearne L , Jackson SH , Moniz C , Hurley M , Swift CG , et al. Vitamin D supplementation improves the balance and functional performance of older people who fall [abstract]. Journal of the American Geriatrics Society 2002;50(4 Suppl):S5.
- * Dhesi JK , Jackson SH , Bearne LM , Moniz C , Hurley MV , Swift CG , et al. Vitamin D supplementation improves neuromuscular function in older people who fall. Age and Ageing 2004;33(6):589-95. [MEDLINE: 15501836]
- N0116016083 . A controlled intervention study of vitamin D supplementation on neuromuscular and psychomotor function in elderly people who fall. National Research Register (NRR) Archive. www.nihr.ac.uk/Pages/NRRArchiveSearch.aspx (accessed 23 February 2011). [NRR Publication ID: N0116016083]

### Di Monaco 2008 {published data only}

- Di Monaco M , Vallero F , De Toma E , De Lauso L , Tappero R , Cavanna A . A single home visit by an occupational therapist reduces the risk of falling after hip fracture in elderly women: a quasi-randomized controlled trial. Journal of Rehabilitation Medicine 2008;40(6):446-50. [MEDLINE: 18509559]

### Dukas 2004 {published data only}

[CTG: NCT00168909]

- Bock O , Boerst H , Runge M , Beller G , Touby F , Tuerk J , et al. Effect of alfacalcidol on volumetric bone mineral density measured by pQCT in alendronate-treated postmenopausal women with osteopenia or osteoporosis: 1 year interim analysis of the ALFA study [abstract]. Journal of Bone and Mineral Research 2007;22(Suppl 1):S215.
- Bock O , Boerst H , Runge M , Schacht E , Martus P , Felsenberg D . Effect of alfacalcidol on biochemical bone markers in alendronate-treated postmenopausal women with osteopenia or osteoporosis: 1 year interim analysis of the ALFA study [abstract]. Journal of Bone and Mineral Research 2006;21(Suppl 1):S306.
- Boerst H , Bock O , Runge M , Degner C , Stephan-Oelkers M , Umrath F , et al. Effects of alfacalcidol on bone markers and bone mineral density in alendronate-treated postmenopausal women with osteopenia or osteoporosis: one year interim analysis of the ALFA study [abstract]. Osteoporosis International 2007;18(Suppl 1):S90-1.
- * Dukas L , Bischoff HA , Lindpaintner LS , Schacht E , Birkner-Binder D , Damm TN , et al. Alfacalcidol reduces the number of fallers in a community-dwelling elderly population with a minimum calcium intake of more than 500 mg daily. Journal of the American Geriatrics Society 2004;52(2):230-6. [MEDLINE: 14728632]
- Dukas L , Bischoff HA , Lindpaintner LS , Schacht E , Birkner-Binder D , Thalmann B , et al. Alfacalcidol reduces the number of fallers and falls in community-dwelling elderly provided a mainimum total daily intake of 500mg calcium [abstract]. Calcified Tissue International 2003;72:371.
- Dukas L , Schacht E , Mazor Z , Stahelin HB . Treatment with alfacalcidol in elderly people significantly decreases the high risk of falls associated with a low creatinine clearance of <65 ml/min. Osteoporosis International 2005;16(2):198-203. [MEDLINE: 15221207]
- Dukas L , Schacht E , Stahelin HB . High risk of falls related to low d-hormone syndrome and its treatment with alfacalcidol. Osteoporosis International 2004;14(Suppl 1):S8-9.
- Dukas LC , Schacht E , Mazor Z , Stahelin HB . A new significant and independent risk factor for falls in elderly men and women: a low creatinine clearance of less than 65 ml/min. Osteoporosis International 2005;16(3):332-8. [MEDLINE: 15241585]
- NCT00168909 . Influence of alfacalcidol on falls in osteopenic/osteoporotic postmenopausal women (ALFA Study). clincialtrials.gov/show/NCT00168909 (accessed 31 August 2011).

### Elley 2008 {published data only}

- ACTRN12605000054617 . Falls Assessment Clinical Trial: randomised controlled trial of a multi-component intervention in primary health care to reduce falls amongst over 75 year old adults with a history of falling. www.anzctr.org.au/trial_view.aspx?ID=85 (accessed 30 November 2011).
- * Elley CR , Robertson MC , Garrett S , Kerse NM , MacKinlay E , Lawton B , et al. Effectiveness of a falls-and-fracture nurse coordinator to reduce falls: a randomized, controlled trial of at-risk older adults. Journal of the American Geriatrics Society 2008;56(8):1383-9. [MEDLINE: 18808597]
- Elley CR , Robertson MC , Kerse NM , Garrett S , McKinlay E , Lawton B , et al. Falls Assessment Clinical Trial (FACT): design, interventions, recruitment strategies and participant characteristics. BMC Public Health 2007;7:185. [MEDLINE: 17662156]

### Fabacher 1994 {published data only}

- Fabacher D , Josephson K , Pietruszka F , Linderborn K , Morley JE , Rubenstein LZ . An in-home preventive assessment program for independent older adults: a randomized controlled trial. Journal of the American Geriatrics Society 1994;42(6):630-8. [MEDLINE: 8201149]

### Faes 2011 {published data only}

[CTG: NCT00512655]

- Faes MC , Reelick MF , Esselink RA , Rikkert MG . Developing and evaluating complex healthcare interventions in geriatrics: the use of the medical research council framework exemplified on a complex fall prevention intervention. Journal of the American Geriatrics Society 2010;58(11):2212-21. [MEDLINE: 21039367]
- * Faes MC , Reelick MF , Melis RJ , Borm GF , Esselink RA , Olde Rikkert MG . Multifactorial fall prevention for pairs of frail community-dwelling older fallers and their informal caregivers: a dead end for complex interventions in the frailest fallers. Journal of the American Medical Directors Association 2011;12(6):451-8.
- NCT00512655 . Trial to reduce falls incidence rate in frail elderly (CP). clinicaltrials.gov/show/NCT00512655 (accessed 31 August 2011).
- Reelick MF , Faes MC , Esselink RA , Kessels RP , Olde Rikkert MG . How to perform a preplanned process evaluation for complex interventions in geriatric medicine: exemplified with the process evaluation of a complex falls-prevention program for community-dwelling frail older fallers. Journal of the American Medical Directors Association 2011;12(5):331-6.

### Fiatarone 1997 {published data only}

- Fiatarone MA , O'Neill EF , Doyle RN , Clements K . Efficacy of home-based resistance training in frail elders (Abstract 985). In: Andrews GR , editors(s). Abstracts of the 16th Congress of the International Association of Gerontology. Bedford Park, South Australia: World Congress of Gerontology Inc, 1997:323. [CENTRAL: CN-00405155]

### Foss 2006 {published data only}

- * Foss AJ , Harwood RH , Osborn F , Gregson RM , Zaman A , Masud T . Falls and health status in elderly women following second eye cataract surgery: a randomised controlled trial. Age and Ageing 2006;35(1):66-71. [MEDLINE: 16364936]
- N0192080923 . Randomised controlled trial of second eye cataract extraction to prevent falls in elderly women. National Research Register (NRR) Archive. www.nihr.ac.uk/Pages/NRRArchiveSearch.aspx (accessed 30 November 2011). [NRR Publication ID: N0192080923]
- Sach TH , Foss AJ , Gregson RM , Zaman A , Osborn F , Masud T , et al. Second-eye cataract surgery in elderly women: a cost-utility analysis conducted alongside a randomized controlled trial. Eye 2010;24(2):276-83. [MEDLINE: 19444295]

### Fox 2010 {published data only}

- Fox PJ , Vazquez L , Tonner C , Stevens JA , Fineman N , Ross LK . A randomized trial of a multifaceted intervention to reduce falls among community-dwelling adults. Health Education and Behavior 2010;37(6):831-48.

### Gallagher 1996 {published data only}

- Gallagher EM , Brunt H . Head over heels: impact of a health promotion program to reduce falls in the elderly. Canadian Journal on Aging 1996;15(1):84-96. [EMBASE 1996164172]

### Gallagher 2001 {published data only}

- Gallagher JC , Fowler S . Effect of estrogen, calcitriol and a combination of estrogen and calcitriol on bone mineral density and fractures in elderly women [abstract]. Journal of Bone and Mineral Research 1999;14(Suppl 1):S209.
- * Gallagher JC , Fowler SE , Detter JR , Sherman SS . Combination treatment with estrogen and calcitriol in the prevention of age-related bone loss. Journal of Clinical Endocrinology and Metabolism 2001;86(8):3618-28. [MEDLINE: 11502787]
- Gallagher JC , Haynatski G , Fowler S . Calcitriol therapy reduces falls and fractures in elderly women [abstract]. Calcified Tissue International 2003;72:334.
- Gallagher JC , Haynatzki G , Fowler S . Effect of estrogen, calcitriol or the combination of both on falls and non vertebral fractures in elderly women [abstract]. Journal of Bone and Mineral Research 2002;17(Suppl 1):S210.
- Gallagher JC , Rapuri P , Smith L . Falls are associated with decreased renal function and insufficient calcitriol production by the kidney. Journal of Steroid Biochemistry and Molecular Biology 2007;103(3-5):610-3. [MEDLINE: 17236758]
- Gallagher JC , Rapuri PB , Haynatzki G , Detter JR . Effect of discontinuation of estrogen, calcitriol, and the combination of both on bone density and bone markers. Journal of Clinical Endocrinology and Metabolism 2002;87(11):4914-23. [MEDLINE: 12414850]
- Gallagher JC , Rapuri PB , Smith LM . An age-related decrease in creatinine clearance is associated with an increase in number of falls in untreated women but not in women receiving calcitriol treatment. Journal of Clinical Endocrinology and Metabolism 2007;92(1):51-8. [MEDLINE: 17032712]
- Gallagher JC . The effects of calcitriol on falls and fractures and physical performance tests. Journal of Steroid Biochemistry and Molecular Biology 2004;89-90(1-5):497-501. [MEDLINE: 15225827]

### Gill 2008 {published and unpublished data}

- * Gill DP , Zou GY , Jones GR , Speechley M . Injurious falls are associated with lower household but higher recreational physical activities in community-dwelling older male veterans. Gerontology 2008;54(2):106-15. [MEDLINE: 18259094]
- Speechley M . Falls data (as supplied 03 June 2008). Data on file.

### Grahn Kronhed 2009 {published data only}

- Grahn Kronhed AC , Hallberg I , Odkvist L , Moller M . Effect of training on health-related quality of life, pain and falls in osteoporotic women. Advances in Physiotherapy 2009;11(3):154-65. [EMBASE: 2009642277]

### Grant 2005 {published and unpublished data}

[ISRCTN: 51647438]

- Anderson FH , Grant AM , Avenell A , Campbell MK , Cooper C , Donaldson C , et al. The RECORD Trial: an evaluation of calcium and/or vitamin D in the secondary prevention of osteoporotic fractures [abstract]. Bone 2005;36(Suppl 2):S122-3.
- Francis RM , Grant AM , RECORD Trial Group . The RECORD trial: a randomised double-blind study of calcium and/or vitamin D in the secondary prevention of low trauma fractures [abstract]. Age and Ageing 2005;34(Suppl 2):ii16.
- Grant AM , Anderson FH , . The RECORD trial: an evaluation of calcium and/or vitamin D in the secondary prevention of osteoporotic fractures [abstract]. Osteoporosis International 2005;16(Suppl 3):S4-5.
- Grant AM , Anderson FH . The Medical Research Council RECORD Trial: an evaluation of calcium and/or vitamin D in the secondary prevention of osteoporotic fractures [abstract]. Osteoporosis International 2004;15(Suppl 2):S13.
- * Grant AM , Avenell A , Campbell MK , McDonald AM , MacLennan GS , McPherson GC , et al. Oral vitamin D3 and calcium for secondary prevention of low-trauma fractures in elderly people (Randomised Evaluation of Calcium Or vitamin D, RECORD): a randomised placebo-controlled trial. Lancet 2005;365(9471):1621-8. [MEDLINE: 15885294]
- N0217084004 . Randomised placebo-controlled trial of daily oral vitamin D and calcium for the secondary prevention of osteoporosis related fractures in the elderly (RECORD). National Research Register (NRR) Archive. www.nihr.ac.uk/Pages/NRRArchiveSearch.aspx (accessed 23 February 2011). [NRR Publication ID: N0217084004]

### Gray-Donald 1995 {published data only}

- Gray-Donald K , Payette H , Boutier V . Randomized clinical trial of nutritional supplementation shows little effect on functional status among free-living frail elderly. Journal of Nutrition 1995;125(12):2965-71. [MEDLINE: 7500174]

### Greenspan 2005 {published data only}

- Greenspan SL , Resnick NM , Parker RA . Combination therapy with hormone replacement and alendronate for prevention of bone loss in elderly women: a randomized controlled trial. JAMA 2003;289(19):2525-33. [MEDLINE: 12759324]
- * Greenspan SL , Resnick NM , Parker RA . The effect of hormone replacement on physical performance in community-dwelling elderly women. American Journal of Medicine 2005;118(11):1232-9. [MEDLINE: 16271907]

### Haines 2009 {published data only}

- ACTRN12607000180415 . Assessment and prevention of falls, functional decline and hospital re-admission in older adults post-hospitalisation. www.anzctr.org.au/trial_view.aspx?ID=81910 (accessed 30 November 2011).
- * Haines TP , Russell T , Brauer SG , Erwin S , Lane P , Urry S , et al. Effectiveness of a video-based exercise programme to reduce falls and improve health-related quality of life among older adults discharged from hospital: a pilot randomized controlled trial. Clinical Rehabilitation 2009;23(11):973-85.

### Haran 2010 {published data only}

[CTG: NCT00350389]

- * Haran MJ , Cameron ID , Ivers RQ , Simpson JM , Lee BB , Tanzer M , et al. Effect on falls of providing single lens distance vision glasses to multifocal glasses wearers: VISIBLE randomised controlled trial. BMJ 2010;340:c2265. [MEDLINE: 20501583]
- Haran MJ , Lord SR , Cameron ID , Ivers RQ , Simpson JM , Lee BB , et al. Preventing falls in older multifocal glasses wearers by providing single-lens distance glasses: the protocol for the VISIBLE randomised controlled trial. BMC Geriatrics 2009;9:10. [MEDLINE: 19321012]
- NCT00350389 . VISIBLE study (Visual Intervention Strategy Incorporating Bifocal & Long-Distance Eyewear). clinicaltrials.gov/show/NCT00350389 (accessed 31 August 2001).

### Harari 2008 {published and unpublished data}

[ISRCTN: 28458424]

- * Harari D , Iliffe S , Kharicha K , Egger M , Gillmann G , von Renteln-Kruse W , et al. Promotion of health in older people: a randomised controlled trial of health risk appraisal in British general practice. Age and Ageing 2008;37(5):565-71. [MEDLINE: 18755784]
- Iliffe S , Kharicha K , Harari D , Swift C , Gillmann G , Stuck AE . Health risk appraisal in older people 2: the implications for clinicians and commissioners of social isolation risk in older people. British Journal of General Practice 2007;57(537):277-82. [MEDLINE: 17394730]
- ISRCTN28458424 . Disability prevention in the older population: use of information technology for health risk appraisal and prevention of functional decline. controlled-trials.com/ISRCTN28458424 (accessed 14 September 2011).
- Kharicha K , Iliffe S , Harari D , Swift C , Gillmann G , Stuck AE . Health risk appraisal in older people 1: are older people living alone an "at-risk" group? British Journal of General Practice 2007;57(537):271-6. [MEDLINE: 17394729]
- Stuck A. personal communication Oct 20 2010.
- Stuck AE , Kharicha K , Dapp U , Anders J , Von Renteln-Kruse W , Meier-Baumgartner HP , et al. The PRO-AGE study: an international randomised controlled study of health risk appraisal for older persons based in general practice. BMC Medical Research Methodology 2007;7:2. [MEDLINE: 17217546]

### Harwood 2004 {published data only}

- * Harwood RH , Sahota O , Gaynor K , Masud T , Hosking DJ . A randomised, controlled comparison of different calcium and vitamin D supplementation regimens in elderly women after hip fracture: The Nottingham Neck of Femur (NoNOF) study. Age and Ageing 2004;33(1):45-51. [MEDLINE: 14695863]
- The Nottingham Neck of Femur Study: the optimal role of vitamin D and calcium in elderly patients with established osteoporosis. National Research Register (NRR) Archive. www.nihr.ac.uk/Pages/NRRArchiveSearch.aspx (accessed 23 February 2011). [NRR Publication ID: N0192080773]

### Harwood 2005 {published data only}

- 192080923 . Randomised trial to assess the efficacy of expedited cataract extraction in the prevention of falls in elderly people awaiting cataract surgery. National Research Register (NRR) Archive. www.nihr.ac.uk/Pages/NRRArchiveSearch.aspx (accessed 30 November 2011). [NRR Publication ID: 192080923]
- Harwood RH , Foss A , Osborn F , Gregson R , Zaman A , Masud T . Falls and health status in elderly women following first eye cataract surgery: a randomised controlled trial [abstract]. Age and Ageing 2005;34(Suppl 1):i21.
- * Harwood RH , Foss AJ , Osborn F , Gregson RM , Zaman A , Masud T . Falls and health status in elderly women following first eye cataract surgery: a randomised controlled trial. British Journal of Ophthalmology 2005;89(1):53-9. [MEDLINE: 15615747]
- N0497017851 . Does expedited cataract extraction reduce the risk of falls in elderly people? - a randomised controlled trial. National Research Register (NRR) Archive. www.nihr.ac.uk/Pages/NRRArchiveSearch.aspx (accessed 30 November 2011). [NRR Publication ID: N0497017851]
- Sach TH , Foss AJ , Gregson RM , Zaman A , Osborn F , Masud T , et al. Falls and health status in elderly women following first eye cataract surgery: an economic evaluation conducted alongside a randomised controlled trial. British Journal of Ophthalmology 2007;91(12):1675-9. [MEDLINE: 17585002]

### Hauer 2001 {published and unpublished data}

- Hauer K , Pfisterer M , Schuler M , Bartsch P , Oster P . Two years later: A prospective long-term follow-up of a training intervention in geriatric patients with a history of severe falls. Archives of Physical Medicine and Rehabilitation 2003;84(10):1426-32. [MEDLINE: 14586908]
- * Hauer K , Rost B , Rutschle K , Opitz H , Specht N , Bartsch P , et al. Exercise training for rehabilitation and secondary prevention of falls in geriatric patients with a history of injurious falls. Journal of the American Geriatrics Society 2001;49(1):10-20. [MEDLINE: 11207837]
- Hauer K , Specht N , Schuler M , Bartsch P , Oster P . Intensive physical training in geriatric patients after severe falls and hip surgery. Age and Ageing 2002;31(1):49-57. [MEDLINE: 11850308]
- Hauer K . personal communication October 6 2006.
- Oster P , Hauer K , Specht N , Rost B , Baertsch P , Schlierf G . Strength and coordination training for prevention of falls in the elderly [Kraft- und Koordinationstraining zur Sturzprävention im Alter]. Zeitschrift fur Gerontologie und Geriatrie 1997;30(4):289-92. [MEDLINE: 9410508]

### Helbostad 2004 {published data only}

- Helbostad JL , Moe-Nilssen R , Sletvold O . Comparison of two types of exercise regimes on selected functional abilities for community-dwelling elderly at risk of falling [abstract]. XVI Conference of the International Society for Postural Gait Research; 2003 March 23-27; Sydney (Australia).
- * Helbostad JL , Sletvold O , Moe-Nilssen R . Effects of home exercises and group training on functional abilities in home-dwelling older persons with mobility and balance problems. A randomized study. Aging - Clinical and Experimental Research 2004;16(2):113-21. [MEDLINE: 15195985]
- Helbostad JL , Sletvold O , Moe-Nilssen R . Home training with and without additional group training in physically frail old people living at home: effect on health-related quality of life and ambulation. Clinical Rehabilitation 2004;18(5):498-508. [MEDLINE: 15293484]

### Hendriks 2008 {published data only}

[ISRCTN: 64716113]

- Bleijlevens MH , Hendriks MR , van Haastregt JC , Crebolder HF , van Eijk JT . Lessons learned from a multidisciplinary fall-prevention programme: the occupational-therapy element. Scandinavian Journal of Occupational Therapy 2010;17(4):319-25.
- Bleijlevens MH , Hendriks MR , van Haastregt JC , van Rossum E , Kempen, GI, et al. Process factors explaining the ineffectiveness of a multidisciplinary fall prevention programme: a process evaluation. BMC Public Health 2008;8:332.
- Hendriks MR , Bleijlevens MH , Van Haastregt JC , Crebolder HF , Diederiks JP , Evers SM , et al. Lack of effectiveness of a multidisciplinary fall-prevention program in elderly people at risk: a randomized controlled trial. Journal of the American Geriatrics Society 2008;56(8):1390–7. [MEDLINE: 18662214]
- Hendriks MR , Bleijlevens MH , Van Haastregt JC , De Bruijn FH , Diederiks JP , Mulder WJ , et al. A multidisciplinary fall prevention program for elderly persons: a feasibility study. Geriatric Nursing 2008;29(3):186-96. [MEDLINE: 18555160]
- * Hendriks MR , Evers SM , Bleijlevens MH , Van Haastregt JC , Crebolder HF , Van Eijk JT . Cost-effectiveness of a multidisciplinary fall prevention program in community-dwelling elderly people: A randomized controlled trial (ISRCTN 64716113). International Journal of Technology Assessment in Health Care 2008;24(2):193-202. [MEDLINE: 18400123]
- Hendriks MR , Van Haastregt JC , Diederiks JP , Evers SM , Crebolder HF , Van Eijk JT . Effectiveness and cost-effectiveness of a multidisciplinary intervention programme to prevent new falls and functional decline among elderly persons at risk: design of a replicated randomised controlled trial [ISRCTN64716113]. BMC Public Health 2005;5:6. [MEDLINE: 15651990]
- ISRCTN64716113 . Preventing further falls and functional decline among elderly persons presented to the Accident and Emergency (A&E) department with a fall: randomised controlled trial. controlled-trials.com/ISRCTN64716113 (accessed 30 November 2011).

### Hill 2000 {published data only}

- Crome P , Hill S , Mossman J , Stockdale P . A randomised controlled trial of a nurse led falls prevention clinic [abstract]. Journal of the American Geriatrics Society 2000;48(8):S78.
- Crome P . personal communication August 29 2006.
- * Hill S , Mossman J , Stockdale P , Crome P . A randomised controlled trial of a nurse-led falls prevention clinic [abstract]. Age and Ageing 2000;29(Suppl 2):20.

### Hogan 2001 {published data only}

- Hogan DB , MacDonald FA , Betts J , Bricker S , Ebly EM , Delarue B , et al. A randomized controlled trial of a community-based consultation service to prevent falls. CMAJ: Canadian Medical Association Journal 2001;165(5):537-43. [MEDLINE: 11563205]

### Hornbrook 1994 {published data only}

- * Hornbrook MC , Stevens VJ , Wingfield DJ , Hollis JF , Greenlick MR , Ory MG . Preventing falls among community-dwelling older persons: results from a randomized trial. Gerontologist 1994;34(1):16-23. [MEDLINE: 8150304]
- Hornbrook MC , Stevens VJ , Wingfield DJ . Seniors' program for injury control and education. Journal of the American Geriatrics Society 1993;41(3):309-14. [MEDLINE: 8440855]
- Stevens VJ , Hornbrook MC , Wingfield DJ , Hollis JF , Greenlick MR , Ory MG . Design and implementation of a falls prevention intervention for community-dwelling older persons. Behavior, Health, and Aging 1991/92;2(1):57-73.

### Huang 2004 {published data only}

- Huang TT , Acton GJ . Effectiveness of home visit falls prevention strategy for Taiwanese community-dwelling elders: randomized trial. Public Health Nursing 2004;21(3):247-56. [MEDLINE: 15144369]

### Huang 2005 {published data only}

- Huang TT , Liang SH . A randomized clinical trial of the effectiveness of a discharge planning intervention in hospitalized elders with hip fracture due to falling. Journal of Clinical Nursing 2005;14(10):1193-201. [MEDLINE: 16238765]

### Huang 2010 {published data only}

- Huang HC , Liu CY , Huang YT , Kernohan WG . Community-based interventions to reduce falls among older adults in Taiwan - long time follow-up randomised controlled study. Journal of Clinical Nursing 2010;19(7-8):959-68.

### Huang 2011 {published data only}

- Huang TT , Wang WS . Comparison of three established measures of fear of falling in community-dwelling older adults: psychometric testing. International Journal of Nursing Studies 2009;46(10):1313-9.
- * Huang TT , Yang LH , Liu CY . Reducing the fear of falling among community-dwelling elderly adults through cognitive-behavioural strategies and intense Tai Chi exercise: a randomized controlled trial. Journal of Advanced Nursing 2011;67(5):961-71.

### Iwamoto 2009 {published data only}

- Iwamoto J , Suzuki H , Tanaka K , Kumakubo T , Hirabayashi H , Miyazaki Y , et al. Preventative effect of exercise against falls in the elderly: A randomized controlled trial. Osteoporosis International 2009;20(7):1233-40.

### Jitapunkul 1998 {published data only}

- Jitapunkul S . A randomised controlled trial of regular surveillance in Thai elderly using a simple questionnaire administered by non-professional personnel. Journal of the Medical Association of Thailand 1998;81(5):352-6. [MEDLINE: 9623035]

### Kamide 2009 {published data only}

- Kamide N , Shiba Y , Shibata H . Effects on balance, falls, and bone mineral density of a home-based exercise program without home visits in community-dwelling elderly women: a randomized controlled trial. Journal of Physiological Anthropology 2009;28(3):115-22. [MEDLINE: 19483372]

### Kärkkäinen 2010 {published data only}

- Kärkkäinen M , Tuppurainen M , Salovaara K , Sandini L , Rikkonen T , Sirola J , et al. Effect of calcium and vitamin D supplementation on bone mineral density in women aged 65-71 years: A 3-year randomized population-based trial (OSTPRE-FPS). Osteoporosis International 2010;21(12):2047-55.
- Kärkkäinen M . Physical Capacity and Supplementation of Vitamin D and Calcium in Postmenopausal Women [thesis]. Kuopio: Univ. of Eastern Finland, 2011. Available from epublications.uef.fi/pub/urn_isbn_978-952-61-0310-5/urn_isbn_978-952-61-0310-5.pdf.
- * Kärkkäinen MK , Tuppurainen M , Salovaara K , Sandini L , Rikkonen T , Sirola J , et al. Does daily vitamin D 800 IU and calcium 1000 mg supplementation decrease the risk of falling in ambulatory women aged 65-71 years? A 3-year randomized population-based trial (OSTPRE-FPS). Maturitas 2010;65(4):359-65. [MEDLINE: 20060665]
- Salovaara K , Tuppurainen M , Kärkkäinen M , Rikkonen T , Sandini L , Sirola J , et al. Effect of vitamin D(3) and calcium on fracture risk in 65- to 71-year-old women: a population-based 3-year randomized, controlled trial--the OSTPRE-FPS. Journal of Bone & Mineral Research 2010;25(7):1487-95.

### Kemmler 2010 {published and unpublished data}

[CTG: NCT00267839]

- * Kemmler W , von Stengel S , Engelke K , Haberle L , Kalender WA . Exercise effects on bone mineral density, falls, coronary risk factors, and health care costs in older women: the randomized controlled senior fitness and prevention (SEFIP) study. Archives of Internal Medicine 2010;170(2):179-85.
- Kemmler W , von Stengel S , Engelke K , Haberle L , Mayhew JL , Kalender WA . Exercise, body composition, and functional ability: a randomized controlled trial. American Journal of Preventive Medicine 2010;38(3):279-87.
- Kemmler W , von Stengel S , Engelke K , Kalender WA . Exercise decreases the risk of metabolic syndrome in elderly females. Medicine & Science in Sports & Exercise 2009;41(2):297-305.
- NCT00267839 . Effect of exercise on risk-factors of elderly women. clinicaltrials.gov/show/NCT00267839 (accessed 30 November 2011).

### Kenny 2001 {published data only}

- * Kenny RA , Richardson DA , Steen N , Bexton RS , Shaw FE , Bond J . Carotid sinus syndrome: a modifiable risk factor for nonaccidental falls in older adults (SAFE PACE). Journal of the American College of Cardiology 2001;38(5):1491-6. [MEDLINE: 11691528]
- Kenny RA , Richardson DA . Carotid sinus syndrome and falls in older adults. American Journal of Geriatric Cardiology 2001;10(2):97-9. [MEDLINE: 11253467]
- Kenny RA , Seifer CM . SAFE PACE - Syncope and falls in the elderly - pacing and carotid sinus evaluation: a randomised controlled trial of cardiac pacing in older patients with falls and carotid sinus hypersensitivity. American Journal of Geriatric Cardiology 1999;8(2):87-90.
- Richardson DA , Steen N , Bond J , Bexton R , Kenny RA . Cardiac pacing reduces falls in carotid sinus hypersensitivity [abstract]. Age and Ageing 2000;29(Suppl 1):46.

### Kingston 2001 {published data only}

- Kingston P , Jones M , Crome P . A RCT of health visitor (HV) intervention in falls [abstract]. Age and Ageing 2001;30(Suppl 1):40.
- * Kingston P , Jones M , Lally F , Crome P . Older people and falls: A randomized controlled trial of a health visitor (HV) intervention. Reviews in Clinical Gerontology 2001;11(3):209-14. [EMBASE: 2002061828]
- Kingston PA . Older people and 'falls' a randomised control trial of health visitor intervention [thesis]. Stoke-on-Trent (UK): Keele University, 1998.
- N0498009612 . Elderly people and accidents: a prospective analysis of accidental causation among elderly populations and their post discharge requirements. National Research Register (NRR) Archive. www.nihr.ac.uk/Pages/NRRArchiveSearch.aspx (accessed 23 February 2011). [NRR Publication ID: N0498009612]

### Korpelainen 2006 {published data only}

[CTG: NCT00655577]

- Korpelainen R , Keinanen-Kiukaanniemi S , Heikkinen J , Vaananen K , Korpelainen J . Effect of exercise on extraskeletal risk factors for hip fractures in elderly women with low BMD: a population-based randomized controlled trial. Journal of Bone & Mineral Research 2006;21(5):772-9. [MEDLINE: 16734393]
- * Korpelainen R , Keinanen-Kiukaanniemi S , Heikkinen J , Vaananen K , Korpelainen J . Effect of impact exercise on bone mineral density in elderly women with low BMD: a population-based randomized controlled 30-month intervention. Osteoporosis International 2006;17(1):109-18. [MEDLINE: 15889312]
- Korpelainen R , Keinanen-Kiukaanniemi S , Nieminen P , Heikkinen J , Vaananen K , Korpelainen J . Long-term outcomes of exercise: follow-up of a randomized trial in older women with osteopenia. Archives of Internal Medicine 2010;170(17):1548-56. [MEDLINE: 20876406]
- NCT00655577 . Exercise and prevention of hip fractures. clinicaltrials.gov/show/NCT00655577 (accessed 31 August 2011).

### Lannin 2007 {published data only}

- Lannin NA , Clemson L , McCluskey A , Lin CW , Cameron ID , Barras S . Feasibility and results of a randomised pilot-study of pre-discharge occupational therapy home visits. BMC Health Services Research 2007;7:42. [MEDLINE: 17355644]

### Latham 2003 {published data only}

- Latham NK , Anderson CS , Lee A , Bennett DA , Moseley A , Cameron ID . A randomized, controlled trial of quadriceps resistance exercise and vitamin D in frail older people: The Frailty Interventions Trial in Elderly Subjects (FITNESS). Journal of the American Geriatrics Society 2003;51:291-9. [MEDLINE: 12588571]

### Li 2005 {published data only}

- * Li F , Harmer P , Fisher KJ , McAuley E , Chaumeton N , Eckstrom E , et al. Tai Chi and fall reductions in older adults: a randomized controlled trial. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences 2005;60(2):187-94. [MEDLINE: 5814861]
- Li F , Harmer P , Fisher KJ , McAuley E . Tai Chi: improving functional balance and predicting subsequent falls in older persons. Medicine and Science in Sports and Exercise 2004;36(12):2046-52. [MEDLINE: 15570138]

### Lightbody 2002 {published data only}

- * Lightbody E , Watkins C , Leathley M , Sharma A , Lye M . Evaluation of a nurse-led falls prevention programme versus usual care: a randomized controlled trial. Age and Ageing 2002;31(3):203-10. [MEDLINE: 12006310]
- N0500000414 . Fallers attending casualty. National Research Register (NRR) Archive. www.nihr.ac.uk/Pages/NRRArchiveSearch.aspx (accessed 23 February 2011). [NRR Publication ID: N0500000414]

### Lin 2007 {published and unpublished data}

- Lin MR , Wolf SL , Hwang HF , Gong SY , Chen CY . A randomized, controlled trial of fall prevention programs and quality of life in older fallers. Journal of the American Geriatrics Society 2007;55(4):499-506. [MEDLINE: 17397426]

### Liu-Ambrose 2004 {published data only}

- Liu-Ambrose T , Khan KM , Eng JJ , Lord SR , McKay HA . Balance confidence improves with resistance or agility training: Increase is not correlated with objective changes in fall risk and physical abilities. Gerontology 2004;50(6):373-82. [MEDLINE: 15477698]
- Liu-Ambrose T , Khan KM , Eng JJ , Lord SR , McKay HA . Strength or agility training significantly reduces fall risk compared to posture training in 75 to 85 year old women with low bone density: a six month RCT [abstract]. XVI th conference of the International Society for Postural and Gait Research; 2003 March 23-27;Sydney (Australia).
- Liu-Ambrose TY , Khan KM , Eng JJ , Gillies GL , Lord SR , McKay HA . The beneficial effects of group-based exercises on fall risk profile and physical activity persist 1 year postintervention in older women with low bone mass: follow-up after withdrawal of exercise. Journal of the American Geriatrics Society 2005;53(10):1767-73. [MEDLINE: 16181178]
- * Lui-Ambrose T , Khan KM , Eng JJ , Janssen PA , Lord SR , McKay HA . Resistance and agility training reduce fall risk in women aged 75 to 85 with low bone mass: a 6-month randomized, controlled trial. Journal of the American Geriatrics Society 2004;52(5):657-65. [MEDLINE: 15086643]

### Liu-Ambrose 2008 {published data only}

[CTG: NCT00323596]

- Davis J , Guy P , Liu-Ambrose T , Donaldson M , Robertson M , Khan K , et al. Cost-effectiveness analysis of the Otago home-based strength and balance retraining in senior fallers [abstract]. Journal of Nutrition, Health & Aging 2009;13(Suppl 1):S436. [DOI: https://doi.org/10.1007/s12603-009-0095-9]
- Donaldson MG . Falls risk in frail seniors: clinical and methodological studies [thesis]. Vancouver (CA): Univ. of British Columbia, 2007.
- * Liu-Ambrose T , Donaldson MG , Ahamed Y , Graf P , Cook WL , Close J , et al. Otago home-based strength and balance retraining improves executive functioning in older fallers: a randomized controlled trial. Journal of the American Geriatrics Society 2008;56(10):1821-30.
- NCT00323596 . Trial of a home based strength and balance retraining program in reducing falls risk factors. clinicaltrials.gov/show/NCT00323596 (accessed 31 August 2011).

### Logan 2010 {published data only}

[ISRCTN: 10538608]

- ISRCTN10538608 . Evaluation of the costs and benefits of computerised on-scene decision support for emergency ambulance personnel to assess and plan appropriate care for older people who have fallen: a randomised controlled trial. controlled-trials.com/ISRCTN10538608 (accessed 23 September 2011).
- * Logan PA , Coupland CA , Gladman JR , Sahota O , Stoner-Hobbs V , Robertson K , et al. Community falls prevention for people who call an emergency ambulance after a fall: randomised controlled trial. BMJ 2010;340:c2102. [MEDLINE: 20460331]
- N0171168738 . An evaluation of the Primary Care falls prevention services for older fallers presenting to the ambulance service. National Research Register (NRR) Archive. www.nihr.ac.uk/Pages/NRRArchiveSearch.aspx (accessed 30 November 2011). [NRR Publication ID: N0171168738]

### Logghe 2009 {published data only}

[ISRCTN: 98840266]

- Logghe IH , Verhagen AP , Rademaker AC , Zeeuwe PE , Bierma-Zeinstra SM , van Rossum E , et al. Explaining the ineffectiveness of a Tai Chi fall prevention training for community-living older people: A process evaluation alongside a randomized clinical trial (RCT). Archives of Gerontology & Geriatrics 2011;52(3):357-62.
- * Logghe IH , Zeeuwe PE , Verhagen AP , Wijnen-Sponselee RM , Willemsen SP , Bierma-Zeinstra SM , et al. Lack of effect of Tai Chi Chuan in preventing falls in elderly people living at home: a randomized clinical trial. Journal of the American Geriatrics Society 2009;57(1):70-5.
- Zeeuwe PE , Verhagen AP , Bierma-Zeinstra SM , Van Rossum E , Faber MJ , Koes BW . The effect of Tai Chi Chuan in reducing falls among elderly people: design of a randomized clinical trial in the Netherlands [ISRCTN98840266]. BMC Geriatrics 2006;6:6. [MEDLINE: 16573825]

### Lord 1995 {published data only}

- * Lord SR , Ward JA , Williams P , Strudwick M . The effect of a 12-month exercise trial on balance, strength, and falls in older women: a randomized controlled trial. Journal of the American Geriatrics Society 1995;43:1198-206. [MEDLINE: 7594152]
- Lord SR , Ward JA , Williams P , Zivanovic E . The effects of a community exercise program on fracture risk factors in older women. Osteoporosis International 1996;6(5):361-7. [MEDLINE: 8931030]

### Lord 2003 {published data only}

- Lord SR , Castell S , Corcoran J , Dayhew J , Matters B , Shan A , et al. The effect of group exercise on physical functioning and falls in frail older people living in retirement villages: a randomized, controlled trial. Journal of the American Geriatrics Society 2003;51(12):1685-92. [MEDLINE: 14687345]

### Lord 2005 {published data only}

- Lord SR , Tiedemann A , Chapman K , Munro B , Murray SM , Gerontology M , et al. The effect of an individualized fall prevention program on fall risk and falls in older people: a randomized, controlled trial. Journal of the American Geriatrics Society 2005;53(8):1296-304. [MEDLINE: 16078954]

### Luukinen 2007 {published data only}

- * Luukinen H , Lehtola S , Jokelainen J , Vaananen-Sainio R , Lotvonen S , Koistinen P . Pragmatic exercise-oriented prevention of falls among the elderly: A population-based, randomized, controlled trial. Preventive Medicine 2007;44(3):265-71. [MEDLINE: 17174387]
- Luukinen H , Lehtola S , Jokelainen J , Vaananen-Sainio R , Lotvonen S , Koistinen P . Prevention of disability by exercise among the elderly: a population-based, randomized, controlled trial. Scandinavian Journal of Primary Health Care 2006;24(4):199-205. [MEDLINE: 17118858]

### Madureira 2010 {published data only}

- * Madureira MM , Bonfa E , Takayama L , Pereira RM . A 12-month randomized controlled trial of balance training in elderly women with osteoporosis: improvement of quality of life. Maturitas 2010;66(2):206-11. [MEDLINE: 20395080]
- Madureira MM , Pereira RMR . A 12-month randomized controlled trial of balance training in elderly women with osteoporosis: Improvement of quality of life and reduction of falls [abstract]. Arthritis and Rheumatism 2009;60(10 Suppl):1496. [EMBASE: 70372871]
- Madureira MM , Takayama L , Gallinaro AL , Caparbo VF , Costa RA , Pereira RM . Balance training program is highly effective in improving functional status and reducing the risk of falls in elderly women with osteoporosis: a randomized controlled trial. Osteoporosis International 2007;18(4):419-25. [MEDLINE: 17089080]

### Mahoney 2007 {published data only}

- Gleason CE , Gangnon RE , Fischer BL , Mahoney JE . Increased risk for falling associated with subtle cognitive impairment: secondary analysis of a randomized clinical trial. Dementia & Geriatric Cognitive Disorders 2009;27(6):557-63. [MEDLINE: 19602883]
- * Mahoney JE , Shea TA , Przybelski R , Jaros L , Gangnon R , Cech S , et al. Kenosha County falls prevention study: a randomized, controlled trial of an intermediate-intensity, community-based multifactorial falls intervention. Journal of the American Geriatrics Society 2007;55(4):489-98. [MEDLINE: 17397425]

### Markle-Reid 2010 {published data only}

[CTG: NCT00463658]

- * Markle-Reid M , Browne G , Gafni A , Roberts J , Weir R , Thabane L , et al. The effects and costs of a multifactorial and interdisciplinary team approach to falls prevention for older home care clients 'at risk' for falling: a randomized controlled trial. Canadian Journal of Aging 2010;29(1):139-61.
- Markle-Reid M , Miles M , Vaitonis V , Henderson S , Browne Weir R , et al. From Isolation to Integration: the Effects and Costs of a Multifactorial and Interdisciplinary Team Approach to Falls Prevention for Frail Older Home Care Clients. Final Research Report. Edmonton: Canadian Patient Safety Institute, 2008.
- NCT00463658 . Interdisciplinary falls prevention for seniors. clinicaltrials.gov/show/NCT00463658 (accessed 31 August 2011).

### McKiernan 2005 {published data only}

- McKiernan FE . A simple gait-stabilizing device reduces outdoor falls and nonserious injurious falls in fall-prone older people during the winter. Journal of the American Geriatrics Society 2005;53(6):943-7. [MEDLINE: 15935015]

### McMurdo 1997 {published data only}

- McMurdo ME , Mole PA , Paterson CR . Controlled trial of weight bearing exercise in older women in relation to bone density and falls. BMJ 1997;314(7080):596. [MEDLINE: 9055716]

### McMurdo 2009 {published data only}

- McMurdo ME , Price RJ , Shields M , Potter J , Stott DJ . Should oral nutritional supplementation be given to undernourished older people upon hospital discharge? A controlled trial. Journal of the American Geriatrics Society 2009;57(12):2239-45.

### Means 2005 {published data only}

- Means KM , Rodell DE , O'Sullivan PS . Balance, mobility, and falls among community-dwelling elderly persons: effects of a rehabilitation exercise program. American Journal of Physical Medicine and Rehabilitation 2005;84(4):238-50. [MEDLINE: 15785256]

### Meredith 2002 {published data only}

- Meredith S , Feldman P , Frey D , Giammarco L , Hall K , Arnold K , et al. Improving medication use in newly admitted home healthcare patients: a randomized controlled trial. Journal of the American Geriatrics Society 2002;50(9):1484-91. [MEDLINE: 12383144]

### Morgan 2004 {published data only}

[CTG: NCT00013078]

- DeVito CA , Morgan RO , Duque M , Abdel-Moty E , Virnig BA . Physical performance effects of low-intensity exercise among clinically defined high-risk elders. Gerontology 2003;49(3):146-54. [MEDLINE: 12679604]
- * Morgan RO , Virnig BA , Duque M , Abdel-Moty E , DeVito CA . Low-intensity exercise and reduction of the risk for falls among at-risk elders. Journals of Gerontology. Series A, Biological Sciences and Medical Sciences 2004;59(10):1062-7. [MEDLINE: 15528779]
- NCT00013078 . Safe-Grip fall/injuries intervention: a randomized controlled trial. clinicaltrials.gov/show/NCT00013078 (accessed 2 September 2011).

### Newbury 2001 {published data only}

- Newbury J , Marley J . Preventive home visits to elderly people in the community. Visits are most useful for people aged >75 [letter]. BMJ 2000;321(7529):512.
- * Newbury JW , Marley JE , Beilby J . A randomised controlled trial of the outcome of health assessment of people aged 75 years and over. Medical Journal of Australia 2001;175(2):104-7. [MEDLINE: 11556409]

### Nikolaus 2003 {published data only}

- * Nikolaus T , Bach M . Preventing falls in community-dwelling frail older people using a home intervention team (HIT): Results from the randomized falls-HIT trial. Journal of the American Geriatrics Society 2003;51(3):300-5. [MEDLINE: 12588572]
- Nikolaus T , Specht-Leible N , Bach M , Wittmann-Jennewein C , Oster P , Schlierf G . Effectiveness of hospital-based geriatric evaluation and management and home intervention team (GEM-HIT). Rationale and design of a 5-year randomized trial. Zeitschrift fur Gerontologie und Geriatrie 1995;28(1):47-53. [MEDLINE: 7773832]

### Nitz 2004 {published and unpublished data}

- * Nitz JC , Choy NL . The efficacy of a specific balance-strategy training programme for preventing falls among older people: a pilot randomised controlled trial. Age and Ageing 2004;33(1):52-8. [MEDLINE: 14695864]
- Nitz JC . personal communication May 6 2005.

### Pardessus 2002 {published data only}

- Pardessus V , Puisieux F , Di P , Gaudefroy C , Thevenon A , Dewailly P . Benefits of home visits for falls and autonomy in the elderly: A randomized trial study. American Journal of Physical Medicine and Rehabilitation 2002;81(4):247-52. [MEDLINE: 11953541]

### Parry 2009 {published data only}

- Parry SW , Steen N , Bexton RS , Tynan M , Kenny RA . Pacing in elderly recurrent fallers with carotid sinus hypersensitivity: a randomised, double-blind, placebo controlled crossover trial. Heart 2009;95(5):405-9. [MEDLINE: 19124530]

### Pereira 1998 {published data only}

- Kriska AM , Bayles C , Cauley JA , LaPorte RE , Sandler RB , Pambianco G . A randomized exercise trial in older women: increased activity over two years and the factors associated with compliance. Medicine and Science in Sports and Exercise 1986;18(5):557-62. [EMBASE: 1987035259]
- * Pereira MA , Kriska AM , Day RD , Cauley JA , LaPorte RE , Kuller LH . A randomized walking trial in postmenopausal women: effects on physical activity and health 10 years later. Archives of Internal Medicine 1998;158(15):1695-701. [MEDLINE: 9701104]
- Pereira MA . Ten year follow-up of a randomized exercise trial in post-menopausal women [thesis]. Pittsburgh (USA): Univ. of Pittsburgh, 1996. [Proquest Digital Dissertations Publication Number AAT 97 16627]

### Perry 2008 {published data only}

- Perry SD , Radtke A , McIlroy WE , Fernie GR , Maki BE . Efficacy and effectiveness of a balance-enhancing insole. Journals of Gerontology Series A-Biological Sciences & Medical Sciences 2008;63(6):595-602.

### Pfeifer 2000 {published data only}

- Minne HW , Pfeifer M , Begerow B , Nachtigall D , Hansen C . Vitamin D and calcium supplementation reduces falls in elderly women via improvement of body sway and normalisation of blood pressure; a prospective, randomised, and double-blind study [abstract]. Osteoporosis International 2000;11(Suppl 2):S115.
- * Pfeifer M , Begerow B , Minne HW , Abrams C , Nachtigall D , Hansen C . Effects of a short-term vitamin D and calcium supplementation on body sway and secondary hyperparathyroidism in elderly women. Journal of Bone and Mineral Research 2000;15(6):1113-8. [MEDLINE: 10841179]
- Pfeifer M , Begerow B , Nachtigall D , Hansen C . Prevention of falls-related fractures: vitamin D reduces body sway in the elderly - a prospective, randomized, double blind study [abstract]. Bone 1998;23(5 Suppl 1):1110.

### Pfeifer 2009 {published data only}

- Minne HW , Dobnig H , Pfeifer M , Suppan K . Effects of vitamin D and calcium supplementation on falls and parameters of muscle function: a prospective, randomized, double-blind multicenter study [abstract]. Osteoporosis International 2006;17(Suppl 2):S212.
- Minne HW , Dobnig H , Pfeifer M , Suppan K . Effects of vitamin D and calcium supplementation on falls and parameters of muscle-function - a prospective, randomized, double-blind multi-center study [abstract]. Osteoporosis International 2006;17(Suppl 1):S21.
- * Pfeifer M , Begerow B , Minne HW , Suppan K , Fahrleitner-Pammer A , Dobnig H . Effects of a long-term vitamin D and calcium supplementation on falls and parameters of muscle function in community-dwelling older individuals. Osteoporosis International 2009;20(2):315-22. [MEDLINE: 18629569]
- Pfeifer M , Dobnig H , Begerow B , Suppan K . Effects of vitamin D and calcium supplementation on falls and parameters of muscle function: a prospective randomized, double-blind multi-centre study [abstract]. Journal of Bone and Mineral Research 2004;19(Suppl 1):S58.
- Pfeifer M , Dobnig H , Minne HW , Suppan K . Effects of vitamin D and calcium supplementation on falls and parameters of muscle function - a prospective, randomized, double-blind multi-center study [abstract]. Osteoporosis International 2005;16(Suppl 3):S45.
- Pfeifer M , Dobnig H , Minne HW , Suppan K . The effects of a supplementation with vitamin D and calcium on falls and muscle function parameters in older people - Results of a prospective, randomised, double-blind multi-centre study [abstract] [Die Wirkungen einer Vitamin-D- und Calcium-Supplementation auf Sturze und Parameter der Muskelfunktion beim alteren Menschen - Ergebnisse einer prospektiven, randomisierten, doppelblinden Multi-center-Studie]. Medizinische Klinik 2005;100:28.

### Pighills 2011 {published data only}

[ISRCTN: 07575807 ]

- ISRCTN07575807 . Reducing home hazards to prevent falls in older people. controlled-trials.com/ISRCTN07575807 (accessed 30 November 2011).
- Pighills A , Torgerson DJ , Sheldon T . Publicity does not increase recruitment to falls prevention trials: the results of two quasi-randomized trials. Journal of Clinical Epidemiology 2009;62(12):1332-5.
- * Pighills AC , Torgerson DJ , Sheldon TA , Drummond AE , Bland JM . Environmental assessment and modification to prevent falls in older people. Journal of the American Geriatrics Society 2011;59(1):26-33. [MEDLINE: 21226674]

### Pit 2007 {published data only}

- Pit SW , Byles JE , Henry DA , Holt L , Hansen V , Bowman DA . A Quality Use of Medicines program for general practitioners and older people: a cluster randomised controlled trial. Medical Journal of Australia 2007;187(1):23-30. [MEDLINE: 17605699]

### Porthouse 2005 {published and unpublished data}

- Cochayne S . personal communication August 16 2005.
- * Porthouse J , Cochayne S , King C , Saxon L , Steele E , Aspray T , et al. Randomised controlled trial of calcium and supplementation with cholecalciferol (vitamin D3) for prevention of fractures in primary care. BMJ 2005;330(7498):1003. [MEDLINE: 15860827]
- Porthouse J , Cockayne S , King C , Saxon L , Steele E , Aspray T . Randomised controlled trial of calcium and vitamin D supplementation for fracture prevention in primary care [abstract]. Osteoporosis.International. 2005;16(Suppl 3):S27.
- Porthouse J , Cockayne S , King C , Saxon L , Steele E , Aspray T . Randomised controlled trial of calcium and vitamin D supplementation for fracture prevention in primary care [abstract]. Osteoporosis International 2004;15(Suppl 2):S13.
- Puffer S . Calcium and vitamin D in primary care. Compliance results from a randomised controlled trial [abstract]. Osteoporosis International 2003;14(Suppl 4):S8.

### Prince 2008 {published data only}

- ACTRN12606000331538 . Effects of vitamin D and calcium on bone and falls in an elderly population of Australian women selected for their history of falling. www.anzctr.org.au/trial_view.aspx?ID=1486 (accessed 30 November 2011).
- * Prince RL , Austin N , Devine A , Dick IM , Bruce D , Zhu K . Effects of ergocalciferol added to calcium on the risk of falls in elderly high-risk women. Archives of Internal Medicine 2008;168(1):103-8. [MEDLINE: 18195202]

### Ralston 2011 {published data only}

- Ralston SH , Binkley N , Boonen S , Kiel DP , Reginster J-Y, Roux C , et al. Randomized trial of alendronate plus vitamin D3 versus standard care in osteoporotic postmenopausal women with vitamin D insufficiency. Calcified Tissue International 2011;88(6):485-94.

### Reid 2006 {published data only}

- Bolland MJ , Bacon CJ , Horne AM , Mason BH , Ames RW , Wang TK , et al. Vitamin D insufficiency and health outcomes over 5 y in older women. American Journal of Clinical Nutrition 2010;91(1):82-9.
- Bolland MJ , Barber PA , Doughty RN , Mason B , Horne A , Ames R , et al. Vascular events in healthy older women receiving calcium supplementation: randomised controlled trial. BMJ 2008;336(7638):262-6.
- Reid IR , Bolland MJ . Calcium supplementation and vascular disease. Climacteric 2008;11(4):280-6.
- * Reid IR , Mason B , Horne A , Ames R , Reid HE , Bava U , et al. Randomized controlled trial of calcium in healthy older women. American Journal of Medicine 2006;119(9):777-85.

### Reinsch 1992 {published data only}

- El-Faizy M , Reinsch S . Home safety intervention for the prevention of falls. Physical & Occupational Therapy in Geriatrics 1994;12(3):33-49. [EMBASE: 1994365778]
- MacRae PG , Feltner ME , Reinsch S . A 1-year exercise program for older women: effects on falls, injuries, and physical performance. Journal of Aging and Physical Activity 1994;2:127-42.
- * Reinsch S , MacRae P , Lachenbruch PA , Tobis JS . Attempts to prevent falls and injury: a prospective community study. Gerontologist 1992;32:450-6. [MEDLINE: 1427246]
- Tobis J , Reinsch S , McRae P , Lachenbruch T . Experimental intervention at senior centres for the prevention of falls [abstract]. Journal of the American Geriatrics Society 1990;38(8):A28.

### Resnick 2002 {published data only}

- Resnick B . Testing the effect of the WALC intervention on exercise adherence in older adults. Journal of Gerontological Nursing 2002;28(6):40-9. [MEDLINE: 12071273]

### Robertson 2001a {published and unpublished data}

- Gardner MM , Buchner DM , Robertson MC , Campbell AJ . Practical implementation of an exercise-based falls prevention programme. Age and Ageing 2001;30(1):77-83. [MEDLINE: 11322678]
- Robertson MC , Campbell AJ , Gardner MM , Devlin N . Preventing injuries in older people by preventing falls: a meta-analysis of individual-level data. Journal of the American Geriatrics Society 2002;50(5):905-11. [MEDLINE: 12028179]
- * Robertson MC , Devlin N , Gardner MM , Campbell AJ . Effectiveness and economic evaluation of a nurse delivered home exercise programme to prevent falls. 1: Randomised controlled trial. BMJ 2001;322(7288):697-701. [MEDLINE: 11264206]
- Robertson MC . Development of a falls prevention programme for elderly people: evaluation of efficacy, effectiveness, and efficiency [thesis]. Dunedin (NZ): Univ. of Otago, 2001.

### Robson 2003 {published data only}

- Robson E , Edwards J , Gallagher E , Baker D . Steady as you go (SAYGO): A falls-prevention program for seniors living in the community. Canadian Journal on Aging 2003;22(2):207-16. [EMBASE: 2003344777]

### Rubenstein 2000 {published data only}

- Rubenstein LZ , Josephson KR , Trueblood PR , Loy S , Harker JO , Pietruszka FM , et al. Effects of a group exercise program on strength, mobility, and falls among fall-prone elderly men. Journals of Gerontology. Series A, Biological Sciences and Medical Sciences 2000;55(6):M317-21. [MEDLINE: 10843351]

### Rubenstein 2007 {published and unpublished data}

- Alessi C . personal communication June 10 2007.
- Josephson K . personal communication November 20 2007.
- * Rubenstein LZ , Alessi CA , Josephson KR , Trinidad Hoyl M , Harker JO , Pietruszka FM . A randomized trial of a screening, case finding, and referral system for older veterans in primary care. Journal of the American Geriatrics Society 2007;55(2):166-74. [MEDLINE: 17302651]

### Russell 2010 {published data only}

[CTG: NCT00217360]

- ACTRN12605000672651 . A randomised controlled trial to reduce further falls and injuries for older fallers presenting to an Emergency Department. www.anzctr.org.au/trial_view.aspx?ID=849 (accessed 14 September 2011).
- Hill K , Womer M , Russell M , Blackberry I , McGann A . Fear of falling in older fallers presenting at emergency departments. Journal of Advanced Nursing 2010;66(8):1769-79.
- NCT00217360 . RCT to reduce further falls and injuries for older fallers presenting to an Emergency Department. clinicaltrials.gov/ct2/show/NCT00217360 (accessed 14 September 2011).
- * Russell MA , Hill KD , Day LM , Blackberry I , Schwartz J , Giummarra MJ , et al. A randomized controlled trial of a multifactorial falls prevention intervention for older fallers presenting to Emergency Departments. Journal of the American Geriatrics Society 2010;58:2265–74.

### Ryan 1996 {published data only}

- Ryan JW , Spellbring AM . Implementing strategies to decrease risk of falls in older women. Journal of Gerontological Nursing 1996;22(12):25-31. [MEDLINE: 9060344]

### Ryan 2010 {published data only}

- Kenny RA , Seifer C . SAFE PACE 2: Syncope and falls in the elderly pacing and carotid sinus evaluation: A randomized control trial of cardiac pacing in older patients with falls and carotid sinus hypersensitivity. American Journal of Geriatric Cardiology 1999;8(2):87. [EMBASE: 1999111785]
- Kenny RA . SAFE PACE 2: Syncope and falls in the elderly - Pacing and carotid sinus evaluation - A randomized controlled trial of cardiac pacing in older patients with falls and carotid sinus hypersensitivity. Europace 1999;1(1):69-72. [PMID: 11220545 ]
- M0021042314 . Syncope and falls in the elderly - Pacing and carotid sinus evaluation: a randomised control trial of cardiac pacing in older patients with falls and carotid sinus hypersensitivity. National Research Register (NRR) Archive. www.nihr.ac.uk/Pages/NRRArchiveSearch.aspx (accessed 23 February 2011). [NRR Publication ID: M0021042314]
- N0123090677 . SAFE PACE 2 - Syncope and falls in the elderly - pacing and carotid sinus evaluation: a randomised control trial of cardiac pacing in older patients with falls and carotid sinus hypersensitivity. National Research Register (NRR) Archive. www.nihr.ac.uk/Pages/NRRArchiveSearch.aspx (accessed 23 February 2011). [NRR Publication ID: N0123090677 ]
- N0183041329 . SAFE PACE 2 trial R&D ref 99/66 Syncope and falls in the elderly - pacing and carotid sinus evaluation randomised control trial of cardiac pacing in older patients with falls and carotid sinus hypersensitivity. National Research register (NRR) archive. www.nihr.ac.uk/Pages/NRRArchiveSearch.aspx (accessed 30 November 2011). [NRR Publication ID: N0183041329]
- N0232077535 . Syncope and falls in the elderly - pacing and carotid sinus evaluation: a randomised controlled trial of cardiac pacing in older patients with falls and carotid sinus hypersensitivity Safe Pace 2. National Research Register (NRR) Archive. www.nihr.ac.uk/Pages/NRRArchiveSearch.aspx (accessed 23 February 2011). [NRR Publication ID: N0232077535]
- N0263052736 . A randomised control trial of cardiac pacing in older patients with falls and carotid sinus hypersensitivity. National Research Register (NRR) Archive. www.nihr.ac.uk/Pages/NRRArchiveSearch.aspx (accessed 23 February 2011). [NRR Publication ID: N0263052736]
- N0277056223 . SAFE PACE 2 - Syncope and falls in the elderly - pacing and carotid sinus evaluation: a randomised control trial of cardiac pacing in older patients with falls and carotid sinus hypersensitivity. National Research Register (NRR) Archive. www.nihr.ac.uk/Pages/NRRArchiveSearch.aspx (accessed 23 February 2011). [NRR Publication ID: N0277056223]
- N0504077783 . SAFE PACE 2 : Syncope and falls in the elderly - pacing and carotid sinus evaluation: A randomised controlled trial of cardiac pacing in older patients with falls and carotid sinus hypersensitivity. (SAFE PACE 2). National Research Register (NRR) Archive. www.nihr.ac.uk/Pages/NRRArchiveSearch.aspx (accessed 23 February 2011). [NRR Publication ID: N0504077783]
- * Ryan DJ , Steen N , Seifer CM , Kenny RA . Carotid sinus syndrome, should we pace? A multicentre, randomised control trial (Safepace 2). Heart 2010;96(5):347-51.

### Salminen 2009 {published and unpublished data}

[CTG: NCT00247546]

- Kivela S-L, Aarnio P , Asikainen E , Hyttinen H , Isoaho R , Karra E , et al. Prevention of injurious falls and fractures in ageing and aged population [abstract]. ProFaNE (Prevention of Falls Network Europe) meeting; 2004 June 11-13; Manchester (UK).
- NCT00247546 . Prevention of falls and injurious falls among elderly people. clinicaltrials.gov/ct2/show/NCT00247546 (accessed 14 September 2011).
- Salminen M , Vahlberg T , Kivela SL . The long-term effect of a multifactorial fall prevention programme on the incidence of falls requiring medical treatment. Public Health 2009;123(12):809-13. [MEDLINE: 19958918]
- Salminen M , Vahlberg T , Sihvonen S , Piirtola M , Isoaho R , Aarnio P , et al. Effects of risk-based multifactorial fall prevention program on maximal isometric muscle strength in community-dwelling aged: a randomized controlled trial. Aging-Clinical & Experimental Research 2008;20(5):487-93. [MEDLINE: 19039292]
- Salminen M , Vahlberg T , Sihvonen S , Sjosten N , Piirtola M , Isoaho R , et al. Effects of risk-based multifactorial fall prevention on postural balance in the community-dwelling aged: a randomized controlled trial. Archives of Gerontology & Geriatrics 2009;48(1):22-7. [MEDLINE: 17950944]
- Salminen MJ , Vahlberg TJ , Salonoja MT , Aarnio PT , Kivelä S-L . Falls data (as supplied 20 May 2008). Data on file.
- * Salminen MJ , Vahlberg TJ , Salonoja MT , Aarnio PT , Kivela SL . Effect of a risk-based multifactorial fall prevention program on the incidence of falls. Journal of the American Geriatrics Society 2009;57(4):612-9. [MEDLINE: 19392952]
- Salonoja M , Salminen M , Aarnio P , Vahlberg T , Kivela SL . One-time counselling decreases the use of benzodiazepines and related drugs among community-dwelling older persons. Age & Ageing 2010;39(3):313-9. [MEDLINE: 20089547]
- Salonoja M , Salminen M , Vahlberg T , Aarnio P , Kivela S-L . Withdrawal of psychotropic drugs decreases the risk of falls requiring treatment. Archives of Gerontology and Geriatrics 2011;54(1):160-7.
- Sjosten NM , Salonoja M , Piirtola M , Vahlberg T , Isoaho R , Hyttinen H , et al. A multifactorial fall prevention programme in home-dwelling elderly people: A randomized-controlled trial. Public Health 2007;121(4):308-18. [MEDLINE: 17320125]
- Sjosten NM , Salonoja M , Piirtola M , Vahlberg TJ , Isoaho R , Hyttinen HK , et al. A multifactorial fall prevention programme in the community-dwelling aged: predictors of adherence. European Journal of Public Health 2007;17(5):464-70. [MEDLINE: 17208952 ]
- Sjosten NM , Vahlberg TJ , Kivela S-L . The effects of multifactorial fall prevention on depressive symptoms among the aged at increased risk of falling. International Journal of Geriatric Psychiatry 2008;23(5):504-10. [EMBASE: 2008251008]
- Vaapio S , Salminen M , Vahlberg T , Kivela SL . Increased muscle strength improves managing in activities of daily living in fall-prone community-dwelling older women. Aging-Clinical & Experimental Research 2011;23(1):42-8.
- Vaapio S , Salminen M , Vahlberg T , Sjosten N , Isoaho R , Aarnio P , et al. Effects of risk-based multifactorial fall prevention on health-related quality of life among the community-dwelling aged: a randomized controlled trial. Health & Quality of Life Outcomes 2007;5:20. [MEDLINE: 17462083]

### Sanders 2010 {published data only}

[ISRCTN: 83409867]

- ACTRN12605000658617 . Vitamin D intervention to prevent falls and fractures and to promote mental well-being. www.anzctr.org.au/trial_view.aspx?ID=767 (accessed 30 November 2011).
- Sanders K , Stuart A , Williamson E , Simpson J , Kotowicz M , Nicholson G . The efficacy of high-dose oral vitamin D3 administered once a year: A randomised, double-blind, placebo-controlled trial (vital D study) for falls and fractures in older women [abstract]. Osteoporosis International 2011;22:S104-5.
- Sanders K . personal communication November 29 2007.
- Sanders KM , Stuart AL , Kotowicz MA , Nicholson GC . Annual feedback is an effective tool for a sustained increase in calcium intake among older women. Nutrients. 2010;2(9):1018-25.
- Sanders KM , Stuart AL , Merriman EN , Read ML , Kotowicz MA , Young D , et al. Trials and tribulations of recruiting 2,000 older women onto a clinical trial investigating falls and fractures: Vital D study. BMC Medical Research Methodology 2009;9:78. [MEDLINE: 19930724]
- Sanders KM , Stuart AL , Williamson EJ , Simpson JA , Kotowicz MA , Nicholson GC . Annual high-dose oral vitamin D for falls and fractures in elderly women: A randomised, double-blind, placebo-controlled trial (Vital D Study) [abstract]. Osteoporosis International 2010;21(Suppl 1):S30.
- * Sanders KM , Stuart AL , Williamson EJ , Simpson JA , Kotowicz MA , Young D , et al. Annual high-dose oral vitamin D and falls and fractures in older women: a randomized controlled trial. [Erratum appears in JAMA 2010;303(23):2357]. JAMA 2010;303(18):1815-22. [MEDLINE: 20460620]

### Sato 2005a (Retracted) {published data only}

- * Sato Y , Kanoko T , Satoh K , Iwamoto J . Menatetrenone and vitamin D2 with calcium supplements prevent nonvertebral fracture in elderly women with Alzheimer's disease. Bone 2005;36(1):61-8. [MEDLINE: 15664003]
- Sato Y , Kanoko T , Satoh K , Iwamoto J . RETRACTED: Menatetrenone and vitamin D2 with calcium supplements prevent nonvertebral fracture in elderly women with Alzheimer's disease. Bone 2018;106:213. [MEDLINE: 15664003]

### Schrijnemaekers 1995 {published data only}

- Schrijnemaekers VJ , Haveman MJ . Effects of preventive outpatient geriatric assessment: short-term results of a randomized controlled study. Home Health Care Services Quarterly 1995;15(2):81-97. [MEDLINE: 10143898]

### Sherrington 2004 {published and unpublished data}

- Sherrington C , Lord SR , Herbert RD . A randomised controlled trial of weight-bearing versus non-weight-bearing exercise for improving physical ability after hip fracture and completion of usual care [abstract]. XVI th conference of the International Society for Postural and Gait Research; 2003 March 23-27;Sydney (Australia).
- Sherrington C , Lord SR , Herbert RD . A randomised trial of weight-bearing versus non-weight-bearing exercise for improving physical ability in inpatients after hip fracture. Australian Journal of Physiotherapy 2003;49(1):15-22. [MEDLINE: 12600250]
- * Sherrington C , Lord SR , Herbert RD . A randomized controlled trial of weight-bearing versus non-weight-bearing exercise for improving physical ability after usual care for hip fracture. Archives of Physical Medicine and Rehabilitation 2004;85(5):710-6. [MEDLINE: 15129393]
- Sherrington C . Personal communication October 30 2004.
- Sherrington C . The effects of exercise on physical ability following fall-related hip fracture [thesis]. Sydney (Australia): Univ. of New South Wales, 2001.

### Shigematsu 2008 {published data only}

- * Shigematsu R , Okura T , Nakagaichi M , Tanaka K , Sakai T , Kitazumi S , et al. Square-stepping exercise and fall risk factors in older adults: a single-blind, randomized controlled trial. Journals of Gerontology Series A-Biological Sciences & Medical Sciences 2008;63(1):76-82. [MEDLINE: 18245764]
- Shigematsu R , Okura T , Sakai T , Rantanen T . Square-stepping exercise versus strength and balance training for fall risk factors. Aging-Clinical & Experimental Research 2008;20(1):19-24. [MEDLINE: 18283224]

### Shumway-Cook 2007 {published data only}

- Shumway-Cook A , Silver I , Mary L , York S , Cummings P , Koepsell T . The effectiveness of a community-based multifactorial intervention on falls and fall risk factors in community living older adults: a randomized, controlled trial... CSM 2007 [abstract]. Journal of Geriatric Physical Therapy 2006;29(3):117.
- * Shumway-Cook A , Silver IF , LeMier M , York S , Cummings P , Koepsell TD . Effectiveness of a community-based multifactorial intervention on falls and fall risk factors in community-living older adults: a randomized, controlled trial. Journals of Gerontology. Series A, Biological Sciences and Medical Sciences 2007;62(12):1420-7. [MEDLINE: 18166695]

### Shyu 2010 {published data only}

- Shyu YI , Liang J , Wu CC , Cheng HS , Chen MC . An interdisciplinary intervention for older Taiwanese patients after surgery for hip fracture improves health-related quality of life. BMC Musculoskeletal Disorders 2010;11:225. [MEDLINE: 20920220]
- Shyu YI , Liang J , Wu CC , Su JY , Cheng HS , Chou SW , et al. Interdisciplinary intervention for hip fracture in older Taiwanese: benefits last for 1 year. Journals of Gerontology Series A-Biological Sciences & Medical Sciences 2008;63(1):92-7. [MEDLINE: 18245766]
- * Shyu YI , Liang J , Wu CC , Su JY , Cheng HS , Chou SW , et al. Two-year effects of interdisciplinary intervention for hip fracture in older Taiwanese. Journal of the American Geriatrics Society 2010;58(6):1081-9. [MEDLINE: 20722845]

### Skelton 2005 {published data only}

- * Skelton D , Dinan S , Campbell M , Rutherford O . Tailored group exercise (Falls Management Exercise -- FaME) reduces falls in community-dwelling older frequent fallers (an RCT). Age and Ageing 2005;34(6):636-9. [EMBASE: 2005539610]
- Skelton D . personal communication February 1 2005.
- Skelton DA , Dinan SM , Campbell M , Rutherford OM . FaME (Falls Management Exercise): An RCT on the effects of a 9-month group exercise programme in frequently falling community dwelling women aged 65 and over [abstract]. Journal of Aging and Physical Activity 2004;12(3):457-8.
- Skelton DA , Dinan SM . Exercise for falls management: Rationale for an exercise programme aimed at reducing postural instability. Physiotherapy Theory and Practice 1999;15(2):105-20. [EMBASE: 1999232161]
- Skelton DA , Stranzinger K , Dinan S , Rutherford OM . BMD improvements following FaME (Falls Management Exercise) in frequently falling women age 65 and over: an RCT... 7th World Congress on Aging and Physical Activity [abstract]. Journal of Aging and Physical Activity 2008;16 Suppl:S89-90.

### Smith 2007 {published data only}

- Anderson FH , Smith HE , Raphael HM , Cooper C . Intramuscular vitamin D increased serum 1,25-dihydroxycholecalciferol but did not affect 25-hydroxy-cholecalciferol levels in healthy older adults [abstract]. Journal of Bone and Mineral Research 2000;15(Suppl 1):S315.
- Anderson FH , Smith HE , Raphael HM , Crozier SR , Cooper C . Effect of annual intramuscular vitamin D3 supplementation on fracture risk in 9440 community-living older people: the Wessex fracture prevention trial [abstract]. Journal of Bone and Mineral Research 2004;19(Suppl 1):S57.
- Arden NK , Crozier S , Smith H , Anderson F , Edwards C , Raphael H , et al. Knee pain, knee osteoarthritis, and the risk of fracture. Arthritis and Rheumatism 2006;55(4):610-5. [MEDLINE: 16874784]
- N0108081272 . Primary prevention of fractures in the elderly: evaluating the effectiveness of annual vitamin D supplementation linked with primary care in influenza immunisation. National Research Register (NRR) Archive. www.nihr.ac.uk/Pages/NRRArchiveSearch.aspx (accessed 23 February 2011). [NRR Publication ID: N0108081272]
- N0187062321 . Wessex fracture prevention study. National Research Register (NRR) Archive. www.nihr.ac.uk/Pages/NRRArchiveSearch.aspx (accessed 23 February 2011). [NRR Publication ID: N0187062321]
- Raphael H , Smith H , Anderson F , Cooper C . Tackling the problems of trial management in primary care - experience from the Wessex research network fracture prevention study of annual vitamin D injection in older people [abstract]. Osteoporosis International 2000;11(Suppl 1):S63-4.
- Smith H , Anderson F , Raphael H , Cooper C . The Wessex research network fracture prevention study - a large pragmatic trial of annual vitamin D injection in older people [abstract]. Osteoporosis International 2000;11(Suppl 1):S64.
- Smith H , Anderson F , Raphael H , Crozier S , Cooper C . Effect of annual intramuscular vitamin D supplementation on fracture risk: population-based, randomised, double-blind, placebo-controlled trial [abstract]. Osteoporosis International 2004;15(Suppl 1):S8.
- * Smith H , Anderson F , Raphael H , Maslin P , Crozier S , Cooper C . Effect of annual intramuscular vitamin D on fracture risk in elderly men and women - a population-based, randomised, double-blind, placebo-controlled trial. Rheumatology 2007;46(12):1852-7. [MEDLINE: 17998225]

### Smulders 2010 {published data only}

[CTG: NCT00432692]

- NCT00432692 . Falls prevention in osteoporosis. clinicaltrials.gov/show/NCT00432692 (accessed 31 August 2011).
- Smulders E , Weerdesteyn V , Duysens J , Laan R , Lankveld W . Falls prevention in persons with osteoporosis: A randomized clinical trial [abstract]. Arthritis and Rheumatism 2009;60(10 Suppl):1883. [EMBASE: 70373615]
- * Smulders E , Weerdesteyn V , Groen BE , Duysens J , Eijsbouts A , Laan R , et al. Efficacy of a short multidisciplinary falls prevention program for elderly persons with osteoporosis and a fall history: a randomized controlled trial. Archives of Physical Medicine and Rehabilitation 2010;91:1705-11.

### Spice 2009 {published and unpublished data}

[CTG: NCT00130624]

- George S , Spice C , Morotti W , Rose J , Harris S , Gordon C . The Winchester Falls Project: a cluster randomised community intervention trial of secondary prevention of falls in community dwelling older people [abstract]. Journal of Epidemiology and Community Health 2006;60(Suppl 1):A17.
- N0278078805 . The Winchester Falls Project: A randomised controlled trial of multidisciplinary assessment in the secondary prevention of falls. National Research Register (NRR) Archive. www.nihr.ac.uk/Pages/NRRArchiveSearch.aspx (accessed 23 February 2011). [NRR Publication ID: N0278078805]
- NCT00130624 . The Winchester Falls Project: A cluster randomised community intervention trial of secondary prevention of falls in community-dwelling older people. clinicaltrials.gov/show/NCT00130624 (accessed 30 November 2011).
- Spice C , Morotti W , Dent T , George S , Rose J , Gordon C . The Winchester Falls Project: A randomised controlled trial of secondary falls prevention [abstract]. Age and Ageing 2005;34(Suppl 2):ii18.
- * Spice C , Morotti W , George S , Dent T , Rose J , Harris S , et al. The Winchester falls project: a randomised controlled trial of secondary prevention of falls in older people. Age and Ageing 2009;38(1):33-40. [MEDLINE: 18829689]
- Spice C . personal communication December 24 2006.

### Spink 2011 {published data only}

- ACTRN12608000065392 . Podiatry treatment to improve balance and prevent falls in older people. www.anzctr.org.au/trial_view.aspx?ID=82558 (accessed 30 November 2011).
- Spink MJ , Fotoohabadi MR , Wee E , Landorf KB , Hill KD , Lord SR , et al. Predictors of adherence to a multifaceted podiatry intervention for the prevention of falls in older people. BMC Geriatrics 2011;11:51.
- * Spink MJ , Menz HB , Fotoohabadi MR , Wee E , Landorf KB , Hill KD , et al. Effectiveness of a multifaceted podiatry intervention to prevent falls in community dwelling older people with disabling foot pain: randomised controlled trial. BMJ 2011;342:d3411.
- Spink MJ , Menz HB , Lord SR . Efficacy of a multifaceted podiatry intervention to improve balance and prevent falls in older people: study protocol for a randomised trial. BMC Geriatrics 2008;8:30. [MEDLINE: 19025668]

### Steadman 2003 {published and unpublished data}

- Kalra L . personal communication March 27 2006.
- * Steadman J , Donaldson N , Kalra L . A randomized controlled trial of an enhanced balance training program to improve mobility and reduce falls in elderly patients. Journal of the American Geriatrics Society 2003;51(6):847-52. [MEDLINE: 12757574]

### Steinberg 2000 {published and unpublished data}

- Peel N , Cartwright C , Steinberg M . Monitoring slips, trips and falls in the older community: preliminary results. Health Promotion Journal of Australia 1998;8(2):148-50.
- Peel N , Steinberg M , Williams G . Home safety assessment in the prevention of falls among older people. Australian and New Zealand Journal of Public Health 2000;24(5):536-9. [MEDLINE: 11109693]
- Peel N . personal communication October 10 2007.
- * Steinberg M , Cartwright C , Peel N , Williams G . A sustainable programme to prevent falls and near falls in community dwelling older people: results of a randomised trial. Journal of Epidemiology and Community Health 2000;54(3):227-32. [MEDLINE: 10746118]

### Stevens 2001 {published data only}

- * Stevens M , Holman CD , Bennett N , De Klerk N . Preventing falls in older people: Outcome evaluation of a randomized controlled trial. Journal of the American Geriatrics Society 2001;49(11):1448-55. [MEDLINE: 11890582]
- Stevens M , Holman CD , Bennett N . Preventing falls in older people: Impact of an intervention to reduce environmental hazards in the home. Journal of the American Geriatrics Society 2001;49(11):1442-7. [MEDLINE: 11890581]

### Suman 2011 {published data only}

- Suman S , Myint PK , Clark A , Das P , Ring L , Trepte NJ . Community-based fall assessment compared with hospital-based assessment in community-dwelling older people over 65 at high risk of falling: a randomized study. Aging-Clinical & Experimental Research 2011;23(1):35-41.

### Suzuki 2004 {published data only}

- Suzuki T , Kim H , Yoshida H , Ishizaki T . Randomized controlled trial of exercise intervention for the prevention of falls in community-dwelling elderly Japanese women. Journal of Bone and Mineral Metabolism 2004;22(6):602-11. [MEDLINE: 15490272]

### Swanenburg 2007 {published data only}

- Swanenburg J , De Bruin ED , Stauffacher M , Mulder T , Uebelhart D . Effects of exercise and nutrition on postural balance and risk of falling in elderly people with decreased bone mineral density: randomized controlled trial pilot study. Clinical Rehabilitation 2007;21(6):523-34. [MEDLINE: 17613583]

### Tinetti 1994 {published data only}

- King MB , Tinetti ME . A multifactorial approach to reducing injurious falls. Clinics in Geriatric Medicine 1996;12(4):745-59. [MEDLINE: 8890114]
- Koch M , Gottschalk M , Baker DI , Palumbo S , Tinetti ME . An impairment and disability assessment and treatment protocol for community-living elderly persons. Physical Therapy 1994;74:286-94; discussion 295-8.
- Rizzo JA , Baker DI , McAvay G , Tinetti ME . The cost-effectiveness of a multifactorial targeted prevention program for falls among community elderly persons. Medical Care 1996;34(9):954-69. [MEDLINE: 8792783]
- Tinetti ME , Baker DI , Garrett PA , Gottschalk M , Koch ML , Horwitz RI . Yale FICSIT: risk factor abatement strategy for fall prevention. Journal of the American Geriatrics Society 1993;41:315-20. [MEDLINE: 8440856]
- * Tinetti ME , Baker DI , McAvay G , Claus EB , Garrett P , Gottschalk M , et al. A multifactorial intervention to reduce the risk of falling among elderly people living in the community. New England Journal of Medicine 1994;331(13):821-7. [MEDLINE: 8078528]
- Tinetti ME , McAvay G , Claus E . Does multiple risk factor reduction explain the reduction in fall rate in the Yale FICSIT Trial? Frailty and Injuries Cooperative Studies of Intervention Techniques. American Journal of Epidemiology 1996;144(4):389-99. [MEDLINE: 8712196]
- Tinetti ME . Prevention of falls and fall injuries in elderly persons: a research agenda. Preventive Medicine 1994;23(5):756-62. [MEDLINE: 7845954]

### Trivedi 2003 {published data only}

- Trivedi DP , Doll R , Tee Khaw K . Effect of four monthly oral vitamin D3 (cholecalciferol) supplementation on fractures and mortality in men and women living in the community: randomised double blind controlled trial. BMJ 2003;326(7387):469-72. [MEDLINE: 12609940]

### Trombetti 2011 {published data only}

[CTG: NCT01107288]

- NCT01107288 . Effects of a music-based multitask exercises program on gait, balance and fall risk in the elderly. clinicaltrials.gov/show/NCT01107288 (accessed 31 August 2011).
- Trombetti A , Hars M , Herrmann F , Kressig R , Ferrari S , Rizzoli R . "Jaques-Dalcroze eurhythmics" improves gait and prevents falls in the elderly [Prevention des chutes par une methode d'exercice en musique (rythmique Jaques-Dalcroze)]. Revue Medicale Suisse 2011;7(299):1305-8.
- Trombetti A , Hars M , Herrmann F , Kressig R , Ferrari S , Rizzoli R . A randomized controlled trial of music-based multitask training on gait, balance and fall risk. Osteoporosis International 2011;22(Suppl 1):S119.
- * Trombetti A , Hars M , Herrmann FR , Kressig RW , Ferrari S , Rizzoli R . Effect of music-based multitask training on gait, balance, and fall risk in elderly people: a randomized controlled trial. Archives of Internal Medicine 2011;171(6):525-33.

### Van Haastregt 2000 {published data only}

- * Van Haastregt JC , Diederiks JP , Van Rossum E , De Witte LP , Voorhoeve PM , Crebolder HF . Effects of a programme of multifactorial home visits on falls and mobility impairments in elderly people at risk: randomised controlled trial. BMJ 2000;321(7267):994-8. [MEDLINE: 11039967]
- Van Haastregt JC , Van Rossum E , Diederiks JP , De Witte LP , Voorhoeve PM , Crebolder HF . Process-evaluation of a home visit programme to prevent falls and mobility impairments among elderly people at risk. Patient Education and Counseling 2002;47(4):301-9. [MEDLINE: 12135821]
- Van Haastregt JC , Van Rossum E , Diederiks JP , Voorhoeve PM , De Witte LP , Crebolder HF . Preventing falls and mobility problems in community-dwelling elders: the process of creating a new intervention. Geriatric Nursing 2000;21(6):309-14. [MEDLINE: 11135129]

### Van Rossum 1993 {published data only}

- Van Rossum E , Frederiks CM , Philipsen H , Portengen K , Wiskerke J , Knipschild P . Effects of preventive home visits to elderly people. BMJ 1993;307(6895):27-32. [MEDLINE: 8343668]

### Vellas 1991 {published data only}

- Vellas B , Albarede JL . A randomized clinical trial on the value of raubasine-dihydroergocristine (Iskedyl(TM)) in the prevention of post fall syndrome [Effet de l'association raubasine-dihydroergocristine (Iskedyl(TM)) sur le syndrome post-chute et sur la prevention de la chute chez le sujet age]. Psychologie Medicale 1991;23(7):831-9. [EMBASE 1991275391]

### Vetter 1992 {published data only}

- Vetter NJ , Lewis PA , Ford D . Can health visitors prevent fractures in elderly people? BMJ 1992;304(6831):888-90. [MEDLINE: 1392755]

### Vind 2009 {published data only}

[CTG: NCT00226486]

- NCT00226486 . Examination and treatment of elderly after a fall. clinicaltrials.gov/show/NCT00226486 (accessed 31 August 2011).
- Vind AB , Andersen HE , Pedersen KD , Joergensen T , Schwarz P . Effect of a program of multifactorial fall prevention on health-related quality of life, functional ability, fear of falling and psychological well-being. A randomized controlled trial. Aging-Clinical & Experimental Research 2010;22(3):249-54.
- * Vind AB , Andersen HE , Pedersen KD , Jorgensen T , Schwarz P . An outpatient multifactorial falls prevention intervention does not reduce falls in high-risk elderly Danes. Journal of the American Geriatrics Society 2009;57(6):971-7. [MEDLINE: 19507291]
- Vind AB , Andersen HE , Pedersen KD , Jorgensen T , Schwarz P . Baseline and follow-up characteristics of participants and nonparticipants in a randomized clinical trial of multifactorial fall prevention in Denmark. Journal of the American Geriatrics Society 2009;57(10):1844-9. [MEDLINE: 19682128]
- Vind AB . personal communication March 30 2006.

### Von Stengel 2011 {published and unpublished data}

[CTG: NCT00292916]

- Kemmler W , Stengel V , Mayer S , Niedermayer M , Hentschke C , Kalender WA . Effect of whole body vibration on the neuromuscular performance of females 65 years and older. One-year results of the controlled randomized ELVIS study [Effekte von Ganzkorpervibrationen auf die neuromuskulare Leistungsfahigkeit von Frauen uber dem 65. Lebensjahr. Einjahresergebnisse der kontrollierten randomisierten ELVIS-Studie]. Zeitschrift fur Gerontologie und Geriatrie 2010;43(2):125-32. [MEDLINE: 19789832]
- NCT00292916 . Effect of whole body vibration on bone and fall related parameters. clinicaltrials.gov/show/NCT00292916 (accessed 31 August 2011).
- von Stengel S , Kemmler W , Engelke K , Bebenek M , Mayhew JL , Kalender WA . Effects of whole body vibration training on the fracture risk of postmenopausal women: preliminary results of the Erlangen Longitudinal Vibration Study (ELVIS) [abstract]. Medicine & Science in Sports & Exercise 2008;40(5 Suppl 1):S313.
- von Stengel S , Kemmler W , Engelke K , Kalender WA . Effect of whole-body vibration on neuromuscular performance and body composition for females 65 years and older: a randomized-controlled trial. Scandinavian Journal of Medicine & Science in Sports 2012;22(1):119-27. [MEDLINE: 20500555]
- * von Stengel S , Kemmler W , Engelke K , Kalender WA . Effects of whole body vibration on bone mineral density and falls: results of the randomized controlled ELVIS study with postmenopausal women. Osteoporosis International 2011;22(1):317-25. [MEDLINE: 20306017]
- von Stengel S , Kemmler W , Mayer S , Engelke K , Klarner A , Kalender WA . Effect of whole body vibration exercise on osteoporotic risk factors [Effekte eines Ganzkorpervibrationstrainings auf Parameter des Frakturrisikos]. Deutsche Medizinische Wochenschrift 2009;134(30):1511-6. [MEDLINE: 19603365]

### Voukelatos 2007 {published and unpublished data}

- Haas M . Economic analysis of tai chi as a means of preventing falls and related injuries among older adults. CHERE working paper 2006/4. Sydney, Australia: Centre for Health Economics Research and Evaluation, University of Technology. datasearch.uts.edu.au/chere/research/working_papers.cfm (accessed 30 November 2011).
- Rissel C , Voukelatos A , Cumming B , Lord S . Central Sydney Tai Chi Trial. Canberra: Australian Resource Centre for Health Care Innovations, 2005.
- * Voukelatos A , Cumming RG , Lord SR , Rissel C . A randomized, controlled trial of tai chi for the prevention of falls: the Central Sydney Tai Chi trial. Journal of the American Geriatrics Society 2007;55(8):1185-91. [MEDLINE: 17661956]
- Voukelatos A , Metcalfe A . Central Sydney Tai Chi Trial: methodology. New South Wales Public Health Bulletin 2002;13(1-2):19.
- Voukelatos A , Rissel C , Cumming R , Lord S . The Central Sydney Tai Chi Trial: a randomised controlled trial of the effectiveness of tai chi in reducing risk of falls in older people. Sydney: NSW Department of Health, 2006 www.health.nsw.gov.au/resources/publichealth/healthpromotion/grants/pdf/cs_tai_chi.pdf (accessed 30 November 2011).
- Voukelatos A . Central Sydney Tai Chi trial. personal communication July 25 2003.

### Wagner 1994 {published data only}

- Wagner EH , LaCroix AZ , Grothaus L , Leveille SG , Hecht JA , Artz K , et al. Preventing disability and falls in older adults: a population-based randomized trial. American Journal of Public Health 1994;84(11):1800-6. [MEDLINE: 7977921]

### Weber 2008 {published data only}

- Weber V , White A , McIlvried R . An electronic medical record (EMR)-based intervention to reduce polypharmacy and falls in an ambulatory rural elderly population. Journal of General Internal Medicine 2008;23(4):399-404. [MEDLINE: 18373136]

### Weerdesteyn 2006 {published and unpublished data}

- * Weerdesteyn V , Rijken H , Geurts AC , Smits-Engelsman BC , Mulder T , Duysens J . A five-week exercise program can reduce falls and improve obstacle avoidance in the elderly. Gerontology 2006;52(3):131-41. [MEDLINE: 16645293]
- Weerdesteyn V . personal communication September 06 2006.

### Whitehead 2003 {published data only}

- Whitehead C , Wundke R , Crotty M , Finucane P . Evidence-based clinical practice in falls prevention: a randomised controlled trial of a falls prevention service. Australian Health Review 2003;26(3):88-96. [MEDLINE: 15368824]

### Wilder 2001 {published data only}

- Wilder P . Seniors to seniors exercise program: a cost effective way to prevent falls in the frail elderly living at home [abstract]. Journal of Geriatric Physical Therapy 2001;24(3):13.

### Wolf 1996 {published data only}

- Kutner NG , Barnhart H , Wolf SL , McNeely E , Xu T . Self-report benefits of Tai Chi practice by older adults. Journals of Gerontology. Series B, Psychological Sciences and Social Sciences 1997;52(5):242-6. [MEDLINE: 9310093]
- McNeely E , Clements SD , Wolf SL . A program to reduce frailty in the elderly. In: Funk SG , Tornquist EM , Champagne MT , Weise RA , editors(s). Key aspects of elder care: managing falls, incontinence, and cognitive impairment. New York: Springer, 1992:89-96.
- O'Grady M , Wolf SL , Barnhart HX , Kutner N , McNeely E . Tai Chi effect on falls in frail older adults [abstract]. Archives of Physical Medicine and Rehabilitation 1997;78:1028. [CENTRAL: CN-00507025]
- Wolf SL , Barnhart HX , Ellison GL , Coogler CE , Horak FB . The effect of Tai Chi Quan and computerized balance training on postural stability in older subjects. Physical Therapy 1997;77(4):371-84. [MEDLINE: 9105340]
- * Wolf SL , Barnhart HX , Kutner NG , McNeely E , Coogler C , Xu T . Reducing frailty and falls in older persons: an investigation of Tai Chi and computerized balance training. Atlanta FICSIT Group. Frailty and Injuries: Cooperative Studies of Intervention Techniques. Journal of the American Geriatrics Society 1996;44(5):489-97. [MEDLINE: 8617895]
- Wolf SL , Kutner NG , Green RC , McNeely E . The Atlanta FICSIT study: two exercise interventions to reduce frailty in elders. Journal of the American Geriatrics Society 1993;41(3):329-32. [MEDLINE: 8440859]

### Wolf 2003 {published data only}

- Greenspan AI , Wolf SL , Kelley ME , O'Grady M . Tai chi and perceived health status in older adults who are transitionally frail: a randomized controlled trial. Physical Therapy 2007;87(5):525-35. [MEDLINE: 17405808]
- Sattin RW , Easley KA , Wolf SL , Chen Y , Kutner MH . Reduction in fear of falling through intense tai chi exercise training in older, transitionally frail adults. Journal of the American Geriatrics Society 2005;53(7):1168-78. [MEDLINE: 16108935]
- Wolf SL , O'Grady M , Easley KA , Guo Y , Kressig RW , Kutner M . The influence of intense Tai Chi training on physical performance and hemodynamic outcomes in transitionally frail, older adults. Journals of Gerontology. Series A, Biological Sciences and Medical Sciences 2006;61(2):184-9. [MEDLINE: 16510864]
- * Wolf SL , Sattin RW , Kutner M , O'Grady M , Greenspan AI , Gregor RJ . Intense Tai Chi exercise training and fall occurrences in older, transitionally frail adults: a randomized, controlled trial. Journal of the American Geriatrics Society 2003;51(12):1693-701. [MEDLINE: 14687346]
- Wolf SL , Sattin RW , O'Grady M , Freret N , Ricci L , Greenspan AI , et al. A study design to investigate the effect of intense Tai Chi in reducing falls among older adults transitioning to frailty. Controlled Clinical Trials 2001;22(6):689-704. [MEDLINE: 11738125]

### Woo 2007 {published and unpublished data}

- * Woo J , Hong A , Lau E , Lynn H . A randomised controlled trial of Tai Chi and resistance exercise on bone health, muscle strength and balance in community-living elderly people. Age and Ageing 2007;36(3):262-8. [MEDLINE: 17356003]
- Woo J . personal communication May 6 2008.

### Wu 2010 {published data only}

- Wu G , Keyes L , Callas P , Ren X , Bookchin B . Comparison of telecommunication, community, and home-based Tai Chi exercise programs on compliance and effectiveness in elders at risk for falls. Archives of Physical Medicine & Rehabilitation 2010;91(6):849-56.

### Wyman 2005 {published and unpublished data}

- Findorff MJ , Stock HH , Gross CR , Wyman JF . Does the Transtheoretical Model (TTM) explain exercise behavior in a community-based sample of older women? Journal of Aging & Health 2007;19(6):985-1003. [MEDLINE: 18165292]
- Findorff MJ , Wyman JF , Nyman JA , Croghan CF . Measuring the direct healthcare costs of a fall injury event. Nursing Research 2007;56(4):283-7. [MEDLINE: 17625468]
- Lindquist R , Wyman JF , Talley KM , Findorff M , Gross CR . Design of control-group conditions in clinical trials of behavioral interventions. Journal of Nursing Scholarship 2007;39(3):214-21. [MEDLINE: 17760793]
- Nachreiner NM , Findorff MJ , Wyman JF , McCarthy TC . Circumstances and consequences of falls in community-dwelling older women. Journal of Women's Health 2007;16(10):1437-46. [MEDLINE: 18062759]
- * Wyman J , Gross C , DiFabio R , Nyman J , Lindquist R , McCarthy T , et al. A randomized trial of exercise, education, and risk reduction counseling to prevent falls in population-based sample of older women [abstract]. Gerontologist 2005;45(Special Issue II):297.
- Wyman J , Gross C , DiFabio R , Nyman J , Lindquist R , McCarthy T , et al. Efficacy of exercise, education, and tailored counseling in reducing falls at 1- and 2-years in older women [abstract]. Gerontologist 2006;46(Special Issue I):141.
- Wyman J . A home-based fall prevention intervention for high risk older women. www.dhs.state.mn.us/main/groups/aging/documents/pub/dhs16_137823.pdf (accessed 14/10/07).
- Wyman J . Design of the Fall Evaluation and Prevention Program (FEPP): a randomized trial of exercise and risk reduction education in high-risk older women [abstract]. ICADI: International conference on aging,disability and independence; 2003 Dec 4-6; Washington (DC). www.icadi.phhp.ufl.edu/2003/presentation.php?PresID=151 (accessed 30 November 2011).
- Wyman JF , Croghan CF , Nachreiner NM , Gross CR , Stock HH , Talley K , et al. Effectiveness of education and individualized counseling in reducing environmental hazards in the homes of community-dwelling older women. Journal of the American Geriatrics Society 2007;55(10):1548-56. [MEDLINE: 17908058]
- Wyman JF . personal communication November 10 2007.

### Yamada 2010 {published data only}

- Yamada M , Tanaka B , Nagai K , Aoyama T , Ichihashi N . Trail-walking exercise and fall risk factors in community-dwelling older adults: preliminary results of a randomized controlled trial. Journal of the American Geriatrics Society 2010;58(10):1946-51. [MEDLINE: 20831723]

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