The effectiveness of multifactorial and multicomponent interventions for the prevention of falls for adults in hospital settings: a systematic review and meta-analysis

Abstract

AbstractObjectiveThe objective of this systematic review and meta-analysis was to evaluate the effectiveness of multicomponent and multifactorial interventions for reducing falls in adult in-patients.IntroductionFalls are the most common cause of accidental injury in hospitals worldwide, resulting in high human and economic costs. In attempts to reduce the number of falls, a wide range of interventions have been employed, often in combination, either as a package (multicomponent) or tailored to the individual (multifactorial). There is a need to synthesise the findings from primary studies and assess which approach may be more effective.Inclusion criteriaThe systematic review included studies comprising adult inpatients aged 18 years and over from any hospital setting including elective, non-elective, day-case and secondary care. Randomized controlled trials (RCT), cluster-randomised trials, quasi-experimental controlled trials and historical controlled trials were included that presented sufficient information regarding the rate or number of falls.MethodsThis effectiveness review was conducted in accordance with JBI methodology and was guided by an a priori protocol. A comprehensive 3-step search strategy was employed across 14 databases. Screening was conducted by two independent reviewers, and data was extracted using a bespoke data extraction tool designed for this review. Methodological quality was assessed using adapted versions of JBI critical appraisal checklists. Meta-analyses were conducted within a Bayesian framework to interpret results probabilistically and account for covariance in multiple sets of falls data reported in the same study. Effect sizes were calculated by comparing the rate or number of falls in the intervention group compared with usual care. Narrative syntheses were conducted on studies that met the inclusion criteria but did not provide sufficient data for inclusion in meta-analyses.ResultsA total of 9,637 records were obtained and following screening 24 studies were included in this review, 21 of which presented sufficient information to be included in meta-analyses. Most studies (n=16) comprised a weaker historical control design with 6 quasi-experimental and only 5 RCT studies. Multifactorial interventions were more common (n=18) than multicomponent (n=6), with the most frequent components including environmental adaptations and assistive aids (75% of studies). Meta-analyses provided evidence that both intervention types were effective at reducing the rate and risk of falls compared to usual care. Evidence was also obtained of greater reductions in rate and risk of falls with multicomponent interventions, however, analyses were potentially confounded by an association between intervention type and study design.ConclusionsFalls interventions routinely employed in hospitals can substantially reduce falls, however, no evidence was obtained in support of tailoring interventions to individual risk factors. Future high-quality RCTs are required that directly compare multicomponent and multifactorial interventions.Key PointsWe found multifactorial and multicomponent interventions to be effective at reducing hospital falls compared to usual care.Evidence was obtained that multicomponent interventions were most effective at reducing the risk and rate of falls in hospitals. However, multicomponent interventions were associated with lower quality study designs.We found no additional benefit of tailoring intervention components based on an individual’s fall risk factors.There is a need for high quality randomised controlled trials comparing multifactorial and multicomponent interventions in hospitals.