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Vitamin D prevents falls – majority of meta-analyses conclude – meta-meta analysis Feb 2015

What Works to Prevent Falls in Community-Dwelling Older Adults? An Umbrella Review of Meta-analyses of Randomized Controlled Trials.

Phys Ther. 2015 Feb 5. [Epub ahead of print]
Stubbs B1, Brefka S2, Denkinger MD3.

BACKGROUND: Preventing falls is an International priority. There is a need to synthesise the highest quality falls prevention evidence in one place for clinicians.

PURPOSE: To conduct an umbrella review of meta-analyses (MA) of randomised controlled trials (RCTs) of falls prevention interventions in community dwelling older adults.

DATA SOURCES: MEDLINE, EMBASE, CINAHL, AMED, BNI, PsycINFO, Cochrane Library, PubMed and the PEDro database.

STUDY SELECTION: MA with one pooled analysis containing ≥ 3 RCTs investigating any intervention to prevent falls in community dwelling older adults aged ≥ 60 years of age were eligible. 16 MA representing 47 pooled analyses were included.

DATA EXTRACTION: Two authors independently extracted data.

DATA SYNTHESIS: Data was narratively synthesised. The methodological quality of the MA was moderate. 3 MA defined a fall and 3 reported adverse events (although minor). There is consistent evidence that exercise reduces falls (including the rate, risk and odds of falling) with 13/14 pooled analyses (93%) from 7 MA demonstrating a significant reduction. The methodological quality of meta-analyses investigating exercise were medium/ high and effect sizes ranged from 0.87 (relative risk (RR) 95% CI 0.81-0.94, N=18, n=3568) to 0.39 (rate ratio (RaR) 95% CI 0.23 - 0.66, N=6). There is consistent evidence that multifactorial interventions reduce falls (5/6, 83% reported significant reduction). There is conflicting evidence regarding the influence of vitamin d supplementation (7/12, 58.3% reported significant reduction).

LIMITATIONS: MA often used different analysis and reporting of key characteristics was often lacking (e.g. participants, heterogeneity, publication bias). There may be some overlap between included MA.

CONCLUSIONS: There is consistent evidence that exercise and individually tailored multifactorial interventions are effective in reducing falls in the community.

© 2015 American Physical Therapy Association. PMID: 25655877

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