Discussion
fall injuries, fall injury, fractures, fall reduction, KFPS, injury and pain
EVENTS, EVENT
The KFPS is a large population-based fall prevention RCT targeted at older community-dwelling women with minimal exclusion criteria. Weekly Tai Chi and gym exercises were combined with free access to recreational facilities, aiming to reduce the number of falls in a 24-months follow-up. The proportion of women who had at least one fall or fall injury was similar in both groups. However, the fall and fall injury rates were lower in the intervention group. Thus, the intervention’s effect was seen on repeat falls, severe fall injuries and fractures. Overall, the intervention group had a reduction of 14.3% in their overall fall rate compared with the control group. Their indoor falls—comprising a quarter of the falls—were especially decreased (−25.6%). Altogether, falls with self-reported severe injury and pain (~41%) were reduced the most. Almost half of the falls occurred on even surfaces—either indoors or outdoors—and a majority of these (68.9%) were due to tripping and slipping, as expected. In general, women’s functional capacity was not affected during the follow-up, but leg extension strength decreased less, and one-leg stance time improved slightly in the intervention group, which may relate to the number of falls. In all, perhaps the approach of working through the community rather than just through healthcare alone to prevent falls may be a better strategy.The main target was the reduction of falls by improving balance, muscle strength and functional capability by promoting physical activity. The findings suggest that the risk factors for indoor and outdoor falls may be different. Although higher fall reduction was observed indoors, the majority (69%) of the falls occurred outdoors. Nevertheless, indoor falls are a common cause of serious fractures such as of the hip, notably since frail older people stay more inside and are at higher risk for indoor falls [The strength of this study is the meticulous fall monitoring and interview within 2 weeks of the reported event. This probably ensured better recollection of the events and circumstances contributing to the falls—and resulted in capturing substantially more falls than anticipated. Previous studies have showed limitations to report falls that occurred during over the preceding 3–12 months [As the exclusion criteria were kept to a minimum, the training was designed with low to moderate intensity to suit most older women with average functional capability. Thus, we did not expect to see a change in terms of body composition or BMD. Nevertheless, slightly less reduced leg extension strength and improved one leg stance time—probably due to better muscle control in the exercise group—have been shown to be beneficial in fall prevention previously [Several factors might potentially affect the study results. For practical reasons, we could only include blinding up to the baseline visit. Some of the study effects may also be influenced by RCT participation bias since only 21.4% of the invited women were recruited. Lastly, verifying SMS fall reports through phone interviews was appropriate to eliminate false positives but did not address false negatives. The number of phone interviewed falls was somewhat lower in the control group (89.6%) versus intervention group (96.6%). This is likely to cause some underreporting of falls in the control group, which may have led to a more conservative estimate in terms of fall prevention. However, this was not the case with fractures which were recorded from registries, regardless of self-reporting.The fall prevention efficacy was as expected to differ from high-risk groups, such as hospitalized or institutionalized adults [In conclusion, fall prevention with light- or moderate-intensity exercise group programmes can reduce falls and fall injuries among older women on a municipal scale. Broader implementation of such strategies and societal health promotion should be developed through municipal services and communities to achieve these aims in the future.