Do exercise interventions designed to prevent falls affect participation in life roles? A systematic review and meta-analysis

Abstract

Background: The World Health Organization describes individuals' functioning at a societal level as 'participation'. Despite being a key component of functioning and an important goal of rehabilitation, participation is not measured consistently in ageing research. The aim was to evaluate the extent to which measurement of participation has been reported in trials of fall prevention interventions and to determine the effect of exercise interventions on participation in life roles. Methods: systematic review with meta-analysis. Randomised controlled trials of exercise interventions that aimed to reduce falls in older people (60+) in community, aged care facilities or hospital settings were included. The outcome of interest was participation in life roles. Trials that measured participation at two time-points were included in the meta-analysis. Results: ninety-six trials met the review inclusion criteria. Participation was measured in 19 of these trials (20%). Nine instruments were used to measure participation. Fifteen trials, involving 3,616 participants, were included in the meta-analysis. The pooled estimate of the effect of interventions including exercise indicated a small improvement in participation (Hedges' g = 0.16, 95% confidence interval = 0.04-0.27, P = 0.006). Meta-regression showed multifactorial intervention with an exercise component had a larger effect than exercise intervention alone, but the difference was not statistically significant (effect on Hedges' g = 0.22, 95% CI = -0.05 to 0.50, P = 0.10). Conclusion: interventions including exercise may improve participation in life roles in older people. The International Classification of Functioning, Disability and Health may be a useful framework for understanding the broader impact of falls prevention interventions. © The Author 2011. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved.