Meta-analysis and GRADE profiles of exercise interventions for falls prevention in long-term care facilities

Abstract

Aims: To provide a comprehensive collection of evidence on the effectiveness of exercise interventions to prevent falls and support clinical decision-making. Design: A systematic literature review and meta-analysis of randomized controlled trails were performed by combining trials from published systematic reviews and more recent ones from a separate literature search. Data Sources: The literature search was performed using PubMed, CINAHL, Cochrane Databases, and Google Scholar dating January 2007 – March 2018. Review Methods: Comparable studies were pooled using the random-effects model. The GRADE approach was used to judge the evidence. Results: Exercises with a balance component or with technical devices reduced falls significantly, however, with low confidence in the evidence. The evidence indicated that exercises conducted longer than 6 months were beneficial. In frail residents, exercise interventions seemed to have substantially negative effects on falls. Conclusions: Exercise interventions with technical devices, those with a balance component, and those performed longer than 6 months are recommended in long-term care settings. Frail residents need special attention when performing exercises due to their increased risk of falling. Impact: Exercises with a balance component and exercises carried out with technical devices have beneficial effects, whereas exercises performed longer than 6 months are more effective than short-term performances. No significant reduction or decrease in the number of falls was found for exercise in cognitively impaired residents. In frail residents, however, the number of fall events increased substantially as a result of exercise interventions. The results of this review are useful for clinical decision-makers in long-term care facilities with regard to the planning and performance of exercise interventions for residents.