Meta‐analysis and GRADE profiles of exercise interventions for falls prevention in long‐term care facilities. (8th November 2019)

• Record Type: Journal Article
• Authors: Schoberer, Daniela; Breimaier, Helga E.
• Is Part Of: Journal of advanced nursing. Volume 76:Number 1(2020)
• Page Start: 121
• Page End: 134
• Publication Date: 2019-11-08
• Subjects: accidental falls -- aged -- exercise -- GRADE approach -- long‐term care -- meta‐analysis -- nursing -- systematic review; Nursing -- Periodicals; 610.7305
• DOI: 10.1111/jan.14238
• Languages: English
• ISSNs: 0309-2402

Abstract

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. Abstract : 目的: 在于为预防跌倒和促进临床决策的运动干预有效性提供全面的证据收集。 设计: 通过结合已发表系统综述的试验和独立文献检索的近期试验, 对随机对照试验进行系统文献综述和荟萃分析。 资料来源: 在PubMed、CINAHL、Cochrane Databases和Google Scholar上搜索了2007年1月至2018年3月的相关文献。 综述方法: 使用了随机效应模型来汇总了可比研究。采用了GRADE方法来判断证据。 结果: 减少使用平衡部件或技术设备的运动明显下降, 但是对证据缺乏信心。有证据表明, 锻炼时间超过6个月大有裨益。对于虚弱的居民, 运动干预似乎对跌倒有很大的负面影响。 结论: 建议在长期护理环境中使用技术设备进行锻炼干预, 使用平衡部件进行锻炼干预, 以及采用时间超过6个月的锻炼干预。需要特别注意在进行锻炼时的虚弱居民, 鉴于他们摔倒的风险与日俱增。 影响: 使用平衡部件的锻炼和使用技术设备进的锻炼同样大有裨益, 而超过6个月的锻炼比短期锻炼更为有效。对于认知障碍类居民, 没有发现因运动而导致跌倒次数显著减少或降低。然而, 对于虚弱的居民, 由于运动干预, 跌倒事件的数量有所显著上升。本篇综述的结果能有助于长期护理机构的临床决策者规划和实施居民运动干预。