Marike Rc Hendriks

Lack of Effectiveness of a Multidisciplinary Fall-Prevention Program in Elderly People at Risk: A Randomized, Controlled Trial

OBJECTIVES: To assess whether a pragmatic multidisciplinary fall‐prevention program was more effective than usual care in preventing new falls and functional decline in elderly people.

Cost-effectiveness of a multidisciplinary fall prevention program in community-dwelling elderly people: A randomized controlled trial (ISRCTN 64716113)

OBJECTIVES Multidisciplinary and multifactorial interventions seem to be effective in preventing falls. We aimed to assess the cost-effectiveness of a multidisciplinary fall prevention program compared with usual Dutch healthcare in community-dwelling people 65 years of age or older who experienced a fall. METHODS Cost-effectiveness and cost-utility analysis were performed from a societal perspective. Falls and healthcare utilization were continuously measured for 12 months. Daily functioning and quality of life were measured at baseline, after 4 and 12 months. Bootstrap analyses were performed to estimate uncertainty of the findings and sensitivity analysis to assess the generalizability of assumptions made. RESULTS One hundred sixty-six participants were randomly allocated to the experimental group and 167 to the control group. The overall response rate was 74 percent. Healthcare and patient and family costs of both groups were comparable. Our analyses showed no effect of the intervention program on falls, daily functioning, or quality of life measures. CONCLUSIONS The multidisciplinary intervention program to prevent falls was not cost-effective compared with usual care in the Netherlands. Notwithstanding our findings, however, falls still have an important impact on society and individuals in terms of costs and effects. Economic evaluations studying promising interventions to prevent falls, therefore, remain necessary.

Which activity monitor to use? Validity, reproducibility and user friendliness of three activity monitors

BackgroundHealth is associated with amount of daily physical activity. Recently, the identification of sedentary time as an independent factor, has gained interest. A valid and easy to use activity monitor is needed to objectively investigate the relationship between physical activity, sedentary time and health. We compared validity and reproducibility of physical activity measurement and posture identification of three activity monitors, as well as user friendliness.MethodsHealthy volunteers wore three activity monitors simultaneously: ActivPAL3, ActiGraphGT3X and CAM. Data were acquired under both controlled (n = 5) and free-living conditions (n = 9). The controlled laboratory measurement, that included standardized walking intensity and posture allocation, was performed twice. User friendliness was evaluated with a questionnaire. Posture classification was compared with direct observation (controlled measurement) and with diaries (free living). Accelerometer intensity accuracy was tested by correlations with walking speed. User friendliness was compared between activity monitors.ResultsReproducibility was at least substantial in all monitors. The difference between the two CAM measurements increased with walking intensity. Amount of correct posture classification by ActivPAL3 was 100.0% (kappa 0.98), 33.9% by ActiGraphGT3X (kappa 0.29) and 100.0% by CAM (kappa 0.99). Correlations between accelerometer intensity and walking speed were 0.98 for ActivPAL3, 1.00 for ActiGraphGT3X and 0.98 for CAM. ICCs between activity monitors and diary were 0.98 in ActivPAL3, 0.59 and 0.96 in ActiGraphGT3X and 0.98 in CAM. ActivPAL3 and ActiGraphGT3X had higher user friendliness scores than the CAM.ConclusionsThe ActivPAL3 is valid, reproducible and user friendly. The posture classification by the ActiGraphGT3X is not valid, but reflection of walking intensity and user friendliness are good. The CAM is valid; however, reproducibility at higher walking intensity and user friendliness might cause problems. Further validity studies in free living are recommended.

Relationship between location and activity in injurious falls: an exploratory study

BackgroundKnowledge about the circumstances under which injurious falls occur could provide healthcare workers with better tools to prevent falls and fall-related injuries. Therefore, we assessed whether older persons who sustain an injurious fall can be classified into specific fall types, based on a combination of fall location and activity up to the moment of the fall. In addition, we assessed whether specific injurious fall types are related to causes of the fall, consequences of the fall, socio-demographic characteristics, and health-related characteristics.MethodsAn exploratory, cross-sectional study design was used to identify injurious fall types. The study population comprised 333 community-dwelling Dutch elderly people aged 65 years or over who attended an accident and emergency department after a fall. All participants received a self-administered questionnaire after being discharged home. The questionnaire comprised items concerning circumstances of the injurious fall, causes of the fall, consequences of the fall, socio-demographic characteristics and health-related characteristics. Injurious fall types were distinguished by analyzing data by means of HOMALS (homogeneity analysis by means of alternating least squares).ResultsWe identified 4 injurious fall types: 1) Indoor falls related to lavatory visits (hall and bathroom); 2) Indoor falls during other activities of daily living; 3) Outdoor falls near the home during instrumental activities of daily living; 4) Outdoor falls away from home, occurring during walking, cycling, and shopping for groceries. These injurious fall types were significantly related to age, cause of the fall, activity avoidance and daily functioning.ConclusionThe face validity of the injurious fall typology is obvious. However, we found no relationship between the injurious fall types and severity of the consequences of the fall. Nevertheless, there appears to be a difference between the prevalence of fractures and the cause of the fall between the injurious fall types. Our data suggests that with regard to prevention of serious injuries, we should pay special attention to outdoor fallers and indoor fallers during lavatory visits. In addition, we should have special attention for causes of the fall. However, the conclusions reached in this exploratory analysis are tentative and need to be validated in a separate dataset.

2014 Consensus Statement from the first Economics of Physical Inactivity Consensus (EPIC) Conference (Vancouver)

This article describes major topics discussed from the ‘Economics of Physical Inactivity Consensus Workshop’ (EPIC), held in Vancouver, Canada, in April 2011. Specifically, we (1) detail existing evidence on effective physical inactivity prevention strategies; (2) introduce economic evaluation and its role in health policy decisions; (3) discuss key challenges in establishing and building health economic evaluation evidence (including accurate and reliable costs and clinical outcome measurement) and (4) provide insight into interpretation of economic evaluations in this critically important field. We found that most methodological challenges are related to (1) accurately and objectively valuing outcomes; (2) determining meaningful clinically important differences in objective measures of physical inactivity; (3) estimating investment and disinvestment costs and (4) addressing barriers to implementation. We propose that guidelines specific for economic evaluations of physical inactivity intervention studies are developed to ensure that related costs and effects are robustly, consistently and accurately measured. This will also facilitate comparisons among future economic evidence.

The Cost-Effectiveness of Measures to Prevent Recurrent Ankle Sprains Results of a 3-Arm Randomized Controlled Trial

Background: Ankle sprains are the most common sports-related injury, associated with a high rate of recurrence and societal costs. Recent studies have emphasized the effectiveness of both neuromuscular training and bracing for the secondary prevention of ankle sprains. Purpose: To evaluate the cost-effectiveness of the separate and combined use of bracing and neuromuscular training for the prevention of the recurrence of ankle sprains. Study Design: Economic and decision analysis; Level of evidence, 2. Methods: A total of 340 athletes (157 male and 183 female; aged 12-70 years) who had sustained a lateral ankle sprain up to 2 months before inclusion were randomized to a neuromuscular training group (n = 107), brace group (n = 113), and combined intervention group (n = 120). Randomization was stratified by medical treatment of the inclusion sprain. Participants in the neuromuscular training group underwent an 8-week home-based exercise program. Participants in the brace group received a semirigid ankle brace to be worn during all sports activities for a period of 12 months. Participants allocated to the combined group underwent both interventions, with the ankle brace to be worn during all sports activities for a period of 8 weeks. The recurrence of ankle sprains and associated costs were registered during the 1-year follow-up. Results: There were no differences between groups at baseline with regard to age, sex, sports participation, previous injury, or knowledge of preventive measures. The incremental cost-effectiveness ratio (ICER) of the brace group in comparison with the combined group was −€2828.30 (approximately –US

Reducing disability in community-dwelling frail older people: cost-effectiveness study alongside a cluster randomised controlled trial

3865.00), based on a difference in the mean cost of −€76.16 (approximately –US

The reduction of disability in community-dwelling frail older people: design of a two-arm cluster randomized controlled trial

104.00) and a difference in the mean effects of 2.68%. The ICER of the neuromuscular training group in comparison with the combined group was €310.08 (approximately US

Continuous versus Intermittent Data Collection of Health Care Utilization

424.00), based on a difference in the mean cost of −€28.37 (approximately –US

A Multidisciplinary Fall Prevention Program for Elderly Persons: A Feasibility Study

39.00) and a difference in the mean effects of 9.15%. Conclusion: Bracing was found to be the dominant secondary preventive intervention over both neuromuscular training and the combination of both measures.