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Strategies to Reduce Injuries and Develop Confidence in Elders (STRIDE): A Cluster-Randomized Pragmatic Trial of a Multifactorial Fall Injury Prevention Strategy: Design and Methods
- Source :
- The journals of gerontology. Series A, Biological sciences and medical sciences, vol 73, iss 8
- Publication Year :
- 2017
- Publisher :
- Oxford University Press (OUP), 2017.
-
Abstract
- Author(s): Bhasin, Shalender; Gill, Thomas M; Reuben, David B; Latham, Nancy K; Gurwitz, Jerry H; Dykes, Patricia; McMahon, Siobhan; Storer, Thomas W; Duncan, Pamela W; Ganz, David A; Basaria, Shehzad; Miller, Michael E; Travison, Thomas G; Greene, Erich J; Dziura, James; Esserman, Denise; Allore, Heather; Carnie, Martha B; Fagan, Maureen; Hanson, Catherine; Baker, Dorothy; Greenspan, Susan L; Alexander, Neil; Ko, Fred; Siu, Albert L; Volpi, Elena; Wu, Albert W; Rich, Jeremy; Waring, Stephen C; Wallace, Robert; Casteel, Carri; Magaziner, Jay; Charpentier, Peter; Lu, Charles; Araujo, Katy; Rajeevan, Haseena; Margolis, Scott; Eder, Richard; McGloin, Joanne M; Skokos, Eleni; Wiggins, Jocelyn; Garber, Lawrence; Clauser, Steven B; Correa-De-Araujo, Rosaly; Peduzzi, Peter | Abstract: Background:Fall injuries are a major cause of morbidity and mortality among older adults. We describe the design of a pragmatic trial to compare the effectiveness of an evidence-based, patient-centered multifactorial fall injury prevention strategy to an enhanced usual care. Methods:Strategies to Reduce Injuries and Develop Confidence in Elders (STRIDE) is a 40-month cluster-randomized, parallel-group, superiority, pragmatic trial being conducted at 86 primary care practices in 10 health care systems across United States. The 86 practices were randomized to intervention or control group using covariate-based constrained randomization, stratified by health care system. Participants are community-living persons, ≥70 years, at increased risk for serious fall injuries. The intervention is a comanagement model in which a nurse Falls Care Manager performs multifactorial risk assessments, develops individualized care plans, which include surveillance, follow-up evaluation, and intervention strategies. Control group receives enhanced usual care, with clinicians and patients receiving evidence-based information on falls prevention. Primary outcome is serious fall injuries, operationalized as those leading to medical attention (nonvertebral fractures, joint dislocation, head injury, lacerations, and other major sequelae). Secondary outcomes include all fall injuries, all falls, and well-being (concern for falling; anxiety and depressive symptoms; physical function and disability). Target sample size was 5,322 participants to provide 90% power to detect 20% reduction in primary outcome rate relative to control. Results:Trial enrolled 5,451 subjects in 20 months. Intervention and follow-up are ongoing. Conclusions:The findings of the STRIDE study will have important clinical and policy implications for the prevention of fall injuries in older adults.
- Subjects :
- Male
Gerontology
and promotion of well-being
Comparative Effectiveness Research
Aging
Nurse falls care managers
Poison control
01 natural sciences
Suicide prevention
law.invention
010104 statistics & probability
0302 clinical medicine
Randomized controlled trial
law
Health care
80 and over
Fall prevention
030212 general & internal medicine
Injuries and Accidents
Aged, 80 and over
Rehabilitation
Head injury
Health Services
The Journal of Gerontology: Medical Sciences
Female
Patient Safety
medicine.symptom
medicine.medical_specialty
Clinical Trials and Supportive Activities
Clinical Sciences
and over
Motivational Interviewing
Risk Assessment
03 medical and health sciences
Clinical Research
Injury prevention
medicine
Humans
Patient and stakeholders in fall injury prevention research
0101 mathematics
Aged
business.industry
Prevention
Prevention of disease and conditions
medicine.disease
Good Health and Well Being
Clinical effectiveness
Falling (accident)
Injury (total) Accidents/Adverse Effects
Physical therapy
3.1 Primary prevention interventions to modify behaviours or promote wellbeing
Wounds and Injuries
Accidental Falls
Geriatrics and Gerontology
business
3.1 Primary prevention interventions to modify behaviours or promote well-being
Subjects
Details
- ISSN :
- 1758535X and 10795006
- Volume :
- 73
- Database :
- OpenAIRE
- Journal :
- The Journals of Gerontology: Series A
- Accession number :
- edsair.doi.dedup.....5705f3fb598b58a528081947f5610aa7
- Full Text :
- https://doi.org/10.1093/gerona/glx190