The effectiveness of e-interventions in preventing falls in community-dwelling older adults: a systematic review and meta-analysis
Author(s)
YEUNG Janice Chan Kuang
Publisher(s):
National University of Singapore
Publication year:
2020
This is a Doctoral dissertation. Background: Falls in older adults can have serious, life-limiting consequences. An increasing number of fall prevention interventions are making use of technology to reduce the number of falls in community-dwelling adults. Various types of e-interventions are being tested in clinical trials and in the community. These include telehealth, exergames, cognitive games, socialized training, smart home systems and non-conventional balance training. Currently, no systematic review and meta-analysis has assessed the overall effectiveness of e-interventions and compared the effectiveness of the different types. Objectives: The aim of this review was to evaluate the effectiveness of e-interventions on prevention of falls for community-dwelling older adults. Methods: A rigorous three-step search was conducted in nine online databases for published and unpublished randomized controlled trials studying e-interventions. Studies were screened and assessed for individual and overall risk of bias by two independent reviewers. Six fall-related outcomes were evaluated in the meta-analysis: fall risk, balance, lower extremity strength, fall efficacy, cognitive function and health-related quality of life. Subgroup and sensitivity analysis were conducted during meta-analysis. Results: Thirty-one studies fit the eligibility criteria and had an overall 74.7% low risk of bias. A total of 4877 older adults from 17 countries were included in narrative synthesis and meta-analysis. Telehealth combined with exercise programmes and smart home systems were able to reduce fall risk significantly (risk ratio=0.79, 95% CI [0.72, 0.86]) . E-interventions also significantly improved balance and fall efficacy (standardized mean difference=0.28, 95% CI [0.04, 0.53]). Lower extremity strength, cognitive function and health-related quality of life did not show significant improvements. Conclusion: Telehealth combined with exercise and smart home systems demonstrated the best evidence of effectiveness in reduction of falls in community-dwelling older adults. However, limited studies and small sample sizes affected power analysis. Future research should focus on testing promising e-interventions on larger samples to improve the strength of evidence of fall prevention by e-interventions. (Edited publisher abstract)
