Summary of findings 5. Summary of findings: Additional exercise plus physiotherapy compared with usual physiotherapy in hospitals.

Additional exercise plus physiotherapy compared with usual physiotherapy for falls prevention in hospitals
Population and setting: older (≥ 65 years) patients in hospital settings Intervention: additional exercise plus physiotherapy Comparison: usual physiotherapy
Outcomes	Illustrative comparative risks* (95% CI)		Relative effect (95% CI)	No of Participants (studies)	Quality of the evidence (GRADE)	Comments
	Assumed risk	Corresponding risk
	Usual physiotherapy	Additional Exercise
Rate of falls Length of follow‐up: inpatient stay (mean 29 days) or 2 weeks	Low‐risk population1		RaR 0.59 (0.26 to 1.34)	215 (2 studies)	+ooo VERY LOW7	One study compared additional exercises versus conventional physiotherapy alone, and 1 study tested additional group standing balance circuit classes
	1300 per 1000 py	767 (338 to 1742) per 1000 py
	Moderate‐risk population2
	3500 per 1000 py	2065 (910 to 4690) per 1000 py
	High‐risk population3
	6000 per 1000 py	3540 (1560 to 8040) per 1000 py
Risk of falling Length of follow‐up: inpatient stay (mean 29 days) or 8 weeks	Low‐risk population4		RR 0.36 (0.14 to 0.93)	83 (2 studies)	+ooo VERY LOW8	One study compared additional exercises versus conventional physiotherapy alone, and 1 study tested additional daily physiotherapy sessions
	30 per 1000	11 (4 to 28) per 1000
	Moderate‐risk population5
	150 per 1000	54 (21 to 140) per 1000
	High‐risk population6
	340 per 1000	122 (48 to 316) per 1000
Risk of fracture	See comment	See comment	See comment			No data available
Adverse events Length of follow‐up: 2 weeks	0 events	0 events	Not estimable	161 (1 study)	+ooo VERY LOW9	One study reported no adverse events, two studies did not report this outcome
*Illustrative risks for the control group were derived from all or subgroups of trials in hospitals reporting the outcome. The exact basis for the assumed risk for each outcome is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; py: person years; RaR: Rate Ratio; RR: Risk Ratio;
GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate.

¹ Low risk was based on the mean control risk of the 7 (bottom third) trials with the lowest rate of falls. The mean rate of falls = 1.27, rounded to 1.3 per person year; thus 1300 per 1000 person years.

² Moderate risk was based on the mean control risk of the 7 (middle third) trials with a moderate rate of falls. The mean rate of falls = 3.23, rounded to 3.5 per person year; thus 3500 per 1000 person years.

³ High risk was based on the mean control risk of the 7 (top third) trials with the highest rate of falls. The mean rate of falls = 6.33, rounded to 6.0 per person year; thus 6000 per 1000 person years.

⁴ Low risk was based on the mean control risk of 10 trials with the lowest risk of falling. The mean risk of falling = 0.034, rounded to 0.03; thus 30 per 1000 people.

⁵ Moderate risk was based on the mean control risk of 7 (middle third) trials reporting the risk of falling. The mean risk of falling = 0.156, rounded to 0.15; thus 150 per 1000 people.

⁶ High risk was based on the mean control risk of 6 (top third) trials reporting the risk of falling. The mean risk of falling = 0.340; thus 340 per 1000 people.

⁷The quality of the evidence was downgraded one level for risk of bias (including unclear risk of selection bias and method of ascertaining falls in one study) and two levels for very serious imprecision (the wide confidence intervals cross the range of estimates of harm and strong effect).

⁸The quality of the evidence was downgraded one level for risk of bias (including unclear risk of bias in both trials for selection bias and high risk of attrition bias for study contributing 69%), one level for indirectness (possibly limited applicability as both trials conducted in UK rehabilitation settings) and one level for imprecision (total N = 83, wide 95% confidence intervals).

⁹The quality of the evidence was downgraded one level for indirectness (single trial in Australian rehabilitation setting), two levels for imprecision (no events recorded, inadequate power to assess rare adverse events) and one level for other reasons (concerns that adverse events were not recorded systematically).