Barnett 2003.
| Methods | Study design: RCT Number of study arms: 2 Length of follow‐up: 12 months | |
| Participants | Setting: Sydney, Australia Number of participants: 163 Number analysed: 150 Number lost to follow‐up: 13 Sample: older people identified as at risk of falling by general practitioner or hospital physiotherapist using assessment tool Age (years): mean 74.9 (SD 10.9) Sex: 67% female Inclusion criteria: age > 65 years; identified as 'at risk' of falling (1 or more of the following risk factors: lower limb weakness, poor balance, slow reaction time) Exclusion criteria: cognitive impairment; degenerative conditions, e.g. Parkinson's disease or medical condition involving neuromuscular, skeletal, or cardiovascular system that precluded taking part in exercise programme |
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| Interventions | 1. Group‐based balance, strength and aerobic training: exercises increased in difficulty, strength training using own body weight; 1 hour a week for 4 terms for 1 year (37 classes) plus home exercise based on class content + diaries to record participation
2. Control: no exercise intervention Both groups received information on strategies for avoiding falls, e.g. hand and foot placement if loss of balance occurred |
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| Outcomes | 1. Rate of falls
2. Number of people who experienced 1 or more falls (risk of falling) 3. Number of people who died |
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| Duration of the study | 52 weeks | |
| Adherence | Adherence measured by class attendance, frequency of home programme 1. Group‐based balance, strength and aerobic training group: Median number of classes attended: 23 (range 0 – 36) Number attended 30 or more classes: 28 (34%) Attending exercise classes at end of trial and performing home programme ≥ 1 a week: 91%, with 13% performing exercises daily |
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| Notes | Source of funding: Bankstown‐Lidcombe hospital Economic information: not reported | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Quote: "randomised in matched blocks" (N = 6) |
| Allocation concealment (selection bias) | Low risk | Consecutively‐numbered, opaque envelopes |
| Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Both groups received information on strategies for avoiding falls and intervention group also received structured weekly exercise sessions. Blinding not reported, but impact of non‐blinding unclear |
| Blinding of outcome assessment (detection bias) Falls | Unclear risk | Falls reported by participants who were aware of their group allocation, by postal surveys monthly in both groups. Telephone interview if not returned by 2 weeks. Unclear whether those conducting telephone check were unblinded |
| Blinding of outcome assessment (detection bias) Fractures | Unclear risk | Not applicable |
| Blinding of outcome assessment (detection bias) Hospital admission, medical attention and adverse events | Unclear risk | Not applicable |
| Blinding of outcome assessment (detection bias) Health related quality of life (self report) | Unclear risk | Not applicable |
| Incomplete outcome data (attrition bias) Falls and fallers | Low risk | Less than 20% of outcome data are missing (8%). Balanced losses in intervention (n = 7) and control (n = 6) groups, with reasons for missing fall data unclear |
| Selective reporting (reporting bias) | Unclear risk | Minimum set of expected outcomes not reported (adverse events not reported) |
| Method of ascertaining falls (recall bias) | Unclear risk | Interval recall. Falls identified by postal survey at the end of each calendar month. Phoned if not returned within 2 weeks |