A post-hospital home exercise program improved mobility but increased falls in older people: A randomised controlled trial

Catherine Sherrington, Stephen R. Lord, Constance M. Vogler, Jacqueline C T Close, Kirsten Howard, Catherine M. Dean, Gillian Z. Heller, Lindy Clemson, Sandra D. O'Rourke, Elisabeth Ramsay, Elizabeth Barraclough, Robert D. Herbert, Robert G. Cumming

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Abstract

Background: Home exercise can prevent falls in the general older community but its impact in people recently discharged from hospital is not known. The study aimed to investigate the effects of a home-based exercise program on falls and mobility among people recently discharged from hospital. Methods and Findings: This randomised controlled trial (ACTRN12607000563460) was conducted among 340 older people. Intervention group participants (n = 171) were asked to exercise at home for 15-20 minutes up to 6 times weekly for 12 months. The control group (n = 169) received usual care. Primary outcomes were rate of falls (assessed over 12 months using monthly calendars), performance-based mobility (Lower Extremity Summary Performance Score, range 0-3, at baseline and 12 months, assessor unaware of group allocation) and self-reported ease of mobility task performance (range 0-40, assessed with 12 monthly questionaries). Participants had an average age of 81.2 years (SD 8.0) and 70% had fallen in the past year. Complete primary outcome data were obtained for at least 92% of randomised participants. Participants in the intervention group reported more falls than the control group (177 falls versus 123 falls) during the 12-month study period and this difference was statistically significant (incidence rate ratio 1.43, 95% CI 1.07 to 1.93, p = 0.017). At 12-months, performance-based mobility had improved significantly more in the intervention group than in the control group (between-group difference adjusted for baseline performance 0.13, 95% CI 0.04 to 0.21, p = 0.004). Self-reported ease in undertaking mobility tasks over the 12-month period was not significantly different between the groups (0.49, 95% CI -0.91 to 1.90, p = 0.488). Conclusions: An individualised home exercise prescription significantly improved performance-based mobility but significantly increased the rate of falls in older people recently discharged from hospital. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12607000563460.

LanguageEnglish
Article numbere104412
Pages1-12
Number of pages12
JournalPLoS ONE
Volume9
Issue number9
DOIs
Publication statusPublished - 2014

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exercise
Randomized Controlled Trials
Control Groups
Task Performance and Analysis
New Zealand
Prescriptions
Registries
Lower Extremity
Clinical Trials
clinical trials
Incidence
incidence
methodology
Calendars

Bibliographical note

Copyright the Author(s) 2014. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

Cite this

Sherrington, C., Lord, S. R., Vogler, C. M., Close, J. C. T., Howard, K., Dean, C. M., ... Cumming, R. G. (2014). A post-hospital home exercise program improved mobility but increased falls in older people: A randomised controlled trial. PLoS ONE, 9(9), 1-12. [e104412]. https://doi.org/10.1371/journal.pone.0104412
Sherrington, Catherine ; Lord, Stephen R. ; Vogler, Constance M. ; Close, Jacqueline C T ; Howard, Kirsten ; Dean, Catherine M. ; Heller, Gillian Z. ; Clemson, Lindy ; O'Rourke, Sandra D. ; Ramsay, Elisabeth ; Barraclough, Elizabeth ; Herbert, Robert D. ; Cumming, Robert G. / A post-hospital home exercise program improved mobility but increased falls in older people : A randomised controlled trial. In: PLoS ONE. 2014 ; Vol. 9, No. 9. pp. 1-12.
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abstract = "Background: Home exercise can prevent falls in the general older community but its impact in people recently discharged from hospital is not known. The study aimed to investigate the effects of a home-based exercise program on falls and mobility among people recently discharged from hospital. Methods and Findings: This randomised controlled trial (ACTRN12607000563460) was conducted among 340 older people. Intervention group participants (n = 171) were asked to exercise at home for 15-20 minutes up to 6 times weekly for 12 months. The control group (n = 169) received usual care. Primary outcomes were rate of falls (assessed over 12 months using monthly calendars), performance-based mobility (Lower Extremity Summary Performance Score, range 0-3, at baseline and 12 months, assessor unaware of group allocation) and self-reported ease of mobility task performance (range 0-40, assessed with 12 monthly questionaries). Participants had an average age of 81.2 years (SD 8.0) and 70{\%} had fallen in the past year. Complete primary outcome data were obtained for at least 92{\%} of randomised participants. Participants in the intervention group reported more falls than the control group (177 falls versus 123 falls) during the 12-month study period and this difference was statistically significant (incidence rate ratio 1.43, 95{\%} CI 1.07 to 1.93, p = 0.017). At 12-months, performance-based mobility had improved significantly more in the intervention group than in the control group (between-group difference adjusted for baseline performance 0.13, 95{\%} CI 0.04 to 0.21, p = 0.004). Self-reported ease in undertaking mobility tasks over the 12-month period was not significantly different between the groups (0.49, 95{\%} CI -0.91 to 1.90, p = 0.488). Conclusions: An individualised home exercise prescription significantly improved performance-based mobility but significantly increased the rate of falls in older people recently discharged from hospital. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12607000563460.",
author = "Catherine Sherrington and Lord, {Stephen R.} and Vogler, {Constance M.} and Close, {Jacqueline C T} and Kirsten Howard and Dean, {Catherine M.} and Heller, {Gillian Z.} and Lindy Clemson and O'Rourke, {Sandra D.} and Elisabeth Ramsay and Elizabeth Barraclough and Herbert, {Robert D.} and Cumming, {Robert G.}",
note = "Copyright the Author(s) 2014. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.",
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Sherrington, C, Lord, SR, Vogler, CM, Close, JCT, Howard, K, Dean, CM, Heller, GZ, Clemson, L, O'Rourke, SD, Ramsay, E, Barraclough, E, Herbert, RD & Cumming, RG 2014, 'A post-hospital home exercise program improved mobility but increased falls in older people: A randomised controlled trial', PLoS ONE, vol. 9, no. 9, e104412, pp. 1-12. https://doi.org/10.1371/journal.pone.0104412

A post-hospital home exercise program improved mobility but increased falls in older people : A randomised controlled trial. / Sherrington, Catherine; Lord, Stephen R.; Vogler, Constance M.; Close, Jacqueline C T; Howard, Kirsten; Dean, Catherine M.; Heller, Gillian Z.; Clemson, Lindy; O'Rourke, Sandra D.; Ramsay, Elisabeth; Barraclough, Elizabeth; Herbert, Robert D.; Cumming, Robert G.

In: PLoS ONE, Vol. 9, No. 9, e104412, 2014, p. 1-12.

Research output: Contribution to journalArticleResearchpeer-review

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T1 - A post-hospital home exercise program improved mobility but increased falls in older people

T2 - PLoS ONE

AU - Sherrington, Catherine

AU - Lord, Stephen R.

AU - Vogler, Constance M.

AU - Close, Jacqueline C T

AU - Howard, Kirsten

AU - Dean, Catherine M.

AU - Heller, Gillian Z.

AU - Clemson, Lindy

AU - O'Rourke, Sandra D.

AU - Ramsay, Elisabeth

AU - Barraclough, Elizabeth

AU - Herbert, Robert D.

AU - Cumming, Robert G.

N1 - Copyright the Author(s) 2014. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

PY - 2014

Y1 - 2014

N2 - Background: Home exercise can prevent falls in the general older community but its impact in people recently discharged from hospital is not known. The study aimed to investigate the effects of a home-based exercise program on falls and mobility among people recently discharged from hospital. Methods and Findings: This randomised controlled trial (ACTRN12607000563460) was conducted among 340 older people. Intervention group participants (n = 171) were asked to exercise at home for 15-20 minutes up to 6 times weekly for 12 months. The control group (n = 169) received usual care. Primary outcomes were rate of falls (assessed over 12 months using monthly calendars), performance-based mobility (Lower Extremity Summary Performance Score, range 0-3, at baseline and 12 months, assessor unaware of group allocation) and self-reported ease of mobility task performance (range 0-40, assessed with 12 monthly questionaries). Participants had an average age of 81.2 years (SD 8.0) and 70% had fallen in the past year. Complete primary outcome data were obtained for at least 92% of randomised participants. Participants in the intervention group reported more falls than the control group (177 falls versus 123 falls) during the 12-month study period and this difference was statistically significant (incidence rate ratio 1.43, 95% CI 1.07 to 1.93, p = 0.017). At 12-months, performance-based mobility had improved significantly more in the intervention group than in the control group (between-group difference adjusted for baseline performance 0.13, 95% CI 0.04 to 0.21, p = 0.004). Self-reported ease in undertaking mobility tasks over the 12-month period was not significantly different between the groups (0.49, 95% CI -0.91 to 1.90, p = 0.488). Conclusions: An individualised home exercise prescription significantly improved performance-based mobility but significantly increased the rate of falls in older people recently discharged from hospital. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12607000563460.

AB - Background: Home exercise can prevent falls in the general older community but its impact in people recently discharged from hospital is not known. The study aimed to investigate the effects of a home-based exercise program on falls and mobility among people recently discharged from hospital. Methods and Findings: This randomised controlled trial (ACTRN12607000563460) was conducted among 340 older people. Intervention group participants (n = 171) were asked to exercise at home for 15-20 minutes up to 6 times weekly for 12 months. The control group (n = 169) received usual care. Primary outcomes were rate of falls (assessed over 12 months using monthly calendars), performance-based mobility (Lower Extremity Summary Performance Score, range 0-3, at baseline and 12 months, assessor unaware of group allocation) and self-reported ease of mobility task performance (range 0-40, assessed with 12 monthly questionaries). Participants had an average age of 81.2 years (SD 8.0) and 70% had fallen in the past year. Complete primary outcome data were obtained for at least 92% of randomised participants. Participants in the intervention group reported more falls than the control group (177 falls versus 123 falls) during the 12-month study period and this difference was statistically significant (incidence rate ratio 1.43, 95% CI 1.07 to 1.93, p = 0.017). At 12-months, performance-based mobility had improved significantly more in the intervention group than in the control group (between-group difference adjusted for baseline performance 0.13, 95% CI 0.04 to 0.21, p = 0.004). Self-reported ease in undertaking mobility tasks over the 12-month period was not significantly different between the groups (0.49, 95% CI -0.91 to 1.90, p = 0.488). Conclusions: An individualised home exercise prescription significantly improved performance-based mobility but significantly increased the rate of falls in older people recently discharged from hospital. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12607000563460.

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