Here is the standardised PICO analysis for the sixty-first uploaded article:
Full Title
Effectiveness of Non-Pharmaceutical Interventions to Prevent Falls and Fall-Related Fractures in Older People Living in Residential Aged Care Facilities – A Systematic Review and Network Meta-Analysis Protocol
Authors: Michiel Twiss, Roger Hilfiker, Timo Hinrichs, Eling D. de Bruin, Slavko Rogan
Journal: Physical Therapy Reviews, 2019; 24(6):291–297
DOI: 10.1080/10833196.2019.1664082
Type of Study
Protocol for a systematic review and network meta-analysis (NMA) using Bayesian methodology
PICO Summary
Population (P)
- Older people (≥60 years) living in residential aged care facilities (RACFs)
- Inclusion: men and women in RACFs, including post-discharge settings
- Exclusion: patients with Parkinson’s disease or stroke, studies with <6 weeks duration, and single-sex studies
Intervention (I)
Non-pharmaceutical interventions, grouped using the ProFaNE classification:
- Exercise-based interventions, including:
- Resistance, endurance, balance, power, flexibility, tai chi, exergaming, multitask, martial arts, dance, vibration therapy
- Hip protectors
- Other strategies:
- Environmental modifications
- Assistive technologies
- Education for staff/residents
Comparison (C)
- Usual care or other non-pharmaceutical interventions
- Randomised and cluster-randomised trials comparing ≥2 interventions or intervention vs. control
Outcomes (O)
Primary Outcome:
- Risk of fall-related fractures
- Measured at ≤1 year and >1 year follow-up
Secondary Outcomes:
- Injurious falls without fracture (requiring medical attention)
- Rate of falls per person-year
- Recurrent falls
- Adverse events related to interventions (especially exercise)
- Cost-effectiveness if data are available
Findings Summary (Protocol Stage)
This protocol aims to conduct the first Bayesian network meta-analysis comparing all major types of non-drug fall prevention strategies in RACFs, using both direct and indirect comparisons. Key features:
- Includes a structured PRISMA-P approach
- Seeks to resolve uncertainty about which exercise types or combinations are most effective
- Will explore how frailty (biological age), baseline fall risk, and level of care affect outcomes via subgroup analyses
- Risk of bias to be assessed using Cochrane RoB 2.0, and certainty of evidence with GRADE/CINeMA
- Will use SUCRA scores to rank intervention effectiveness
The study explicitly acknowledges that:
- Exercise may be beneficial or harmful depending on resident frailty
- Past reviews have not disaggregated exercise types or tailored for RACF populations
- Adverse events are likely underreported and will be included where possible
Conclusion
This rigorous, registered review protocol will provide a much-needed comparative ranking of the relative benefits and harms of non-drug strategies to prevent falls and fractures in aged care residents. Its focus on clinical relevance, frailty stratification, and Bayesian methods offers strong potential to inform multidisciplinary RACF fall prevention planning.
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