Definitions and methods of measuring and reporting on injurious falls in randomised controlled fall prevention trials: a systematic review

Abstract

Background: The standardisation of the assessment methodology and case definition represents a major precondition for the comparison of study results and the conduction of meta-analyses. International guidelines provide recommendations for the standardisation of falls methodology; however, injurious falls have not been targeted. The aim of the present article was to review systematically the range of case definitions and methods used to measure and report on injurious falls in randomised controlled trials (RCTs) on fall prevention.

Methods: An electronic literature search of selected comprehensive databases was performed to identify injurious falls definitions in published trials. Inclusion criteria were: RCTs on falls prevention published in English, study population ≥ 65 years, definition of injurious falls as a study endpoint by using the terms "injuries" and "falls".

Results: The search yielded 2089 articles, 2048 were excluded according to defined inclusion criteria. Forty-one articles were included. The systematic analysis of the methodology applied in RCTs disclosed substantial variations in the definition and methods used to measure and document injurious falls. The limited standardisation hampered comparability of study results. Our results also highlight that studies which used a similar, standardised definition of injurious falls showed comparable outcomes.

Conclusions: No standard for defining, measuring, and documenting injurious falls could be identified among published RCTs. A standardised injurious falls definition enhances the comparability of study results as demonstrated by a subgroup of RCTs used a similar definition. Recommendations for standardising the methodology are given in the present review.

Figure 1

Flowchart of the process of literature search and extraction of RCTs meeting the inclusion criteria.

Figure 2

Injury categories of the newly developed system are defined by both symptoms and medical care use. Definition of serious injuries represents the endpoint with highest accuracy but requires largest sample size due to low incidence of these falls. Definition of moderate and/or minor injuries requires smaller sample sizes but reduces accuracy of data (illustrated by left and right arrow).