Feasibility and Clinical Efficacy of a Multidisciplinary Home-Telehealth Program to Prevent Falls in Older Adults: A Randomized Controlled Trial

Abstract

Objectives: The aim of this study was to determine the feasibility and efficacy of a 6-month tele-rehabilitation home-based program, designed to prevent falls in older adults with 1 or more chronic diseases (cardiac, respiratory, neuromuscular or neurologic) returning home after in-hospital rehabilitation for their chronic condition. Patients were eligible for selection if they had experienced a fall during the previous year or were at high risk of falling.

Design: Randomized controlled trial. Tele-rehabilitation consisted of a falls prevention program run by the physiotherapist involving individual home exercise (strength, balance, and walking) and a weekly structured phone-call by the nurse inquiring about the disease status and symptoms and providing patient support.

Setting and participants: Two hundred eighty-three patients (age 79 ± 6.6 years; F = 59%) with high risk of falls and discharged home after in-hospital rehabilitation were randomized to receive home-based program (intervention group, n = 141) or conventional care (control group, n = 142).

Measures: Incidence of falls at home in the 6-month period (primary outcome); time free to the first fall and proportion of patients sustaining ≥2 falls (secondary outcomes).

Results: During the 6 months, 85 patients fell at least once: 29 (20.6%) in the Intervention Group versus 56 (39.4%) in the control group (P < .001). The risk of falls was significantly reduced in the intervention group (relative risk =0.60, 95% confidence interval: 0.44-0.83; P < .001). The mean ± standard deviation time to first fall was significantly longer in intervention group than control group (152 ± 58 vs 134 ± 62 days; P = .001). Significantly, fewer patients experienced ≥2 falls in the intervention group than in the control group: 11 (8%) versus 24 (17%), P = .020.

Conclusions: A 6-month tele-rehabilitation home-based program integrated with medical/nursing telesurveillance is feasible and effective in preventing falls in older chronic disease patients with a high risk of falling.

Keywords: Fall prevention; chronic disease; home tele-rehabilitation; older adults; telemedicine.