AUTHOR=La Porta Fabio , Lullini Giada , Caselli Serena , Valzania Franco , Mussi Chiara , Tedeschi Claudio , Pioli Giulio , Bondavalli Massimo , Bertolotti Marco , Banchelli Federico , D'Amico Roberto , Vicini Roberto , Puglisi Silvia , Clerici Pierina Viviana , Chiari Lorenzo ,  The PRECISA Group , Porta Fabio La , Caselli Serena , Clerici Pierina Viviana , Cavazza Stefano , Serraglio Valeria , Vannini Maria Cristina , Bovolenta Federica , Lullini Giada , Puglisi Silvia , Gallo Angela , Mussi Chiara , Bertolotti Marco , Scotto Roberto , Lancellotti Giulia , Valzania Franco , Falzone Francesca , Montanari Monica , Luca Maria Luisa De , Malagoli Emanuela , Franchini Elisa , Palmisano Luisa , Serafini Franca , Tedeschi Claudio , Anselmi Gioacchino , D'Alleva Valentina , Matteo Mariangela Di , Ferrari Rosalinda , Costi Stefania , Simeone Filomena , D'Apote Giulia , Rizzica Alessandra , Galavotti Maria Beatrice , Ghirelli Marta , Pioli Giulio , Bendini Chiara , Lancellotti Giulia , Bondavalli Massimo , Georgopoulos Eleni , D'Amico Roberto , Balduzzi Sara , Vicini Roberto , Banchelli Federico , Chiari Lorenzo , Mellone Sabato , Coni Alice 

TITLE=Efficacy of a multiple-component and multifactorial personalized fall prevention program in a mixed population of community-dwelling older adults with stroke, Parkinson's Disease, or frailty compared to usual care: The PRE.C.I.S.A. randomized controlled trial

JOURNAL=Frontiers in Neurology

VOLUME=13

YEAR=2022

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2022.943918

DOI=10.3389/fneur.2022.943918

ISSN=1664-2295

ABSTRACT=<sec><title>Background</title><p>Fall risk in the elderly is a major public health issue due to the injury-related consequences and the risk of associated long-term disability. However, delivering preventive interventions in usual clinical practice still represents a challenge.</p></sec><sec><title>Aim</title><p>To evaluate the efficacy of a multiple-component combined with a multifactorial personalized intervention in reducing fall rates in a mixed population of community-dwelling elderly compared to usual care.</p></sec><sec><title>Design</title><p>Randomized Controlled Trial (NCT03592420, <ext-link ext-link-type="uri" xlink:href="https://clinicalTrials.gov" xmlns:xlink="http://www.w3.org/1999/xlink">clinicalTrials.gov</ext-link>).</p></sec><sec><title>Setting</title><p>Outpatients in two Italian centers.</p></sec><sec><title>Population</title><p>403 community-dwelling elderly at moderate-to-high fall risk, including subjects with Parkinson's Disease and stroke.</p></sec><sec><title>Methods</title><p>After the randomization, the described interventions were administered to the intervention group (<italic>n</italic> = 203). The control group (<italic>n</italic> = 200) received usual care and recommendations to minimize fall risk factors. In addition, each participant received a fall diary, followed by 12 monthly phone calls. The primary endpoint was the total number of falls in each group over 12 months, while the secondary endpoints were other fall-related indicators recorded at one year. In addition, participants' functioning was assessed at baseline (T1) and 3-month (T3).</p></sec><sec><title>Results</title><p>690 falls were reported at 12 months, 48.8% in the intervention and 51.2% in the control group, with 1.66 (± 3.5) and 1.77 (± 3.2) mean falls per subject, respectively. Subjects with ≥ 1 fall and ≥2 falls were, respectively, 236 (58.6%) and 148 (36.7%). No statistically significant differences were observed between groups regarding the number of falls, the falling probability, and the time to the first fall. According to the subgroup analysis, no significant differences were reported. However, a statistically significant difference was found for the Mini-BESTest (<italic>p</italic> = 0.004) and the Fullerton Advanced Balance Scale (<italic>p</italic> = 0.006) for the intervention group, with a small effect size (Cohen's d 0.26 and 0.32, respectively), at T1 and T3 evaluations.</p></sec><sec><title>Conclusions</title><p>The intervention was ineffective in reducing the number of falls, the falling probability, and the time to the first fall at 12 months in a mixed population of community-dwelling elderly. A significant improvement for two balance indicators was recorded in the intervention group. Future studies are needed to explore different effects of the proposed interventions to reduce falls and consequences.</p></sec>