TY - JOUR
T1 - Strategies to reduce injuries and develop confidence in elders (STRIDE)
T2 - A cluster-randomized pragmatic trial of a multifactorial fall injury prevention strategy: Design and methods
AU - Bhasin, Shalender
AU - Gill, Thomas M.
AU - Reuben, David B.
AU - Latham, Nancy K.
AU - Gurwitz, Jerry H.
AU - Dykes, Patricia
AU - McMahon, Siobhan K
AU - Storer, Thomas W.
AU - Duncan, Pamela W.
AU - Ganz, David A.
AU - Basaria, Shehzad
AU - Miller, Michael E.
AU - Travison, Thomas G.
AU - Greene, Erich J.
AU - Dziura, James
AU - Esserman, Denise
AU - Allore, Heather
AU - Carnie, Martha B.
AU - Fagan, Maureen
AU - Hanson, Catherine
AU - Baker, Dorothy
AU - Greenspan, Susan L.
AU - Alexander, Neil
AU - Ko, Fred
AU - Siu, Albert L.
AU - Volpi, Elena
AU - Wu, Albert W.
AU - Rich, Jeremy
AU - Waring, Stephen C.
AU - Wallace, Robert
AU - Casteel, Carri
AU - Magaziner, Jay
AU - Charpentier, Peter
AU - Lu, Charles
AU - Araujo, Katy
AU - Rajeevan, Haseena
AU - Margolis, Scott
AU - Eder, Richard
AU - McGloin, Joanne M.
AU - Skokos, Eleni
AU - Wiggins, Jocelyn
AU - Garber, Lawrence
AU - Clauser, Steven B.
AU - Correa-De-Araujo, Rosaly
AU - Peduzzi, Peter
N1 - Publisher Copyright:
© The Author(s) 2017.
PY - 2018/7/9
Y1 - 2018/7/9
N2 - Background: Fall injuries are a major cause of morbidity and mortality among older adults. We describe the design of a pragmatic trial to compare the effectiveness of an evidence-based, patient-centered multifactorial fall injury prevention strategy to an enhanced usual care. Methods: Strategies to Reduce Injuries and Develop Confidence in Elders (STRIDE) is a 40-month cluster-randomized, parallel-group, superiority, pragmatic trial being conducted at 86 primary care practices in 10 health care systems across United States. The 86 practices were randomized to intervention or control group using covariate-based constrained randomization, stratified by health care system. Participants are community-living persons, ≥70 years, at increased risk for serious fall injuries. The intervention is a comanagement model in which a nurse Falls Care Manager performs multifactorial risk assessments, develops individualized care plans, which include surveillance, follow-up evaluation, and intervention strategies. Control group receives enhanced usual care, with clinicians and patients receiving evidence-based information on falls prevention. Primary outcome is serious fall injuries, operationalized as those leading to medical attention (nonvertebral fractures, joint dislocation, head injury, lacerations, and other major sequelae). Secondary outcomes include all fall injuries, all falls, and well-being (concern for falling; anxiety and depressive symptoms; physical function and disability). Target sample size was 5,322 participants to provide 90% power to detect 20% reduction in primary outcome rate relative to control. Results: Trial enrolled 5,451 subjects in 20 months. Intervention and follow-up are ongoing. Conclusions: The findings of the STRIDE study will have important clinical and policy implications for the prevention of fall injuries in older adults.
AB - Background: Fall injuries are a major cause of morbidity and mortality among older adults. We describe the design of a pragmatic trial to compare the effectiveness of an evidence-based, patient-centered multifactorial fall injury prevention strategy to an enhanced usual care. Methods: Strategies to Reduce Injuries and Develop Confidence in Elders (STRIDE) is a 40-month cluster-randomized, parallel-group, superiority, pragmatic trial being conducted at 86 primary care practices in 10 health care systems across United States. The 86 practices were randomized to intervention or control group using covariate-based constrained randomization, stratified by health care system. Participants are community-living persons, ≥70 years, at increased risk for serious fall injuries. The intervention is a comanagement model in which a nurse Falls Care Manager performs multifactorial risk assessments, develops individualized care plans, which include surveillance, follow-up evaluation, and intervention strategies. Control group receives enhanced usual care, with clinicians and patients receiving evidence-based information on falls prevention. Primary outcome is serious fall injuries, operationalized as those leading to medical attention (nonvertebral fractures, joint dislocation, head injury, lacerations, and other major sequelae). Secondary outcomes include all fall injuries, all falls, and well-being (concern for falling; anxiety and depressive symptoms; physical function and disability). Target sample size was 5,322 participants to provide 90% power to detect 20% reduction in primary outcome rate relative to control. Results: Trial enrolled 5,451 subjects in 20 months. Intervention and follow-up are ongoing. Conclusions: The findings of the STRIDE study will have important clinical and policy implications for the prevention of fall injuries in older adults.
KW - Clinical effectiveness
KW - Fall prevention
KW - Nurse falls care managers
KW - Patient and stakeholders in fall injury prevention research
UR - http://www.scopus.com/inward/record.url?scp=85050476843&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85050476843&partnerID=8YFLogxK
U2 - 10.1093/gerona/glx190
DO - 10.1093/gerona/glx190
M3 - Article
C2 - 29045582
AN - SCOPUS:85050476843
SN - 1079-5006
VL - 73
SP - 1053
EP - 1061
JO - Journals of Gerontology - Series A Biological Sciences and Medical Sciences
JF - Journals of Gerontology - Series A Biological Sciences and Medical Sciences
IS - 8
ER -