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Features of effective hospital fall prevention trials: an intervention component analysis

BMC Geriatrics volume 24, Article number: 1023 (2024) Cite this article

Abstract

Background

Falls in hospitals continue to burden patients, staff, and health systems. Prevention approaches are varied, as well as their success at preventing falls. Intervention component analysis (ICA) is useful in indicating important features associated with successful interventions in sets of trial with high heterogeneity.

Methods

We conducted an ICA of systematically identified randomised controlled trials of interventions for preventing falls in older people in hospitals. Trial characteristics were extracted; inductive thematic analysis of published papers from included trials to seek triallists perspectives on drivers of success or failure of trials was conducted (ICA stage one) followed by a stratified thematic synthesis by trial outcomes, where trials were classified as positive or negative based on their falls rate or falls risk ratios (ICA stage two) and mapped to the presence of the theorised drivers of success or failure of the trials.

Results

45 trials met the inclusion criteria. Inductive thematic analysis of 50 papers revealed three key drivers (themes), each with subthemes, of effective inpatient hospital fall prevention trials. Theme 1, integration with the local setting, was present in 79% of the positive trials and 67% of the negative trials (79% vs 62% engaging ward staff and 33% vs 43% engaging hospital management). Theme 2, responsive interventions, was present in 83% of the positive trials and 71% of the negative trials (29% vs 38% targeting patient risk assessments and 83% vs 57% tailoring to patient needs and abilities). Theme 3, patient and family involvement, featured in 83% of the positive trials and 52% of the negative trials (50% vs 19% through fall prevention awareness and 58% vs 48% through an active role in fall prevention).

Conclusion

Tailored fall prevention approaches and involving patient and family in fall prevention through increasing awareness, in addition to integration with the local intervention setting, appear to play a role in impacting the effectiveness of fall prevention interventions. These theories should be considered in the design of future fall prevention programs and trials and require further evaluation in high quality trials.

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Introduction

Falls in hospitals remain frequent and continue to cause patient physical and psychological harm and health professional distress [1,2,3]. The ongoing economic burden of hospital falls on health systems internationally is also evident [4, 5]. Hospital falls are more common in older patients and those with cognitive or chronic impairments [6, 7], with this patient group occupying increasing proportions of hospital beds [8].

There are multifactorial intrinsic and extrinsic risks for inpatient hospital falls and thus prevention approaches are highly varied and often complex [9]. Environmental interventions such as alarms and flooring, medication reviews, patient and/or staff education, exercise, service model changes and combinations of these approaches are examples of frequently trialled interventions [3, 10]. The effectiveness of these approaches is also highly variable. Evidence on how best to reduce falls across all hospital settings remains uncertain. The most recent Cochrane review update of interventions for preventing falls in older people in hospitals concluded that multifactorial interventions, where multiple interventions are delivered but the selection of interventions is based on individual patient risk assessment, may reduce falls in hospitals, however this was based on low certainty evidence in a subacute setting only [10]. While multifactorial approaches and patient education have shown positive results in subacute settings [11,12,13], large trials of multifactorial interventions in acute settings have proven ineffective [14, 15].

Intervention Component Analysis (ICA) aims to identify critical features of complex interventions important to implementation success [16]. It applies inductive thematic analysis to triallists’ reported reflections on implementation factors that may have affected outcomes, and triangulates the findings from this analysis with a stratified thematic synthesis of the outcomes of included trials to reveal theories as to what may contribute to the success or failure of interventions and their implementation [16, 17]. ICA is especially useful in providing practical suggestions to support evidence translation where sets of trials have high heterogeneity and systematic review evidence is inconclusive [17,18,19].

This study utilises an ICA to address the research questions: 1) What features do triallists consider contribute to successful inpatient hospital fall prevention? 2) What is the distribution of these features across trials with positive and negative falls outcomes? 3) How may the distribution of these features account for positive and negative falls outcomes in trials?

Methods

Study selection

This analysis included randomised controlled trials (RCTs) of interventions for preventing falls in older people (participant age 65 years and over) in hospitals where reported falls outcomes were suitable for determining the ratio of the rate of falls or risk of falling (as utilised in meta-analyses) [10]. Inclusion criteria followed Cameron et al.’s 2018 Cochrane Collaboration systematic review on preventing falls in older people in care facilities and hospitals but only trials in the hospital setting were included [10]. A detailed description of the inclusion and exclusion criteria is provided in Additional File 1. For consistency with the Cochrane review, no date restrictions were applied as inclusion/exclusion criteria.. Trials from the 2018 review plus additional hospital trials identified by systematic searching of CENTRAL, MEDLINE, Embase, and CINAHL databases from 2017 to December 2022 were included. Trial records, conference abstracts and protocols were excluded. All records were screened for inclusion independently by two reviewers. Any discrepancies were resolved by discussion or involvement of a third author.

Top-up search

A top-up search from December 2022 to October 2024 was conducted consistent with the search strategy described above and included in Additional File 3. Two reviewers independently screened the records to identify any additional trials published since December 2022. Trial data were extracted for the new trials identified, and stage two of the ICA was updated to include the additional trials. It was not considered necessary to update stage one of the ICA as papers included in the initial thematic analysis had reached data saturation and a relatively small number of additional studies were unlikely to yield sufficient novel information to alter the themes [20]. The intention of the update was rather to determine whether the final ICA theories were supported by more recent trials [21].

Data extraction

Two authors independently extracted characteristics and outcomes data and conducted risk of bias assessment for the trials included in addition to those from the 2018 Cochrane review [10]. Study and participant characteristics data were extracted including trial design, trial duration, sample size, hospital setting (acute, subacute, or mixed), intervention category (based on Prevention of Falls Network Europe (ProFaNE) fall-prevention taxonomy) [22], participant population, age, gender and fall outcomes reported. Risk of bias was conducted according to the Cochrane 2011 risk of bias 1 tool, plus items for method of ascertaining falls and baseline imbalance [23]. Assessors were not blinded to author and source institutions. Disagreement was resolved by consensus or by third party adjudication.

The overall effect of individual trials was reported as the ratio of the rate of falls or risk of falling between trial arms. Rate of falls (number of falls per unit of time) was reported as a rate ratio with a 95% confidence interval. Risk of falling (proportion of people falling one or more times) was reported as a risk ratio with 95% confidence interval. If a rate or risk ratio was not reported in the trial paper but appropriate raw data were available, ratios with 95% confidence intervals were calculated in Excel, RevMan or Stata. For rate of falls, the reported rate of falls in each group and the total number of falls for participants contributing data, or the total number of falls and the actual total length of time falls were monitored (person years) for participants contributing data, were used. For risk of falling, the odds ratio, relative risk or hazard ratio for first fall and number of participants contributing data in each group were used. If both adjusted and unadjusted rate and risk estimates were reported the unadjusted estimate was used unless the adjustment was for clustering. Where trial authors had not adjusted for clustering, the reviewers conducted adjustments using intra-cluster correlation coefficients reported by Hill et al [12] (rate of falls 0.016, risk of falling 0.016, and risk of fracture 0.005) [12]. Which trial outcomes were calculated or adjusted for clustering by the review authors is indicated in the footnotes to Table 1.

Table 1 Summary characteristics of 45 included trials
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For trial characteristics, trials were allocated to one of five outcome categories, where an increase or decrease of 0.25 in the point estimate was considered to indicate appreciable benefit or harm. This is considered a clinically meaningful reduction in falls and is also based on the GRADE Group’s guidance for use in rating the certainty of evidence [24]. The categories included: i) Statistically significant reduction in falls where the point estimate is < 0.75 and the confidence interval does not cross 1; ii) Statistically non-significant reduction in falls where the point estimate is < 0.75 but the confidence interval crosses 1; iii) Significant effect on falls not detected or not present where the point estimate is between 0.75 and 1.25 regardless of confidence interval; iv) Statistically non-significant increase in falls where the point estimate is > 1.25 but the confidence interval crosses 1; v) Statistically significant increase in falls where the point estimate is > 1.25 and the confidence interval does not cross 1. Where ratios of the rate of falls and risk of falling were both reported, the rate ratio was used, as rate data appears to be more sensitive to change [10].

Intervention component analysis

The ICA was conducted in two stages:

Inductive thematic analysis

All papers associated with trials meeting the inclusion criteria published before December 2022 were imported into NVivo [25]. Inductive line-by-line coding and thematic analysis of authors perspectives of trial features and their impact on the outcome of the intervention was conducted following the reflexive thematic analysis methods of Braun and Clark [26]. Initial coding of a random sample of six trials’ papers was conducted independently by two authors (CM and JS) for agreement on appropriate coding. One author (CM) coded the remaining trial papers and subsequently grouped initial codes and considered relationships between codes. Grouping of and relationships between codes were checked by a second author (JS) for agreement. Inductive thematic analysis of codes and the relationship between codes generated key themes and subthemes relevant to the research question regarding features triallists associated with contributing to more successful inpatient hospital fall prevention trials. Findings from this stage of the analysis were presented to members of the research team (JS, CS, SD, VN, AH) who have a mix of expertise in hospital fall prevention, critical evidence review, intervention component analysis and qualitative analysis, for critical feedback. Once consensus on the themes and subthemes was reached, a standard definition for each was agreed upon. The results of this stage of the analysis were also discussed and agreed upon with a consumer representative with lived experience of falls in hospital.

Stratified thematic synthesis by trial outcome

Falls outcomes of all included trials were coded in a stratified thematic synthesis using two categories of trial outcomes. Trials with a reduction in falls indicated by a point estimate < 0.75, regardless of statistical significance, were considered as positive (categories i and ii from Table 1), studies with no impact on falls (category iii; a point estimate between 0.75 and 1.25), or an increase in falls (categories iv and v; a point estimate > 1.25) were considered as negative [22]. Although this may include some studies with positive findings due to chance, it also enables the appropriate categorisation of trials too small to detect statistically significant between group differences [27].

Using the definitions for the themes and subthemes developed in stage one, all included trial papers were screened independently by 2 authors (CM and VN) and scored for their presence or absence of the themes and subthemes. If there was no mention of a theme feature it was coded as absent. Any discrepancies in the screening were resolved via discussion between the authors or involvement of a third author. A table was constructed to synthesise the presence and absence of the themes and subthemes for each trial based on whether the trial had positive or negative falls outcomes.

Results

Trial and participant characteristics

Forty-five trials were included, published across 14 countries. Twenty- four were conducted in acute care settings, 14 in sub-acute care settings and 7 across a mix of acute and sub-acute care settings (Table 1). There were 10 different intervention types based on ProFaNE categorisation [22]. Participant ages ranged from 18 to 101 years old with a mean of 79.2 and all but one study [28] included male and female patients (Table 1). Additional file 2 provides a more comprehensive summary of trial characteristics and the risk of bias assessment.

In terms of effectiveness, seven studies [11,12,13, 29,30,31,32] demonstrated a statistically significant reduction in falls. Eighteen studies [14, 28, 33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49] demonstrated a statistically non-significant reduction in falls. Fourteen studies [15, 50,51,52,53,54,55,56,57,58,59,60,61] demonstrated no effect on falls. Six studies [62,63,64,65,66,67] demonstrated a statistically non-significant increase in falls. No studies demonstrated a statistically significant increase in falls.

Stage 1 of the ICA

The thematic analysis included 50 papers from 37 trials. Inductive thematic analysis of the study papers revealed three main themes, each with two subthemes, that triallists associated with contributing to effective inpatient hospital fall prevention, as described below. Illustrative quotes for the themes and subthemes are provided in Table 2.

Table 2 Informal evidence supporting ICA theme 1 and subthemes and correspondence with trial outcomes
Full size table
  1. 1.

    Local integration

The most common theme across the studies was the positive impact of fall prevention activities which were well integrated with the local intervention setting. This integration was in the form of engaging ward staff with the fall prevention intervention delivery (subtheme a) or working with hospital management at the ward and/or organisation level to optimise intervention suitability and implementation (subtheme b).

  1. 1a)

    Ward staff engagement

Eighteen studies [4, 7, 12,13,14,15, 33, 34, 36, 42, 43, 45, 46, 53, 59, 64, 65, 67] described the important impact that engaging frontline ward staff with fall prevention interventions can have on the effectiveness of the intervention. In seven of these studies [12, 14, 15, 36, 43, 45, 65] authors referred specifically to nursing staff as being important to engage in the intervention delivery, while the remaining studies referred to clinical ward staff more broadly. Most of the studies described the benefit in relation to ward staff engagement generally, for example through clinical ward staff providing some or all aspects of an intervention or staff being supportive of the intervention. Five studies [12, 14, 15, 46, 65] reflected on the importance of ward staff leading or feeling ownership of fall prevention initiatives and also on the importance of ward staff behaviour change.

  1. 1b)

    Hospital management involvement

Twelve studies [4, 12,13,14,15, 30, 33, 43, 44, 46, 64] discussed benefits associated with working with hospital management to optimise intervention and implementation suitability and success. All but two [30, 44] of these studies described the importance of engagement with ward level management (e.g. through tailoring interventions and implementation strategies to specific ward needs and considering each ward’s competing priorities). Six [14, 15, 30, 43, 44, 64] described the importance of engagement with organisation level management (e.g. through responding to institution needs and considering relevant systems already in place). Four studies [14, 30, 64, 68] discussed benefits related to the involvement of both ward and organisation management, especially regarding the positive system level impact this can have.

  1. 2.

    Responsive fall prevention

The importance of responsive fall prevention interventions and implementation strategies was the next major theme to emerge. Responsive fall prevention was described in two ways: a) interventions targeted to individual patient fall risks and b) interventions and or implementation strategies tailored to patient needs and abilities regardless of whether the intervention was targeted to fall risk factors. Most studies discussed just one of these subthemes, although three studies reflected on the importance of both these aspects for an appropriate intervention [11, 13, 14]. Illustrative quotes for the subthemes are provided in Table 3.

Table 3 Informal evidence supporting ICA theme 2 and subthemes and correspondence with trial outcomes
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  1. 2a)

    Intervention assessment targeted to individual patient risks

Ten studies [4, 11, 13,14,15, 30, 39, 50, 53, 67] discussed the benefits of individual comprehensive risk assessment, with or without formal risk assessment tools, to ensure interventions targeted specific patient risks such as functional and cognitive impairments.

  1. 2b)

    Intervention delivery tailored to patient needs and abilities

Eleven studies [11,12,13,14, 34, 36, 37, 41, 45, 52, 57] discussed the benefits of considering the needs of individual patients or patient cohorts and the appropriateness of the interventions and implementation strategies to ensure needs are adequately targeted and interventions are appropriate to any relevant personal factors (i.e. life goals, motivations, need for encouragement, cognitive and/ or physical ability).

  1. 3.

    Patient and family involvement in fall prevention

The final theme focused on the role patient and family can play in positively influencing intervention success. Studies described two options for this involvement: a) patient/ family awareness and b) patient/ family active contribution. Illustrative quotes for the subthemes are provided in Table 4.

Table 4 Informal evidence supporting ICA theme 3 and subthemes and correspondence with trial outcomes
Full size table
  1. 3a)

    Patient/ family awareness

Ten studies [7, 34, 36, 40, 42, 45, 52, 53, 57, 59] described the benefit of patients and/ or family members being aware of the patient’s risk of falling or of awareness of simple advice about how to reduce this risk. In five of the studies [7, 11, 34, 52, 59] the benefit was related to patient fall prevention awareness or education intentionally delivered through the fall prevention intervention. In the other five [40, 42, 45, 53, 57] studies, the benefit of patient awareness was discussed as related to inadvertent patient recognition of falls risks and prevention by way of the research trial they were participating in, e.g. the Hawthorne effect.

  1. 3b)

    Patient/family active contribution

Six studies [12, 14, 38, 41, 52, 53] discussed the positive impact of patients being supported to take a leading role in fall prevention, in some cases working as a team with hospital staff.

Three studies discussed the important role patients’ family can play in fall prevention, two [40, 57] in relation to fall prevention awareness and one [38] in relation to active involvement in fall prevention.

Stage 2 of the ICA

All included trials were screened for presence and absence of the themes and subthemes that emerged in stage one of the ICA. This was mapped against the study outcomes with 24 studies considered positive and 21 considered neutral or negative (Table 5). Of the 24 positive trials, 79% featured integration with the local setting (79% engaging ward staff and 33% engaging hospital management), 83% featured responsive interventions (29% targeting patient risk assessments and 83% tailoring to patient needs and abilities) and 83% featured patient and family involvement (50% through fall prevention awareness and 58% through an active role in fall prevention). Of the 21 negative trials, 67% featured integration with the local setting (62% engaging ward staff and 43% engaging hospital management), 71% featured responsive interventions (38% targeting patient risk assessments and 57% tailoring to patient needs and abilities) and 52% featured patient and family involvement (19% through fall prevention awareness and 48%through an active role in fall prevention). The correspondence between the trial outcomes and each of the subthemes is provided in Tables 2, 3, 4 and 5.

Table 5 Presence of themes and subthemes in hospital fall prevention trials
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Explanatory theories that emerged from this analysis to guide successful approaches to hospital fall prevention are presented in Table 6.

Table 6 ICA theories of successful hospital fall prevention approaches
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Discussion

This study found that triallists associate integration with the local setting, responsive interventions using targeted and tailored approaches and patient and family involvement as components that may contribute to effective inpatient hospital fall prevention trials.

When considering this finding within the context of the outcome of the studies, we found that integration with the local setting was present in a majority of trials and quite evenly across trials with both positive and negative falls outcomes. This suggests that while integration with the local setting may be necessary for the successful implementation of any program, this feature does not appear to be a factor that alone can drive the success of falls prevention approaches within the hospital context, i.e. other features will also need to be present to drive successful outcomes. Features more frequently present in the positive trials than the negative trials were subtheme 2b of responsive interventions (interventions tailored to the needs and abilities of patients 83% vs 57%) and theme 3 patient and family involvement 83% vs 52%), suggesting that these features may play an important role in the effectiveness of falls prevention approaches in hospital settings.

This ICA thus indicated an explanatory theory to guide successful approaches to hospital fall prevention. The two theories to emerge were:

  1. 1)

    Fall prevention approaches that engage patients and/ or their family or carers, particularly through fall prevention awareness, in addition to integrating with the local context, may be more successful at reducing falls.

  2. 2)

    Fall prevention approaches that tailor to the needs and abilities of patients, in addition to integrating with the local context, may be more successful at reducing falls.

Our findings support the benefit of patient and family involvement in hospital fall prevention. This is consistent with the most recent systematic review of hospital fall prevention interventions conducted by Morris and colleagues in 2022 [3] and Heng et al.’s recent scoping review of patient education in hospital fall prevention [69]. The benefits of engaging patients and local clinicians in fall prevention was highlighted in these reviews by the significant positive effects that patient education and goal setting had on hospital inpatient fall rates and risk of falling. Additionally, the recent World Falls Guidelines [2] recommended that all hospitalised older patients, and other high risk patient groups, be engaged in hospital fall prevention education aligning with the World Health Organisation’s Global Safety Action Plan’s recommendation to partner with patients and families as partners in safe care [70]. Hospital patients, their families and clinicians also appear optimistic about patient and family involvement in hospital fall prevention, highlighted in recent qualitative work with these stakeholders [71].

Morris et al.’s recent systematic review highlighted promising results linked to tailored hospital fall prevention programs such as in targeted provision of therapeutic exercises and the importance of considering local needs for effective programs in everyday clinical settings [3]. Tailored intervention delivery has also emerged as being associated with successful exercise and multifactorial fall prevention interventions in residential aged care settings through the application of the ICA methodology [13, 19, 72]. The need for responsive tailoring of interventions is also reflected in the wider patient safety intervention literature where the importance of adaptive design of interventions and their implementation is emphasised [70, 73, 74]. For example, tailoring of hand hygiene interventions, especially via psychological frameworks, in hospital units has shown promising results in preventing hospital acquired infections [75, 76].

Strengths and limitations

This study uses rigorous methodology, including extensive database searching and systematic study identification and inclusion, to suggest key considerations in implementing fall prevention approaches in hospital settings. The large number of studies included and the spread across acute and subacute settings and broad population groups, such as those with and without cognitive impairments, are strengths. This scope has meant that relatively historic studies have been included, for example Mayo and colleagues’ 1994 trial [53]. Whilst approaches to falls prevention have changed over time, the inclusion of older studies ensures the theories developed from this work considered the full body of evidence.

There are also some limitations to this study. While many studies [37] were included, trials with a mean participant age of less than 65, those without data suitable to determine a ratio of the rate of falls or risk of falling and study designs other than RCTs were excluded. Inclusion of different study designs may add to the perspectives obtained, but inclusion of RCT evidence alone ensured that the themes developed could be examined against a high standard of comparative outcome evidence. As with all qualitative research, there is some degree of subjectivity, however independent coding by two authors for the inductive thematic analysis and trial presence of themes, and review by the wider research team, minimised the potential for bias in this study [77]. The ICA theory development is limited by the fact that the coding of the presence of developed themes relied on the clear reporting of these in the trial papers, i.e. if a theme was not mentioned, it was coded as absent. The descriptions of some interventions were broad and lacking specificity so in some cases the themes may have been present but not clearly reported. Thus, further study is required to confirm the role of these features in effective falls prevention efforts.

Stage 2 of the ICA, examining the correspondence of trial outcomes to the themes, used a threshold of a reduction in the risk or rate ratio of falls of greater than 0.25, regardless of statistical significance, to indicate a positive trial. The approach of focussing on the size of effects rather than statistical significance was undertaken in order to learn from studies that may have been too small to detect statistically significant between group differences. However, this approach risks categorising some studies as positive that may be due to chance. The threshold of a 25% reduction in falls is considered to be clinically meaningful. The largest trial included in this review had a moderately low rate of falls in the control arm of the trial of 2,570 falls per 1000 person years (7.03 per 1000 occupied bed days), with 40 of 1000 patients falling one or more times [14]. A 25% reduction in this rate of falls would result in 642 fewer falls per 1000 person years (1.78 per 1000 bed days) and 10 fewer patients falling per 1000.

This study included trials of all intervention types in hospital fall prevention, with only a few studies representing each intervention type. Therefore, only broadly applicable intervention, implementation and contextual features likely to be important in successful trials can be identified as dominant themes. The intervention features that may be associated with successful trials in specific intervention categories, for example exercise or environmental modifications, could not be identified due to this diversity. Other ICAs have been applied to trials all applying a particular intervention type and thus are being utilised to identify more specific features of the intervention as well as contextual and implementation factors (e.g. the identification of realistic and easy to follow progressive exercise in standing as a key component of exercise interventions in residential aged care facilities revealed in Dawson et al.’s ICA) [19, 72]. However, for falls prevention in the hospital setting, there is greater diversity of interventions, and no single intervention category has been studied in enough trials to inform such an analysis.

Implications

While the ICA method cannot definitively establish causation between tailored fall prevention interventions and patient and family involvement in fall prevention, and more successful fall prevention interventions, it does offer guidance for important factors to consider in future hospital fall prevention research and clinical practice. The results of this study suggest the need for researchers and clinicians to consider the ability of fall prevention approaches to be tailored to local settings and patient needs and engage with patients and families. This aligns with the increasing attention being paid to locally driven quality improvement approaches to fall prevention [78, 79], patient centred fall prevention care [80], and balancing gold standard evidence with frontline knowledge of what patients, staff and health systems require locally [3, 81].

The results of this ICA may also inform a Qualitative Comparative Analysis [82] where the theories developed in this study may be tested to determine whether one or both of the emerged theories differentiate successful from unsuccessful trials. The methods for applying QCA to ICA findings have been published [18] and applied to public health interventions [82, 83] and residential aged care fall prevention interventions [19].

Conclusion

This ICA identified three features that triallists believe are associated with effective inpatient hospital fall prevention trials. These included integration of the fall prevention strategy with the local setting, targeted and tailored approaches to fall prevention and involving patient and family in fall prevention interventions. A stratified thematic synthesis by trial outcomes indicated that tailored approaches to fall prevention (subtheme 2b) and involving patient and family in fall prevention (theme 3), was present in more positive than negative trials. This suggests that these features, when present in addition to integration with the local setting (theme 1), which emerged as a necessary but insufficient feature, may be critical in impacting the effectiveness of fall prevention interventions in hospital settings. These features should be incorporated into the design of future fall prevention programs.

Data availability

The data underlying this article are available within the manuscript and its online supplementary material and the published manuscripts of the referenced included trials.

Abbreviations

ICA:

Intervention Component Analysis

RCT:

Randomised Controlled Trial

ProFaNE:

Prevention of Falls Network Europe

References

  1. King B, Pecanac K, Krupp A, Liebzeit D, Mahoney J. Impact of Fall Prevention on Nurses and Care of Fall Risk Patients. Gerontologist. 2018;58(2):331–40.

    PubMed  Google Scholar 

  2. Montero-Odasso M, van der Velde N, Martin FC, Petrovic M, Tan MP, Ryg J, et al. World guidelines for falls prevention and management for older adults: a global initiative. Age Ageing. 2022;51(9):afac205.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Morris ME, Webster K, Jones C, Hill AM, Haines T, McPhail S, et al. Interventions to reduce falls in hospitals: a systematic review and meta-analysis. Age Ageing. 2022;51(5):afac077.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Dykes PC, Curtin-Bowen M, Lipsitz S, Franz C, Adelman J, Adkison L, et al. Cost of Inpatient Falls and Cost-Benefit Analysis of Implementation of an Evidence-Based Fall Prevention Program. JAMA Health Forum. 2023;4(1):e225125.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Morello RT, Barker AL, Ayton DR, Landgren F, Kamar J, Hill KD, et al. Implementation fidelity of a nurse-led falls prevention program in acute hospitals during the 6-PACK trial. BMC Health Serv Res. 2017;17(1):383.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Royal College of Physicians. National Audit of Inpatient Falls annual report (2021 clinical and 2022 facilities audit data). London: RCP; 2022.

  7. Shorr RI, Staggs VS, Waters TM, Daniels MJ, Liu M, Dunton N, et al. Impact of the hospital-acquired conditions initiative on falls and physical restraints: a longitudinal study. J Hosp Med. 2019;14:E31–6.

    Article  PubMed  Google Scholar 

  8. Reid N, Gamage T, Duckett SJ, Gray LC. Hospital utilisation in Australia, 1993–2020, with a focus on use by people over 75 years of age: a review of AIHW data. Med J Aust. 2023;219(3):113–9.

    Article  PubMed  Google Scholar 

  9. Ghosh M, O’Connell B, Afrifa-Yamoah E, Kitchen S, Coventry L. A retrospective cohort study of factors associated with severity of falls in hospital patients. Sci Rep. 2022;12(1):12266.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Cameron ID, Dyer SM, Panagoda CE, Murray GR, Hill KD, Cumming RG, et al. Interventions for preventing falls in older people in care facilities and hospitals. Cochrane Database Syst Rev. 2018;9(9):CD005465.

    PubMed  Google Scholar 

  11. Haines T, Bennell K, Osborne R, Hill K. Effectiveness of targeted falls prevention programme in subacute hospital setting: randomised controlled trial. BMJ. 2004;321(7441):676.

    Article  Google Scholar 

  12. Hill AM, McPhail SM, Waldron N, Etherton-Beer C, Ingram K, Flicker L, et al. Fall rates in hospital rehabilitation units after individualised patient and staff education programmes: a pragmatic, stepped-wedge, cluster-randomised controlled trial. Lancet. 2015;385(9987):2592–9.

    Article  PubMed  Google Scholar 

  13. Ang E, Mordiffi SZ, Wong HB. Evaluating the use of a targeted multiple intervention strategy in reducing patient falls in an acute care hospital: a randomized controlled trial. J Adv Nurs. 2011;67(9):1984–92.

    Article  PubMed  Google Scholar 

  14. Barker AL, Morello RT, Wolfe R, Brand CA, Haines TP, Hill KD, et al. 6-PACK programme to decrease fall injuries in acute hospitals: cluster randomised controlled trial. BMJ. 2016;352: h6781.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Cumming RG, Sherrington C, Lord SR, Simpson JM, Vogler C, Cameron ID, et al. Cluster randomised trial of a targeted multifactorial intervention to prevent falls among older people in hospital. BMJ. 2008;336(7647):758–60.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Sutcliffe K, Thomas J, Stokes G, Hinds K, Bangpan M. Intervention Component Analysis (ICA): a pragmatic approach for identifying the critical features of complex interventions. Syst Rev. 2015;4:140.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Sutcliffe K, Kneale D, Thomas J. Exploiting insights and harnessing heterogeneity: combining intervention component analysis (ICA) and qualitative comparative analysis (QCA) to explore context and implementation in systematic reviews of complex interventions. J Epidemiol Commun Health. 2022;76:A76–7.

    Google Scholar 

  18. Sutcliffe K, Kneale D, Thomas J. “Leading from the front” implementation increases the success of influenza vaccination drives among healthcare workers: a reanalysis of systematic review evidence using Intervention Component Analysis (ICA) and Qualitative Comparative Analysis (QCA). BMC Health Serv Res. 2022;22(1):653.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Suen J, Kneale D, Sutcliffe K, Kwok W, Cameron ID, Crotty M, et al. Critical features of multifactorial interventions for effective falls reduction in residential aged care: a systematic review, intervention component analysis and qualitative comparative analysis. Age Ageing. 2023;52(11):afad185.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Bradshaw C, Atkinson S, Doody O. Employing a Qualitative Description Approach in Health Care Research. Glob Qual Nurs Res. 2017;4:2333393617742282.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Stokes G, Sutcliffe K, Thomas J. Is a one-size-fits-all “12-month rule” appropriate when it comes to the last search date in systematic reviews? BMJ Evid Based Med. 2023;28(6):359–63.

    Article  PubMed  Google Scholar 

  22. Lamb SE, Becker C, Gillespie LD, Smith JL, Finnegan S, Potter R, et al. Reporting of complex interventions in clinical trials: development of a taxonomy to classify and describe fall-prevention interventions. Trials. 2011;12:125.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Higgins JP, Altman DG, Gotzsche PC, Juni P, Moher D, Oxman AD, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 2011;343:d5928.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Guyatt G, Oxman AD, Kunz R, Brozek J, Alonso-Coello P, Rind D, et al. Corrigendum to GRADE guidelines 6. Rating the quality of evidence-imprecision. J Clin Epidemiol 2011;64:1283–1293. J Clin Epidemiol. 2021;137:265.

    Article  PubMed  Google Scholar 

  25. QSR International Pty Ltd. NVivo. Vol 13: ed 2023.

  26. Braun V, Clarke V. Reflecting on reflexive thematic analysis. Qual Res Sport Exercise Health. 2019;11(4):589–97.

    Article  Google Scholar 

  27. Walter SD, Thabane L, Briel M. The fragility of trial results involves more than statistical significance alone. J Clin Epidemiol. 2020;124:34–41.

    Article  PubMed  Google Scholar 

  28. Jarvis N, Kerr K, Mockett S. Pilot study to explore the feasibility of a randomised controlled trial to determine the dose effect of physiotherapy on patients admitted to hospital following a fall. Pract Evid. 2007;2:4–12.

    Google Scholar 

  29. Di Massimo DS, Catania G, Crespi A, Fontanella A, Manfellotto D, La Regina M, et al. Intentional rounding versus standard of care for patients hospitalised in internal medicine wards: Results from a cluster-randomised nation-based study. J Clin Med. 2022;11(14):3976.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Stenvall M, Olofsson B, Lundstrom M, Englund U, Borssen B, Svensson O, et al. A multidisciplinary, multifactorial intervention program reduces postoperative falls and injuries after femoral neck fracture. Osteoporos Int. 2007;18(2):167–75.

    Article  CAS  PubMed  Google Scholar 

  31. Di Gennaro G, Chamitava L, Pertile P, Ambrosi E, Mosci D, Fila A, et al. A stepped-wedge randomised controlled trial to assess efficacy and cost-effectiveness of a care-bundle to prevent falls in older hospitalised patients. Age Ageing. 2024;53(1):afad244.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Xiong X, Zang J, Zhu C, Wei W, Wang P, Wang J, et al. Effects of Proprioceptive Neuromuscular Facilitation Technique on Balance Function and Muscle Health in Older Adults With High Fall Risk. J Gerontol Nurs. 2024;50(8):37–44.

    Article  PubMed  Google Scholar 

  33. Daley B, Fetherman B, Turner J. Staffing Utilization and Fall Prevention With an Electronic Surveillance Video System: A Randomized Controlled Study. J Nurs Care Qual. 2021;36(1):57–61.

    Article  PubMed  Google Scholar 

  34. Donald IPP, Pitt K, Armstrong E, Shuttleworth H. Preventing falls on an elderly care rehabilitation ward. Clin Rehabil. 2000;14:178–85.

    Article  CAS  PubMed  Google Scholar 

  35. Dykes PC, Carroll DL, Hurley A, Lipsitz S, Benoit A, Chang F, et al. Fall prevention in acute care hospitals: a randomized trial. JAMA. 2010;304(17):1912–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Healey F, Monro A, Cockram A, Adams V, Heseltine D. Using targeted risk factor reduction to prevent falls in older in-patients: a randomised controlled trial. Age Ageing. 2004;33(4):390–5.

    Article  PubMed  Google Scholar 

  37. Liang Y, Wang R, Jiang J, Tan L, Yang M. A randomized controlled trial of resistance and balance exercise for sarcopenic patients aged 80–99 years. Sci Rep. 2020;10(1):18756.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Martinez FT, Tobar C, Beddings CI, Vallejo G, Fuentes P. Preventing delirium in an acute hospital using a non-pharmacological intervention. Age Ageing. 2012;41(5):629–34.

    Article  PubMed  Google Scholar 

  39. Michalek C, Wehling M, Schlitzer J, Frohnhofen H. Effects of “Fit fOR The Aged” (FORTA) on pharmacotherapy and clinical endpoints–a pilot randomized controlled study. Eur J Clin Pharmacol. 2014;70(10):1261–7.

    Article  CAS  PubMed  Google Scholar 

  40. Partridge JS, Harari D, Martin FC, Peacock JL, Bell R, Mohammed A, et al. Randomized clinical trial of comprehensive geriatric assessment and optimization in vascular surgery. Br J Surg. 2017;104(6):679–87.

    Article  CAS  PubMed  Google Scholar 

  41. Pfeiffer K, Kampe K, Klenk J, Rapp K, Kohler M, Albrecht D, et al. Effects of an intervention to reduce fear of falling and increase physical activity during hip and pelvic fracture rehabilitation. Age Ageing. 2020;49(5):771–8.

    Article  PubMed  Google Scholar 

  42. Treacy D, Schurr K, Lloyd B, Sherrington C. Additional standing balance circuit classes during inpatient rehabilitation improved balance outcomes: an assessor-blinded randomised controlled trial. Age Ageing. 2015;44(4):580–6.

    Article  PubMed  Google Scholar 

  43. van Gaal BG, Schoonhoven L, Mintjes JA, Borm GF, Hulscher ME, Defloor T, et al. Fewer adverse events as a result of the SAFE or SORRY? programme in hospitals and nursing homes. part i: primary outcome of a cluster randomised trial. Int J Nurs Stud. 2011;48(9):1040–8.

    Article  PubMed  Google Scholar 

  44. Wald HL, Glasheen JJ, Guerrasio J, Youngwerth JM, Cumbler EU. Evaluation of a hospitalist-run acute care for the elderly service. J Hosp Med. 2011;6(6):313–21.

    Article  PubMed  Google Scholar 

  45. Wolf KH, Hetzer K, Schwabedissen HM, Wiese B, Marschollek M. Development and pilot study of a bed-exit alarm based on a body-worn accelerometer. Z Gerontol Geriatr. 2013;46(8):727–33.

    Article  PubMed  Google Scholar 

  46. Young J, Green J, Farrin A, Collinson M, Hartley S, Smith J, et al. A multicentre, pragmatic, cluster randomised, controlled feasibility trial of the POD system of care. Age Ageing. 2020;49(4):640–7.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Wang Q, Zou H, Wang Q. The effectiveness of multimedia combined with teach-back method on the level of knowledge, confidence and behavior of professional caregivers in preventing falls in elderly patients: A randomized non-blind controlled clinical study. Medicine (Baltimore). 2022;101(39):e30869.

    Article  PubMed  Google Scholar 

  48. Morris ME, Thwaites C, Lui R, McPhail SM, Haines T, Kiegaldie D, et al. Preventing hospital falls: feasibility of care workforce redesign to optimise patient falls education. Age Ageing. 2024;53(1):afad250.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Twibell KR, Delaney L, Siela D, Coers G, Davis C, Drown C, et al. Tailoring Fall Prevention Videos for Medical-Surgical Inpatients: A Randomized Controlled Trial. Medsurg Nursing. 2023;32(3):170–8.

  50. Burleigh E, McColl J, Potter J. Does vitamin D stop inpatients falling? A randomised controlled trial. Age Ageing. 2007;36(5):507–13.

    Article  PubMed  Google Scholar 

  51. Farhat A, Al-Hajje A, Lang PO, Csajka C. Impact of Pharmaceutical Interventions with STOPP/START and PIM-Check in Older Hospitalized Patients: A Randomized Controlled Trial. Drugs Aging. 2022;39(11):899–910.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Haines TP, Hill AM, Hill KD, McPhail S, Oliver D, Brauer S, et al. Patient education to prevent falls among older hospital inpatients: a randomized controlled trial. Arch Intern Med. 2011;171(6):516–24.

    Article  PubMed  Google Scholar 

  53. Mayo NE, Gloutney L, Levy AR. A Randomized Trial of Identification Bracelets to Prevent Falls Among Patients in a Rehabilitation Hospital. Arch Phys Med Rehabil. 1994;74:1302–8.

    Article  Google Scholar 

  54. McCullagh R, O’Connell E, O’Meara S, Dahly D, O’Reilly E, O’Connor K, et al. Augmented exercise in hospital improves physical performance and reduces negative post hospitalization events: a randomized controlled trial. BMC Geriatr. 2020;20(1):46.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Mudge AM, McRae P, Banks M, Blackberry I, Barrimore S, Endacott J, et al. Effect of a Ward-Based Program on Hospital-Associated Complications and Length of Stay for Older Inpatients: The Cluster Randomized CHERISH Trial. JAMA Intern Med. 2022;182(3):274–82.

    Article  PubMed  Google Scholar 

  56. Scheffers-Barnhoorn MN, van Eijk M, van Haastregt JCM, Schols J, van Balen R, van Geloven N, et al. Effects of the FIT-HIP Intervention for Fear of Falling After Hip Fracture: A Cluster-Randomized Controlled Trial in Geriatric Rehabilitation. J Am Med Dir Assoc. 2019;20(7):857–65 e2.

    Article  PubMed  Google Scholar 

  57. Senserrick C, Lawler K, Scroggie GD, Williams K, Taylor NF. Three short sessions of physiotherapy during rehabilitation after hip fracture were no more effective in improving mobility than a single longer session: a randomised controlled trial. Physiotherapy. 2021;112:87–95.

    Article  PubMed  Google Scholar 

  58. Shorr RI, Chandler AM, Mion LC, Waters TM, Liu M, Daniels MJ, et al. Effects of an intervention to increase bed alarm use to prevent falls in hospitalized patients: a cluster randomized trial. Ann Intern Med. 2012;157(10):692–9.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Haines TP, Bell RA, Varghese PN. Pragmatic, cluster randomized trial of a policy to introduce low-low beds to hospital wards for the prevention of falls and fall injuries. J Am Geriatr Soc. 2010;58(3):435–41.

    Article  PubMed  Google Scholar 

  60. Cuvelier C, Hars M, Zamorani-Bianchi MP, Herrmann FR, Wieczorkiewicz CD, Zekry D, et al. Hypnosis to reduce fear of falling in hospitalized older adults: a feasibility randomized controlled trial. Pilot Feasibility Stud. 2023;9(1):139.

    Article  PubMed  PubMed Central  Google Scholar 

  61. Hastings SN, Stechuchak KM, Choate A, Van Houtven CH, Allen KD, Wang V, et al. Effects of Implementation of a Supervised Walking Program in Veterans Affairs Hospitals. Ann Intern Med. 2023;176(6):743–50.

    Article  PubMed  PubMed Central  Google Scholar 

  62. Appel L, Appel E, Kisonas E, Lewis-Fung S, Pardini S, Rosenberg J, et al. Evaluating the Impact of Virtual Reality on the Behavioral and Psychological Symptoms of Dementia and Quality of Life of Inpatients With Dementia in Acute Care: Randomized Controlled Trial (VRCT). J Med Internet Res. 2024;26:e51758.

    Article  PubMed  PubMed Central  Google Scholar 

  63. Gazineo D, Godino L, Decaro R, Calogero P, Pinto D, Chiari P, et al. Assisted walking program on walking ability in in-hospital geriatric patients: a randomized trial. J Am Geriatr Soc. 2021;69(3):637–43.

    Article  PubMed  Google Scholar 

  64. Hempenius L, Slaets JP, van Asselt D, de Bock GH, Wiggers T, van Leeuwen BL. Outcomes of a Geriatric Liaison Intervention to Prevent the Development of Postoperative Delirium in Frail Elderly Cancer Patients: Report on a Multicentre, Randomized, Controlled Trial. PLoS ONE. 2013;8(6):e64834.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  65. Koh SLHN, Lee JY, Loo YL, Muthu R. Impact of a fall prevention programme in acute hospital settings in Singapore. Singapore Med J. 2009;50(4):425–32.

    CAS  PubMed  Google Scholar 

  66. Lozano-Vicario L, Zambom-Ferraresi F, Zambom-Ferraresi F, de Asteasu MLS, Galbete-Jiménez A, Muñoz-Vázquez ÁJ, et al. Effects of exercise intervention for the management of delirium in hospitalized older adults: a randomized clinical trial. J Am Med Dir Assoc. 2024;25(8):104980.

    Article  PubMed  Google Scholar 

  67. Mador JE, Giles L, Whitehead C, Crotty M. A randomized controlled trial of a behavior advisory service for hospitalized older patients with confusion. Int J Geriatr Psychiatry. 2004;19(9):858–63.

    Article  PubMed  Google Scholar 

  68. Hill AM, Waldron N, Etherton-Beer C, McPhail SM, Ingram K, Flicker L, et al. A stepped-wedge cluster randomised controlled trial for evaluating rates of falls among inpatients in aged care rehabilitation units receiving tailored multimedia education in addition to usual care: a trial protocol. BMJ Open. 2014;4(1):e004195.

    Article  PubMed  PubMed Central  Google Scholar 

  69. Heng H, Jazayeri D, Shaw L, Kiegaldie D, Hill AM, Morris ME. Hospital falls prevention with patient education: a scoping review. BMC Geriatr. 2020;20(1):140.

    Article  PubMed  PubMed Central  Google Scholar 

  70. Global patient safety action plan 2021–2030: towards eliminating avoidable harm in health care. Geneva: World Health Organization; 2021. Licence: CC BY-NC-SA 3.0 IGO.

  71. McLennan C, Sherrington C, Tilden W, Jennings M, Richards B, Hill A-M, et al. Considerations across multiple stakeholder groups when implementing fall prevention programs in the acute hospital setting: a qualitative study. Age Ageing. 2024;53(10):afae208.

    Article  PubMed  PubMed Central  Google Scholar 

  72. Dawson R, Suen J, Sherrington C, Kwok W, Pinheiro MB, Haynes A, et al. Effective fall prevention exercise in residential aged care: an intervention component analysis from an updated systematic review. Br J Sports Med. 2024;58(12):641–8.

    Article  PubMed  Google Scholar 

  73. Dekker-van Doorn C, Wauben L, van Wijngaarden J, Lange J, Huijsman R. Adaptive design: adaptation and adoption of patient safety practices in daily routines, a multi-site study. BMC Health Serv Res. 2020;20(1):426.

    Article  PubMed  PubMed Central  Google Scholar 

  74. Mistri IU, Badge A, Shahu S. Enhancing Patient Safety Culture in Hospitals. Cureus. 2023;15(12):e51159.

    PubMed  PubMed Central  Google Scholar 

  75. Srigley JA, Corace K, Hargadon DP, Yu D, MacDonald T, Fabrigar L, et al. Applying psychological frameworks of behaviour change to improve healthcare worker hand hygiene: a systematic review. J Hosp Infect. 2015;91(3):202–10.

    Article  CAS  PubMed  Google Scholar 

  76. von Lengerke T, Ebadi E, Schock B, Krauth C, Lange K, Stahmeyer JT, et al. Impact of psychologically tailored hand hygiene interventions on nosocomial infections with multidrug-resistant organisms: results of the cluster-randomized controlled trial PSYGIENE. Antimicrob Resist Infect Control. 2019;8:56.

    Article  Google Scholar 

  77. Leavey P. SJ (ed) Qualitative Data Analysis Strategies. The Oxford Handbook of Qualitative Research 2nd ed, Oxford Handbooks. Oxford Academic. 2020.

  78. Montero-Odasso M, van der Velde N, Alexander NB, Becker C, Blain H, Camicioli R, et al. New horizons in falls prevention and management for older adults: a global initiative. Age Ageing. 2021;50(5):1499–507.

    Article  PubMed  Google Scholar 

  79. Shaw L, Kiegaldie D, Farlie MK. Education interventions for health professionals on falls prevention in health care settings: a 10-year scoping review. BMC Geriatr. 2020;20(1):460.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  80. Albertini A, Fernandes RP, Puschel VAA, Maia FOM. Person-centered care approach to prevention and management of falls among adults and aged in a Brazilian hospital: a best practice implementation project. JBI Evid Implement. 2023;21(1):14–24.

    Article  PubMed  Google Scholar 

  81. Montero-Odasso MM, Kamkar N, Pieruccini-Faria F, Osman A, Sarquis-Adamson Y, Close J, et al. Evaluation of Clinical Practice Guidelines on Fall Prevention and Management for Older Adults: A Systematic Review. JAMA Netw Open. 2021;4(12):e2138911.

    Article  PubMed  PubMed Central  Google Scholar 

  82. Thomas J, O’Mara-Eves A, Brunton G. Using qualitative comparative analysis (QCA) in systematic reviews of complex interventions: a worked example. Syst Rev. 2014;3:67.

    Article  PubMed  PubMed Central  Google Scholar 

  83. Batho A, Kneale D, Sutcliffe K, Williams ACC. Sufficient conditions for effective psychological treatment of chronic pain: a qualitative comparative analysis. Pain. 2021;162(10):2472–85.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

Dr Venisa Kwok and Ms Tania Marin assisted with screening studies in the top-up search.

Funding

The National Health and Medical Research Council (NHMRC) of Australia funded Centre for Research Excellence – Prevention of Fall related Injuries provides JS and SD partial salary funding. The funders had no role in the study design and will not have any role during its execution, analyses, interpretation of the data or decision to submit results.

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Authors and Affiliations

  1. School of Public Health, Faculty of Medicine and Health, Institute for Musculoskeletal Health, The University of Sydney, Sydney Local Health District, Sydney, Australia

    Charlotte McLennan, Catherine Sherrington, Veethika Nayak & Abby Haynes

  2. Flinders University, College of Medicine and Public Health, Flinders Health and Medical Research Institute, Adelaide, SA, Australia

    Jenni Suen & Suzanne Dyer

  3. Centre for Education and Research On Ageing, Concord Clinical School, Faculty of Medicine and Health, Concord Hospital, The University of Sydney, Sydney, Australia

    Vasi Naganathan

  4. EPPI Centre, Social Research Institute, University College London, London, UK

    Katy Sutcliffe & Dylan Kneale

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  1. Charlotte McLennan
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Contributions

All authors were involved in applying the ICA methodology in this study. Initial data analysis was undertaken by CM, JS, SD and VeN. Feedback on data analysis provided by CS, AH and VaN. CM drafted the manuscript and tables. All authors critically revised the manuscript for intellectual content.

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Correspondence to Charlotte McLennan.

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McLennan, C., Sherrington, C., Suen, J. et al. Features of effective hospital fall prevention trials: an intervention component analysis. BMC Geriatr 24, 1023 (2024). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12877-024-05587-w

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BMC Geriatrics

ISSN: 1471-2318

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