Letter to the Editor: A Multifactorial Trial to Prevent Serious Fall Injuries

“In the Strategies to Reduce Injuries and Develop Confidence in Elders (STRIDE) study (July 9 issue), Bhasin et al. evaluated the effectiveness of individualized recommendations to prevent fall injuries. We find the lack of significant success with this strategy to be wholly unsurprising. Referrals or recommendations alone are insufficient to reduce falls. The STRIDE intervention successfully expanded the role of primary care providers to include fall-risk screening, assessment, and individualized care plans. It did not include any direct procedural interventions (e.g., exercise, medication management, home safety modifications, and vision care) or the necessary extensive support to ensure their receipt.

[..] In an earlier commentary in the Journal regarding pragmatic trials, Ford and Norrie noted that “a trial that is dominated by poor adherence to the protocol or poor delivery of the intervention is of limited use.” The STRIDE study showed that screening, assessment, and care planning to reduce the risk of serious falls can be added to primary care. Now it is essential to design pragmatic trials that also include the most important components of fall prevention: exercise, medication management, home safety modifications, and vision care.”

Full letter to the editor, Hartley G, Eckstrom E and Allison L. New England Journal of Medicine 2020.10.1