A team of NDORMS researchers at the Centre for Statistics in Medicine (CSM) and Centre for Rehabilitation Research in Oxford (RRIO) has investigated the impact of the Prevention of Falls Network Europe (ProFaNE) core outcome recommendations.
The resulting article, published in March 2016, was a featured article in Trials journal last week. Core outcome sets have been proposed for many clinical areas, but little work has been done on whether they are used enough to standardise a research field and improve research synthesis.
Falling is a common problem in old age, and as age increases, so too does the risk and severity of falls. Elderly people who fall often suffer reduced mobility and independence, and can suffer serious injury and even death.
ProFaNE was set up in 2003 to help improve research into fall prevention and disseminate best practices to support those most at risk of falls and their effects. To make sure that all fall prevention research can be compared and synthesised into clinical recommendations, the ProFaNE Network proposed a set of core outcomes in 2005 that every fall prevention trial should measure and report.
The CSM/RRIO team reviewed all fall prevention trial reports since 2005 that cited the ProFaNE recommendations and assessed how well they actually adhered to the recommendations. Only about 14% of all fall prevention trials cited the recommendations, showing a serious lack of uptake across the research field.
The team found that in those reports that did cite the recommendations, some recommendations were generally followed, but others were usually not followed. For example, most of the studies used the recommended definition of a fall and reported the risk of falling and the number and rate of falls.
This result is encouraging, as these outcomes are often the primary outcome for these kinds of trials, so are the first outcome used to compare trials. However, most of the trials did not follow the recommendations on measuring and reporting fall-related injuries. The result? An intervention’s effect on number of falls can easily be compared across studies, but its effect on limiting injury cannot be easily compared. The latter is important information for those working with elderly people at risk of falls.
Bethan Copsey, RRIO statistician, said “Evaluating the impact and use of the recommendations has definitely been a useful process to provide evidence on where recommendations are not being followed and thus highlight areas where recommendations may not be fit-for-purpose. We are currently taking steps to review and update the recommendations to ensure they are as clear and relevant as possible.”
The CSM/RRIO researchers are now undertaking a two-pronged approach to improve the use of the core outcome set in fall prevention trials. They are conducting a survey of people working in the area of fall prevention to find out whether the ProFaNE recommendations are still fit-for-purpose or require updating. Once this is completed, they will work to improve awareness of the core outcome set and the importance of using it.
This work is supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care Oxford at Oxford Health NHS Foundation Trust. More information can be found on the CLAHRC Oxford website.