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Appendix A: Intervention Study Selection Process

In 2003, the RAND Corporation was commissioned by the Centers for Medicare and Medicaid Services (CMS) to review and analyze the existing research on fall prevention interventions. They conducted a comprehensive literature search and reviewed 826 intervention studies, of which 95 met the following selection criteria: (1) included adults aged ≥65 years; (2) used a randomized controlled trial or controlled clinical trial study design; (3) identified falls as an outcome; and (4) measured the number of falls at least 3 months after the start of the intervention. Of the 95 studies, 57 had falls as a primary outcome and 38 of the 57 reported either the number of subjects who fell at least once or the monthly rate of falling. RAND included these 38 studies in their meta-analyses to determine the effectiveness of fall prevention interventions (categorized as exercise, education, environmental modification, or multiple component interventions).*

Beginning with the 38 studies RAND included in their meta-analysis (used by permission, L. Rubenstein, personal communication), CDC identified those that met the following inclusion criteria: (1) included communitydwelling adults aged ≥65 years; (2) used a randomized controlled study design; (3) measured falls as a primary outcome; and (4) demonstrated statistically significant positive results for at least 1 fall outcome (e.g., showed statistically fewer falls for intervention participants). As illustrated in Figure 1, CDC excluded 1 study that focused on nursing home residents, 4 that did not include falls as a primary outcome, and 25 that did not demonstrate statistically significant, positive results. Of the remaining 8, 2 described the same study and were combined. Lastly, CDC identified 7 studies published after the RAND Report that met the established criteria. In total, the first edition of the Compendium included 14 studies published before December 31, 2004.

Updates in the Second Edition

In 2009, CDC undertook to update the original Compendium. A comprehensive literature search of randomized controlled trials of fall interventions published between January 1, 2005 and December 31, 2009 identified 86 studies. As Figure 2 illustrates, 2 interventions were excluded because they were already in the Compendium. Of the remaining 84 studies, CDC excluded 20 that were not randomized controlled trials, 15 that did not focus on community-dwelling adults aged ≥65 years, 27 that did not include falls as a primary outcome, and 14 that did not demonstrate statistically significant, positive results. In total, 8 studies published between January 2005 and December 2009 were added to the Compendium.

* Available at www.cms.gov/PrevntionGenInfo/Downloads/Exercise%20Report.pdf

Figure 1. Flow chart showing the selection process for studies used in the first edition of the Compendium

Figure 1: This figure illustrates the selection process of the studies included in the first edition of the Compendium.  The first box of the flow chart shows the initial number of studies reviewed and ends with the number of studies included in the compendium.  Boxes going right and left of the top to bottom flow chart illustrate the studies excluded.

Figure 2. Flow chart showing the selection process for studies used in the second edition of the Compendium

Figure 2: This figure illustrates the section process of the studies added on to the first edition of the compendium.   The first box of the flow chart shows the number of studies reviewed that were published between January 1, 2005 and December 31, 2009.  The last box of the flow chart shows the number of studies added on to the first edition of the compendium. Boxes going right and left of the top to bottom flow chart illustrate the studies excluded.

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