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OTIS – The effectiveness of Occupational Therapist led home environmental assessment and modification for the reduction of falls among high-risk older people: a randomised controlled trial

There was some limited evidence that home hazard assessment and environmental modification delivered by an occupational therapist may help reduce falls in older people, a major cause of morbidity and mortality. However our study did not find this was the case in community-dwelling older people deemed at higher risk of falling. 

Why did we do this research?

Falls in older people are a major cause of morbidity and mortality but there are ways of reducing falls. There was some evidence to suggest that home hazard assessment and environmental modification delivered by an occupational therapist may reduce falls at home among older people likely to be at risk.

What did we do?

We undertook a pragmatic, two-arm modified cohort randomised controlled trial in eight NHS trusts in primary and secondary care in England. In total, 1331 participants were randomised in a 2:1 allocation to either usual care plus a falls prevention leaflet or to receive the home hazard assessment and environmental modification intervention, plus usual care and a falls prevention leaflet. The primary outcome was the number of falls per participant over the 12 months from randomisation. Secondary outcomes included; proportion of fallers and multiple fallers, time to fall, and fear of falling.

Who was involved?

Participants were aged 65 years or over, willing to receive a home visit from an occupational therapist, were community-dwelling and had experienced at least one fall in the previous 12 months, or reported a fear of falling.

What did we find?

We did not find any effect on the rate of self-reported falls among a population of older people with an elevated falls risk. Consequently, we do not recommend occupational therapist-led home assessment for patients who have characteristics similar to those of patients included in our study. Scarce occupational therapist resources would be better employed elsewhere.

Publications

• Cockayne S, Pighills A, Adamson J, et al. Home environmental assessments and modification delivered by occupational therapists to reduce falls in people aged 65 years and over: the OTIS RCT. Health Technol Assess 2021;25(46) https://doi.org/10.3310/hta25460 
• Cockayne S, Pighills A, Fairhurst C et al. Home hazard assessment and environmental modification to prevent falls in older people: the OTIS trial [version 1; peer review: 1 approved, 1 approved with reservations]. F1000Research 2021, 10:500 (https://doi.org/10.12688/f1000research.52313.1)
• Cockayne S, Pighills A, Adamson J on behalf of the OTIS study, et alCan occupational therapist-led home environmental assessment prevent falls in older people? A modified cohort randomised controlled trial protocol BMJ Open 2018;8:e022488. https://doi.org/10.1136/bmjopen-2018-022488 

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