EFECTIVIDAD DE LAS INTERVENCIONES EDUCATIVAS PARA LA PREVENCIÓN DE CAÍDAS: REVISIÓN SISTEMÁTICA

Ximenes, Maria Aline Moreira; Brandão, Maria Girlane Sousa Albuquerque; Araújo, Thiago Moura de; Galindo Neto, Nelson Miguel; Barros, Lívia Moreira; Caetano, Joselany Áfio

doi:10.1590/1980-265X-TCE-2020-0558

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Literature Review • Texto contexto - enferm. 30 • 2021 • https://doi.org/10.1590/1980-265X-TCE-2020-0558 linkcopiar

EFECTIVIDAD DE LAS INTERVENCIONES EDUCATIVAS PARA LA PREVENCIÓN DE CAÍDAS: REVISIÓN SISTEMÁTICA

Autoría SCIMAGO INSTITUTIONS RANKINGS

Objetivo: evaluar la efectividad de las intervenciones educativas para la prevención de caídas implementadas en un hospital, entorno domiciliario e instalaciones de atención a largo plazo para ancianos.

Método: revisión sistemática, basada en la pregunta orientadora: ¿cuál es la efectividad de las intervenciones educativas aisladas para la prevención de caídas en adultos y ancianos desarrolladas en estudios experimentales? La búsqueda se realizó en las bases de datos electrónicas: Scopus, PubMed/PMC, Web of Science, CINAHL, SciELO, Cochrane y EMBASE. El factor de exposición fue la intervención educativa en la prevención de caídas, y como resultados: reducción de las tasas de caída, mejora del conocimiento, percepción y adherencia a la atención preventiva para pacientes adultos y ancianos. Solo se incluyeron ensayos controlados aleatorios, en todos los idiomas y publicados entre 2011 y 2020.

Resultados: se identificaron 1474 artículos, de los cuales se incluyeron 16. Cuatro estudios no mostraron efectividad relacionada con la prevención de caídas. Como características comunes, estos estudios se realizaron con pacientes ancianos y sin seguimiento presencial. Los otros fueron efectivos para reducir caídas y/o mejorar conocimientos y fueron en su mayoría estudios con intervenciones personalizadas, realizadas por enfermeras y mediadas por tecnologías educativas.

Conclusión: las intervenciones educativas son eficaces para prevenir caídas en el hogar, el hospital y las instalaciones de atención a largo plazo para los ancianos. Los estudios han demostrado tasas reducidas de caídas, mejor conocimiento y participación en estrategias de prevención.

DESCRIPTORES:
Accidentes por caídas; Prevención de accidentes; Educación en salud; Promoción de la salud; Atención de enfermería; Revisión

Database	Search structures
EMBASE	(falls OR “acidental falls” OR falling OR “fall risk” OR “falls prevention” OR “accident prevention”) AND (“health education” OR “health promotion” OR “patient education” OR “educational technology” OR “instructional technology”) AND (“clinical trial” OR “clinical trials (topic)”)
PuBMed	(“acidental falls” OR “falls prevention” OR “accident prevention”) AND (“health education” OR “patient education” OR “educational technology” OR “instructional technology”) AND (“clinical trial” OR “clinical trials as topic”)
Scopus
Web of Science	(falls OR “acidental falls” OR “fall risk” OR “falls prevention” OR “accident prevention”) AND (“health education” OR “health promotion” OR “patient education” OR “educational technology” OR “instructional technology”) AND (“clinical trial” OR “clinical trials as topic”)
CINAHL
Cochrane
SciELO	(falls OR “acidental falls” OR “accident prevention”) AND (“health education” OR “health promotion” OR “patient education” OR “educational technology” OR “instructional technology”)

Studies	Sample/ Losses	Locations	Educational interventions	Number of sessions/ Duration	Comparator	Result measures	Main results
Mora Pinzon M, et al., 2019⁹	29 Latin elderly people/17%	Community institution	Educational group sessions, with discussions on fall prevention strategies.	Eight/ six months	Randomized single-arm clinical trial	Fall Behavioral Risk Scale (RcQ); Timed Up and Go (TUG); Adoption of individual protection behaviors.	In six months: there was a significant improvement in the mean of RcQ (p <0.001); In the TUG, there was no improvement (p=0.07); 57.9% continued to exercise, 94% adopted safer walking strategies and 67% performed at least one safety recommendation at home.
Hill, et al., 2015¹⁸	3,606 elderly people/ none	Hospital	Personalized follow-up of fall risk prevention, using videos (DVD) and leaflets to record goals.	Three to five/ 12.5 months	Usual care	Audit of notification of cases of falls in the hospital.	There were fewer falls (p=0.003) and falls with injuries (p=0.06) in IG.
Potter, et al., 2014¹⁹	132 patients with cancer/ 42%	Hospital	Video fall prevention instructions and information leaflet. Delivery of a copy of a DVD video to be shown at home after discharge.	Free/ three months	Standard hospital video and information leaflet	Fall registration calendar; Fall Risk Awareness Questionnaire (FRAQ); Aware Fall Risk Scale.	Improvement in the Aware Fall Risk Scale (p <0.01); There were no differences in the FRAQ scores between the study groups (p=0.49); IG was more likely to report episodes of falls with injuries (p <0.05) and to make changes at home (p <0.05).
Taylor et al., 2017²⁰	22 elderly people/ 8,3%	Home	Personalized education on fall prevention at home, with simulation of the identified environmental risk and practical guidelines to correct it.	Three/ six months	Widespread fall risk education	Confidence and Balance Scale; Observation based on forms created by the authors.	Best score on the confidence scale, with personalized environmental recommendations (p <0.05); Significant difference in the average of adherence to preventive care with personalized education (69%) compared to generalized (37%).
Harper et al., 2017²¹	412 elderly people/ 8,2%	Hospital	Brief educational intervention with individual discussion on risk of falling.	One/ six months	Usual care	Fall risk screening; Functional capacity; Self-report on the occurrence of falls; Hospital records.	Falls occurred in both groups during follow-up (OR 0.81, 95% CI 0.53 - 1.25, p=0.34); IG had fewer hospital admissions (p=0.002) and improved physical function (p=0.007).
Park et al., 2019¹⁰	124 elderly people/ 29%	NH	Group and individual education on goal setting, role of caregiver and nurse. Demonstration of prevention strategies through videos.	Six/ six months	Usual care	Morse Fall Scale; Numbers of notification of falls per 1,000 patients/day.	Lower rate of falls in IG; Number of falls per 1,000 patients/day went from 3.38 before the intervention to 1.69 after three months (p=0.044) and decreased from 3.26 to 0.76 after 6 months of intervention (p=0.049).
Troncoso et al., 2019¹¹	154 elderly people/ 16,8%	Home	Personalized home visit on fall prevention, with a risk management plan for falls and telephone follow-up.	Five/ five months	Usual care	Subjective awareness of fall risk; Calendar for registration of falls.	There was a difference in the means of perceiving the risk associated with walking (IG=13.83 and CG=12.40) and the presence of objects or furniture (IG=4.31 and CG=2.64); In IG, 7.9% suffered at least a fall in the five-month period and in CG 27.7% fell (p=0.004).
Ang et al., 2011²²	1,822 patients adults/ none	Hospital	Educational session, with interventions according to participants’ risk factors; First, the specific fall risk was identified and then strategies were provided to reduce the specific risk of patients.	One/ eight months	Usual care	Incidence of falls in the hospital.	Fall incidence rates were 1.5% (95% CI 0.9-2.6) in CG and 0.4% (95% CI 0.2-1.1) in IG.
Barker et al., 2019²³	523 elderly people/ 17,7%	Home	Educational program with home fall risk assessment; Telephone guidance, coaching, goal setting and support for evidence-based risk factor management.	Three to four/two months	Usual care	Hospitalization rates Occurrence of fractures; Quality of life and deaths per person/year, during the 12-month study period.	There was no difference in injuries due to falls (p=0.374); The fracture rate was significantly lower in IG (p=0.03); There were no significant differences in other secondary outcomes between groups.
Naseri et al., 2019²⁴	390 elderly people/ 25%	Hospital	Educational intervention with individual and personalized discussion using leaflets and videos; Formulation of goals for post-discharge care, based on patient preferences.	One one-to-one session and three phone backups/six months	Usual care	Receiving formal or informal assistance to assist in patient care; Katz index; Lawton and Brody Scale; Practice of exercises.	There was no difference in engagement in preventing falls (p=0.3); Participants’ dependency levels remained high during follow-up; The proportion of all participants who exercised after hospital discharge increased by 30% (p=0.05).
Hill et al., 2011²⁵	1206 elderly people/ 87%	Hospital	IG 1 - individual education with a self-directed multimedia program on fall prevention, consisting of a DVD and a written handout; IG 2 - complete educational program, with multimedia educational package and additional monitoring by a health professional.	One/six months	Usual care	Falls occurred for six months after discharge.	CG had the lowest rates of falls (3.62/1,000 person-days), compared to the group with only materials (5.36/1,000 person-days) or the full program group (4.40/1,000 person-days) morning).
Hill et al., 2019²⁶	390 elderly people/ 2%	Hospital	Individualized education, with printed materials and video with information on falls and specific prevention for the post-discharge period.	Seven/ six months	Usual care + education program on aspects of positive aging.	Falls rate in the six months after hospital discharge; Rate of harmful falls and proportion of participants who suffered one or more falls in that period;	There were no differences in the rates of falls between CG and IG (5.9/1,000 patients/day), in the six months after hospital discharge; 164 participants fell, 79 fell once (IG=43; CG=36), 46 fell twice (IG=26; CG=20) and 39 fell more than twice (IG=22; CG=17).
Schepens et al., 2012²⁷	68 elderly people/ 22%	Home	IG 1 - presentation of vignettes, with specific daily situations, narrated in the first person and which included risks of falls; IG 2 - the same intervention as IG 1 was carried out including setting goals and strategies for preventing falls.	One/ One month	No intervention	Identification of situations with risks of falling during pre- and post-test.	The number of fall risks identified in the post-test was significantly higher than the number identified in the pre-test for IG 1 (p=0.004), IG 2 (p=0.002), but not for CG (p=0 , 96); IG 1 identified more risks of falling than CG (p=0.029) as well as IG 2 (p=0.007).
Hill et al., 2013²⁸	50 elderly people/ 4%	Hospital	Delivery of written and video materials, followed by individual discussion sessions, with educators beside patients.	Two sessions and a phone backup/One month	Usual care	Involvement in fall prevention strategies in the month after discharge; Self-awareness risk and knowledge about fall prevention strategies after hospital discharge.	IG was significantly more experienced, confident and motivated to be involved in fall prevention strategies after receiving health education (p <0.01); One month after discharge, 87.5% participants in IG agreed that knowledge levels increased (p=0.01).
Ueda et al., 2017²⁹	60 elderly people/ 13.3%	Home	Individualized education aimed at changing habits according to individual risks; Exercise guidance.	One/ One month	Intervention on exercises to prevent falls	Occurrence of falls recorded by patients in a calendar provided by the researcher.	No falls occurred in IG (n=25) during follow-up; Two participants (7.7%) fell in CG (n=26); IG had 75% fewer falls than CG.
Kuhlens- chmidt et al., 2016³⁰	91 adult patients/ none	Hospital	Video application developed by the researcher; Education with printed leaflet on risks of falling; Discussion with the research nurse.	One/ Not reported	Hospital standard education leaflet	Perceived fall risk and willingness to ask for help.	There was a difference in the proportion of patients who perceived themselves to be at high risk for pre- and post-intervention falls (p=0.01); No change was seen in the confidence or willingness to ask for help in the intervention group.

Studies	Risks of bias
Studies	Domain 1 Sequence generation	Domain 2 Effect attributed to the intervention	Domain 3 Incomplete results data	Domain 4 Result measurement	Domain 5 Reported result	General RoB*
Mora Pinzon et al., 2019⁹	High risk	Low risk	Low risk	High risk	Low risk	High risk
Hill et al., 2015¹⁸	Low risk	Low risk	Low risk	Low risk	Low risk	Low risk
Potter et al., 2014¹⁹	Uncertain risk	High risk	Low risk	Low risk	Low risk	High risk
Taylor et al., 2017²⁰	Uncertain risk	Low risk	Low risk	High risk	Low risk	High risk
Harper et al., 2017²¹	Uncertain risk	High risk	Low risk	Uncertain risk	Low risk	High risk
Park et al., 2019¹⁰	Low risk	Low risk	Low risk	Uncertain risk	Low risk	Uncertain risk
Troncoso et al., 2019¹¹	Uncertain risk	Low risk	Low risk	Uncertain risk	Low risk	Uncertain risk
Ang et al., 2011²²	Low risk	Low risk	Low risk	Low risk	Low risk	Low risk
Barker et al., 2019²³	Low risk	Low risk	Low risk	Low risk	Low risk	Low risk
Naseri et al., 2019²⁴	Uncertain risk	Uncertain risk	Low risk	High risk	Low risk	High risk
Hill et al., 2011²⁵	Low risk	Low risk	Low risk	Low risk	Low risk	Low risk
Hill et al., 2019²⁶	Low risk	Low risk	Low risk	Low risk	Low risk	Low risk
Schepens et al., 2012²⁷	Low risk	Uncertain risk	Low risk	Low risk	Low risk	Uncertain risk
Hill et al., 2013²⁸	Low risk	Low risk	Low risk	Low risk	Low risk	Low risk
Ueda et al., 2017²⁹	Low risk	Uncertain risk	Low risk	Low risk	Low risk	Uncertain risk
Kuhlenschmidt et al., 2016³⁰	Low risk	High risk	Low risk	Low risk	Low risk	High risk

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Universidade Federal de Santa Catarina, Programa de Pós Graduação em Enfermagem Campus Universitário Trindade, 88040-970 Florianópolis - Santa Catarina - Brasil, Tel.: (55 48) 3721-4915 / (55 48) 3721-9043 - Florianópolis - SC - Brazil
E-mail: textoecontexto@contato.ufsc.br

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[TFN1] DVD: Digital Video Disc; IG: Intervention Group; CG: Control Group; OR: Odds Ratio; CI: Confidence Interval.