Recommendation grades (A-E) and levels of evidence (1, 2-1, 2-2, 2-2, 3, good, fair, and poor) are defined at the end of the "Major Recommendations" field.
Interventions Directed to the General Population of Long-Term Care Facility (LTC) Residents
The Canadian Task Force on Preventive Health Care (CTFPHC) concludes that there is fair evidence to recommend that a multifactorial intervention program for long-term care residents prevents falls and reduces the rate of injurious falls and hip fractures. Residents should be assessed on admission and re-assessed after a fall (B Recommendation). (Jensen et al., 2003; Becker et al., 2003 [1, fair])
The CTFPHC concludes that there is insufficient evidence to recommend structured multidisciplinary programs that are targeted exclusively to those deemed at highest risk to reduce the risk of future falls* (I Recommendation). (Kerse et al., 2004 [1, fair]; Rubenstein et al., 1990 [1, fair]; Shaw et al., 2003 [1, fair]; Ray et al., 1997 [1, fair})
*Note: There is evidence that a comprehensive assessment done in a timely manner after a fall (e.g., within a week) can reduce future hospitalization (Rubenstein et al., 1990 [1, fair]). Such assessments can detect recent changes in an individual's health or function, such as an acute or progressive illness, a need for evaluation of medications, increasing frailty, etc.
Selective Interventions Such as Exercise of Physical Therapy
The CTFPHC concludes that there is insufficient evidence to recommend that exercise alone or in combination with other limited interventions is effective in preventing falls in long-term care facility residents (I Recommendation). (Nowalk et al., 2001 [1, fair]; Mulrow et al., 1994 [1, fair]; Fiatarone et al., 1994 [1, fair]; McMurdo, Millar, & Daly, 2000 [1, fair])
Definitions:
Levels of Evidence
Research Design Rating
1: Evidence from randomized controlled trial(s)
2-1: Evidence from controlled trial(s) without randomization
2-2: Evidence from cohort or case-control analytic studies, preferably from more than one centre or research group
2-3: Evidence from comparisons between times or places with or without the intervention; dramatic results from uncontrolled studies could be included here
3: Opinions of respected authorities, based on clinical experience; descriptive studies or reports of expert committees
Quality (Internal Validity) Rating
Good: A study that meets all design- specific criteria* well
Fair: A study that does not meet (or it is not clear that it meets) at least one design-specific criterion* but has no known "fatal flaw"
Poor: A study that has at least one design-specific* "fatal flaw", or an accumulation of lesser flaws to the extent that the results of the study are not deemed able to inform recommendations
*General design-specific criteria are outlined in Harris RP, Helfand M, Woolf SH, Lohr KN, Mulrow CD, Teutsch SM, Atkins D. Current Methods of the U.S. Preventive Services Task Force: A Review of the Process. Am J Prev Med 2001;20(suppl 3):21-35. Inclusion/exclusion criteria are detailed above in the "Description of Methods Used to Collect/Select the Evidence" field.
Recommendation Grades for Specific Clinical Preventive Actions
A: The Canadian Task Force (CTF) concludes that there is good evidence to recommend the clinical preventive action.
B: The CTF concludes that there is fair evidence to recommend the clinical preventive action.
C: The CTF concludes that the existing evidence is conflicting and does not allow making a recommendation for or against use of the clinical preventive action; however other factors may influence decision-making.
D: The CTF concludes that there is fair evidence to recommend against the clinical preventive action.
E: The CTF concludes that there is good evidence to recommend against the clinical preventive action.
I: The CTF concludes that there is insufficient evidence (in quantity and/or quality) to make a recommendation, however other factors may influence decision-making.
