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ORIGINAL ARTICLE
Effect of a fall prevention program for elderly persons attending a rural
family medicine center, Egypt
Rabab Atta Mohammed
1
&Hebatallah Nour-Eldein
1
&Amani Waheed El.Din Abdel-Halim
2
&
Abdulmajeed Ahmed Abdulmajeed
1
Received: 25 March 2018 /Accepted: 16 July 2018
#Springer-Verlag GmbH Germany, part of Springer Nature 2018
Abstract
Background In Egypt, few studies have explored the problem of falling and interventions to prevent falls in older adults.
Objective To assess the effect of multifactorial, individualized interventions for prevention of falls among elderly persons.
Methods A quasi-experimental intervention study design with pre-post assessment was used. A sample of 100 community-dwelling
personsaged60yearsorolderwasselectedfromtheFanaraFamilyMedicine Center regestries. An evidence-based, coordinated fall
prevention program was implemented. The primary outcome measure was rate of falls assessed at baseline and 12 months. The
secondary outcomes were changes in home hazards, functional status, muscle strength, balance and adherence to Otago exercises.
Results There was a statistically significant difference in rate of falls (P= 0.049) and recurrent falls (P= 0.011) among partici-
pants from baseline to 12 months post-intervention. There were statistically significant improvements from baseline to post-
intervention in dynamic balance (P= 0.02), muscle strength (P< 0.001), adherence to Otago exercises (P<0.001)andthetotal
score of home hazards (P=0.029).
Conclusion The multifactorial fall prevention program was effective in reducing the rate of falls and most home hazards and
improving functional performance and balance abilities in community-dwelling older adults after 1-year follow-up.
Keywords Elderly .Fall prevention .GARS .Otago exercises
Introduction
Falls are one of the most common and serious threats to older
individuals because they can be associated with considerable
morbidity, decreased functioning, premature nursing home
admissions or even death (Stevens et al. 2012). The health
burden of falls also includes injury-related high health care
consumption, costs and reduced quality of life. The rate of
hospital admission due to falls for people aged 60 years and
over in Western countries ranges from 1.6 to 3.0 per 10,000
population. Falls account for 40% of all injury-related deaths
(Hartholt et al. 2011;WHO2007).
Annually, about 28–35% of persons 65 years orolder fall at
least once with an increase to 32–42% after the age of 70, and
15% of elderly people fall at least twice. The frequency of falls
among aging populations living in nursing homes is higher
than among community-dwelling older people. (WHO 2007:
Sandholzer et al. 2004). Falls among the elderly can be due to
intrinsic factors [e.g., age, female gender, solitary lifestyle,
medications, medical conditions (arthritis, chronic obstructive
pulmonary disease, depression and vascular diseases) and gait
problems] or extrinsic factors (e.g., environmental causes such
as poor lighting, slippery floors and uneven surfaces)
(Dionyssiotis 2012).
Evidence-based fall prevention programs may benefit older
people with risk factors for falls and fall-related injuries
(Grundstrom et al. 2012). Family physicians have an important
role in screening older patients for risk of falls, implementing
single- or multicomponent fall preventive interventions in co-
operation with other health professionals and supporting the
patient uptake of recommendations. An enhanced primary
health care plan can facilitate the implementation of fall preven-
tion programs (Al-Aama 2011; Australian Commission on
Safety and Quality in Health Care ACSQHC 2009).
*Hebatallah Nour-Eldein
hebanour20@hotmail.com
1
Family Medicine Department, Faculty of Medicine, Suez Canal
University, Ismailia City, Egypt
2
Community, Public Health, Occupational and Environmental
Department, Faculty of Medicine, Suez Canal University, Ismailia
City, Egypt
Journal of Public Health: From Theory to Practice
https://doi.org/10.1007/s10389-018-0959-8
The authors found few published studies about the problem
of falls and coordinated primary care interventions designed to
prevent them in older adults. Therefore, this study aimed to
assess the effect of multifactorial, individualized interventions
on rate of falls among the elderly living in the community and
attending a rural family medicine center.
Null hypothesis H0: Multifactorial, individualized inter-
ventions for the prevention of falls could not make a signifi-
cant difference between pre- and post-intervention in the rate
of falls among elderly people living in the community and
attending a rural family medicine center.
Alternative hypothesis H1: Multifactorial, individualized
interventions for the prevention of falls could make a signifi-
cant difference between pre- and post-intervention in the rate
of falls among elderly people living in the community and
attending a rural family medicine center.
Methods
Study design A quasi-experimental intervention study design
with pre-post assessment was used for evaluation of the effect
of a fall prevention program. Setting: Recruitment and med-
ical examinations took place in the Fanara Family Medicine
Center, which is affiliated with the Suez Canal University
Hospital in Ismailia Governorate, to which referrals for spe-
cific interventions were also made. Home hazards and Otago
exercise program components were home-based. The study
was conducted between January 2015–May 2016.
Study population The study was conducted on elderly persons
aged 60 years or older who were attending the Fanara Family
Medicine Center. Inclusion criteria: Community-dwelling per-
sons. Exclusion criteria: Elderly people needing human assis-
tance for performing the basic activities of daily living and those
living in a nursing/residential home with a terminal disease or
cognitive impairment as identified by Callahan Six-item
Screener (Callahan et al. 2002). The study sample was obtained
through simple random sampling from registries. Based on a
reduction in rate of falls from 52 to 32% in a previous study
(Close et al. 1999), the sample size was calculated to be 72
elderly subjects + 20% dropout (14 elderly subjects) = 86 elder-
ly subjects and was expanded to include 100.
Study tools
Patients were interviewed by the first author using valid and
reliable tools:
CAREFALL Triage Instrument (CTI): personal data
including, name, date of birth and gender of the participants
and 44 items to assess history of falls and modifiable risk
factors for recurrent falls in elderly patients such as: fre-
quency of falling, circumstances of current fall, fall history,
mobility before falls and high risk of osteoporosis, vision,
urinary incontinence, social situations, depression and
chronic diseases with one open-ended question about med-
ications (Boele van Hensbroek et al. 2009).
Groningen Activity Restriction Scale (GARS):usedto
measure disability in activities of daily living (ADL) and
instrumental activities of daily living (IADL). The re-
sponse is based on what the patient is able to do rather
than what s/he usually does. It included 18 items with a
minimum score of 18 and maximum of 72. The higher the
score is, the greater the disability (Kempen et al. 1996).
The instrument was translated into Arabic and had been
validated in a previous study (Kamel et al. 2013).
Home Falls and Accidents Screening Tool (HOME
FAST): assessed the conditions that may contribute to falls
at home: bathroom, floors, furniture, lighting, mobility,
stairways/steps and storage. It included 25 questions, and
hazards were scored as being present or not. The higher the
score is, the higher the risk of falling (Mackenzie et al. 2000).
Physical examination: equipment used included weight
and tape scales to measure the body mass index, a mercury
sphygmomanometer to measure blood pressure in the sitting,
prone and standing positions and a Snellen chart to assess
visual acuity. A stopwatch and two armchairs for functional
assessment of the exercise program were also used in two
tests: Timedupandgotest(TUGT): a tool to measure older
adult mobility and dynamic balance abilities that measures
the time taken to stand from a chair, walk 3 m and returnt o the
chair. A score of ≥14 s has been shown to indicate a high risk
of falls (Herman et al. 2011;ShumwayCooketal.2000).
The 30-s chair stand test (30s-CST): a measure of leg
strength and endurance, it consists of manually counting
the number of sit-stand-sit cycles completed during the 30 s
of the test (Jones et al. 1999; Rikli and Jones 1999).
Multifactorial intervention program
The intervention program components were based onthe Falls
Assessment Clinical Trial (FACT) (Elley et al. 2007)withthe
modification of referral to specialists instead of to family phy-
sicians. Each participant received different combinations of
interventions based on his/her individual assessment.
Fall-related medical problem assessment
and management
Each participant received an individualized assessment,
education, prescription and modification of treatment at
J Public Health (Berl.): From Theory to Practice
the Fanara Family Medicine Center. Referral of patients to
specialists in the Suez Canal University Hospital was ini-
tiated when deemed necessary and included referral to an
ophthalmologist when visual acuity was < 20/40 on the
Snellen chart and referral to a physiotherapist for patients
with gait disorders.
Bone health assessment and management
An assessment of high risk for osteoporosis was carried out.
Supplementation with calcium and vitamin D was prescribed in
appropriate doses. Referral for a bone density scan was made in
case of previous fragility fractures. Proper management includ-
ed bisphosphonates (Liberman and Cheung 2015).
Home hazard assessment and modifications
Each participant received baseline and post-intervention as-
sessments; the first home visit was made within 2 weeks of
the initial examination to evaluate home hazards and environ-
mental safety. The participants received appropriate advice on
changes needed and education about activities to reduce risk
of falls (Cumming et al. 1999).
Otago exercise program
An evidence-based fall prevention program was delivered
at home, with a minimum seven home visits. Elements in-
cluded strength, balance and walking exercises and a focus
on major lower limb muscles—knee flexors, knee exten-
sors and hip abductors—for functional movements and
walking. Ankle dorsiflexor and plantar flexor muscles were
trained for recovering balance (Tools to Implement the
Otago Exercise Program 2016). Participants were encour-
aged to complete the exercises three times a week. This
took about 30–45 min per week. Participants were encour-
aged to walk outside the home at least twice a week to help
increase physical capacity. Participants who exercised at
least 3 days/week were classified as having good compli-
ance, while poor compliance was defined as performing
exercises < 3 days/week (Kuptniratsaikul et al. 2011).
The intervention program was delivered by the first author,
with the assistance of a nurse trained in home visits and spe-
cialists working at the Suez Canal University Hospital if re-
ferral was needed. The program started with one 30–45-min
session for assessment and management at the Fanara Family
Medicine Center. Each person received a home hazard assess-
ment, modification advice and 30–45 min of training sessions
for performing Otago exercises at home, with a minimum of
eight sessions.
Each participant received a diary for 12 months to regis-
ter any falls during the year of follow-up, a booklet contain-
ing illustrations and instructions about home safety, Otago
visit charts for prescribing the level of exercise and a calen-
dar for recording adherence to Otago exercises. TUGT and
30s-CST were used to monitor a participant’s success with
Otago. Participants were contacted monthly by telephone
for an interview about their falls and any consequences re-
lating to the previous month and encouraged to adhere the
Otago exercise program.
Primary outcome variables: rate of falls during 1 year fol-
low-up: The percentage of elderly people reporting one or
more falls over the 12-month follow-up and the percentage
of recurrent falls (two or more) during the 12-month follow-
up. A fall was defined as Ban unexpected event in which the
participants come to rest on the ground, floor, or other lower
level (Lamb et al. 2005). Injuries as consequences of falls
were classified as moderate (abrasions, bruising, cuts, de-
crease in physical function for a period of 3 days or more,
sprains or sought medical attention) or serious (fractures, hos-
pital admission or sutures required). The variables were re-
ported by the participants at baseline and 12 months.
Secondary outcome variables Patient daily functioning (ADL,
IADL, GARS), functional assessment by Otago exercises
(TUGT, 30s-CST) and compliance with Otago exercises were
assessed at baseline, 6 and 12 months. Home hazards were
assessed at baseline and 12 months.
Statistical analysis Data were analyzed by the Statistical
Package for Social Sciences (SPSS), version 20.
Continuous data were tested for normality using the
Shapiro-Wilk test. Non-parametric tests were used for com-
parison between categorical variables and continuous non-
normally distributed variables. McNamara’s test was used
to analyze dichotomous dependent variables in paired com-
parisons. Friedman’s test was used to detect differences in
functional status, strength and balance abilities as continu-
ous, not normally distributed data across three time points,
with post hoc analysis using the Wilcoxon signed-rank test.
Cochran’s Q was used to compare categorical data across
three time points, with post hoc analysis using McNemar’s
test. The Pvalue was considered statistically significant if ≤
0.05 and < 0.017 for multiple comparison.
Results
One hundred participants were included at baseline and
6 months after the study, with a 100% response rate, but un-
fortunately 3% were missing after 12 months because of par-
ticipants passing away. The age of the elderly persons ranged
from 60 to 79 years with a mean of 65.1. Nearly two thirds
J Public Health (Berl.): From Theory to Practice
(63%) of participants had a positive history of falls, and 39%
of fallers experienced recurrent falls. Injuries following falls
occurred in half of fallers, the most frequent injury being
bruising (31.7%). Fractures, classified as serious injuries from
falls, occurred among 4.7% of the cases (Table 1). The entire
study sample (100%) received education on Otago exercises,
more than half (62%) followed instructions about home haz-
ard correction, and referral to ophthalmologists was needed in
(14%) of participants (Table 2).
There were statistically significant differences in the pro-
portions of falls and recurrent falls: Baseline to post-
intervention falls decreased from 63.4 to 49.5%, respectively,
and recurrent falls reduced from 40.8% at baseline to 25.8%
post-intervention (Table 3).
There was a highly statistically significant improvement in
ADL, IADL, GARS and 30s-CSTscores, (P<0.001)between
the time points (baseline, post 6 months and post 12 months)
(Table 4). There were statistically significant improvements in
30s-CST scores (P< 0.001), TUGT scores (P= 0.02) and
compliance with Otago exercises between the time points
(baseline, post 6 months and post 12 months) (Table 5).
The scores of some home hazards elements, e.g., the con-
dition of floors, lighting, storage and mobility (P< 0.05).
There were significant improvements in the total score of
home hazards (P< 0.05) (Table 6).
Discussion
According to the current study, our intervention was asso-
ciated with a significant reduction in rate of both single and
recurrent falls among participants leading to acceptance of
the alternative hypothesis. Similar findings were reported
in Egypt by El-Gilany et al. (2013) who found that multiple
interventions individually delivered to elderly persons in a
rural community were associated with a significant reduc-
tion in the rate of recurrent falls after 1-year follow-up.
These findings agreed with the PROFET study in the UK,
which indicated that an interdisciplinary approach to this
high-risk population can significantly decrease the risk of
further falls and limit functional impairment (Close et al.
1999). Similar conclusions were reached by studies in
Canada, the UK and New Zealand (Cusimano et al. 2008;
Davison et al. 2005; Robertson et al. 2002). Several ran-
domized trials, systematic reviews and meta-analyses have
shown and supported the theory that multi-intervention
Table 1 Baseline demographic and clinical characteristics of the study
sample
Characteristic Total (n=100)
Age in years, mean (SD) 65.1 (4.7)
Females, n(%) 66 (66%)
Smokers, n(%) 24 (24%)
No. of medical conditions, median [IQR] 2 [1–3]
No. of medications, median [IQR] 1 [0–4]
Previous cerebrovascular incidents, n(%) 1 (1%)
Systolic blood pressure (mmHg), mean (SD) 130.2 (14.9)
Diastolic blood pressure (mmHg), mean (SD) 82.7 (8.3)
Height, mean (SD) 161 (6.2)
Weight, mean (SD) 74.8 (10.9)
Body mass index (kg/m
2
), mean (SD) 26.9 (3.9)
Falls in previous year, n(%) 63 (63%)
Once 24 (24%)
Recurrent (2 or more) 39 (39%)
Consequences of falls (n=63)
None 30 (47.6%)
Bruising 20 (31.7%)
Cuts 3 (4.8%)
Fractures 3 (4.8%)
More than one injury 7 (11.1%)
IQR interquartile range
Table 2 Frequency participants received one or more individualized
interventions (n=100)
Intervention Frequency (%)
Medication changes
Medication added 11 (11)
Medication reduced 8 (8)
Medication withdrawn 6 (6)
Balance and gait
Walking aids 16 (16)
Diagnosis and treatment of underlying cause 8 (8)
Advice on footwear 43 (43)
Physiotherapy referral 5 (5)
Bone health
Calcium and vitamin D 6 (6)
Referral for DEXA scan 2 (2)
Biphosphonate treatment 1 (1)
Impaired vision
Advice on glare-free lighting 36 (36)
Referral to ophthalmologist 14 (14)
Urinary incontinence
Advice on night lights 18 (18)
Bladder training 18 (18)
Postural hypotension
Compensatory strategies 5 (5)
Pressure stockings recommended 5 (5)
Referral to cardiologist 2 (2)
Home safety
Identify and modify minor home hazards 62 (62)
Exercise
Otago exercise program 100 (100)
J Public Health (Berl.): From Theory to Practice
strategies can prevent falls in community-dwelling, cogni-
tively intact elderly adults by 20%–45% at both high and
low risk for falls (Gillespie et al. 2003).
On the other hand, a study by Shumway-Cook et al. (2007)
reported that a community-based, multifactorial program only
produced small but significant improvements in fall risk fac-
tors (strength, balance), but did not reduce the incidence rate
of falls in sedentary, healthy, community-living older adults in
a 12-month period. Previous studies in The Netherlands by
Hendriks et al. (2008) and in Canada by Hogan et al. (2001)
found that the multidisciplinary fall prevention program was
not effective in preventing first falls and functional decline
among the elderly with a history of falls.
Differences between the outcomes of previous studies can
be explained by variations in intervention designs or in the
studied populations. It is possible that patients enrolling in
trials that showed favorable outcomes of the multifactorial fall
intervention program were more at risk of falling and therefore
more likely to benefit from the program than patients assessed
in those trials that showed ineffectiveness of the program.
Also, issues in participant adherence to recommendations
may have varied between the studied populations, and differ-
entmethodsmayhavebeenusedtoassessthem.
According toour study findings, there was an improvement
in functional status of elderly individuals as assessed by
GARS scores across three time points, namely, at baseline
and 6 and 12 months post-intervention. Specific measurement
of ADL and IADL showed significant improvements post-
intervention. This finding is consistent with previous results
by El-Gilany et al. (2013) who found that the percentage of
dependent elderly decreased significantly after interventions
as measured by ADLs and IADLs. Similar findings were re-
ported by Gitlin et al. (2006), who found that community-
dwelling older adults with functional difficulties benefited
from a multicomponent intervention that addressed both
environmental and behavioral factors, with participants
demonstrating greater confidence in managing ADL after
6 months of intervention. The PROFET study by Close et al.
(1999) found that a multidisciplinary fall prevention program
had favorable effects on daily functioning and could signifi-
cantly limit functional impairment among high-risk
populations.
In contrast, Hendriks et al. (2008) demonstrated a lack of
effectiveness of a multidisciplinary fall prevention program in
elderly people at risk; in their study, the program was found to
affect neither falls nor daily functioning. Another study by de
Vries et al. (2010) that was conducted to evaluate the effec-
tiveness of a multifactorial intervention in older persons with a
high risk of recurrent falls also showed no effect on functional
status as measured by ADL.
Our study showed that individualized fall risk treatment
with simple exercises can significantly increase balancing
abilities and lower limb muscle strength and improve the func-
tional assessment as indicated by TUGT and 30s-CST scores.
These improved outcomes may be due to the encouragement
of the elderly to be aware of falls and to perform regular
exercise at home. Our findings are consistent with findings
from an Asian study by Lee et al. (2013) that found the
Table 3 Comparison of baseline
and 12 months post-intervention
for falls, recurrent falls and
injuries
Variable Baseline (n= 93) Post (n= 93) McNemar’stestPvalue
No. (%) No. (%)
Patients reporting falls (≥1) 59 (63.4) 46 (49.5) 0.049*
Recurrent falls (≥2) 38 (40.8) 24 (25.8) 0.011*
Injuries after falls
a
32 (34.4) 16 (17.2) 0.327
*P≤0.05 is significant
a
Contusion/hematomas, wounds and fractures
Table 4 Comparison of participants’daily functioning at baseline, 6 months and 12 months after intervention
Variables Baseline
Median [IQR]
Post 6 months
Median [IQR]
Post 12 months
Median [IQR]
Friedman’s
test
Pvalue Baseline vs.
post 6 months
a
Baseline vs.
post 12 months
a
Post 6 months
vs. post 12 months
a
ZPvalue Z Pvalue Z Pvalue
ADL 14 [12–17] 13 [12–16] 12 [11–15] 20.1 < 0.001
b
−3.97 < 0.001
b
−3.34 < 0.001
b
−0.105 0.916
IADL 21 [15–24] 18 [14–22] 18 [14–22] 39.4 < 0.001
b
−5.16 < 0.001
b
−3.99 <0.001
b
−0.372 0.710
GARS 34 [28–40] 32 [25–40] 30 [25–39] 53.7 < 0.001
b
−6.01 < 0.001
b
−5.65 < 0.001
b
−0.90 0.368
IQR interquartile range, ADL activities of daily living, IADL instrumental activities of daily living, GARS Groningen activity restriction scale
*
Pvalue is significant if ≤0.05 or < 0.017 for multiple comparisons
a
Posthoc analysis with Wilcoxon signed-rank test (Z)
J Public Health (Berl.): From Theory to Practice
multifactorial fall prevention program with exercise interven-
tion was beneficial in improving functional performance as
demonstrated by a great improvement in the TUGT scores.
However, it also appeared that the immediate improvement
in function and physical performance did not lead to a reduc-
tion in fall incidence over a longer time. Similarly, Shumway-
Cook et al. (2007) found that community-based, multifaceted
intervention was effective in improving balance, mobility and
leg strength, as demonstrated by small but significant im-
provements in both the TUGT and 30s-CST.
A study by Vogler et al. (2012) also found that balance
improvements and fall risk reductions were reported in a 12-
week home-based exercise program for older people; however
the beneficial effects were found to be partially or even totally
lost 12 weeks after cessation of the intervention. These find-
ings were in contrast to de Vries et al. (2010) who found that a
multifactorial fall prevention program has no effect whatsoev-
er on physical performance measured by TUGT scores.
The present study showed that there was a significant im-
provement in compliance with Otago exercises from baseline
to post-intervention, as supported by the improvements in the
TUGT and 30s-CST measures. However, they are in contrast
to findings by Kuptniratsaikul et al. (2011) who reported that
although compliance was good (most subjects performed ex-
ercises regularly, at least 3 days/week), it had no effect on
functional assessments including TUGT and 30s-CST scores.
They explained this finding by the low sample size and the
fact that most of the participants were young-old with a mean
age of 67.1 years, so their balance ability many be better than
participants in other studies.
In our study, we found a significant decrease in the scores
for the home hazards category and some of its items such as
condition of floors, lighting, storage and mobility (P<0.05).
These findings may be due to increasing awareness about
environmental hazard modification and safety measures.
Similar findings were reported by El-Gilany et al. (2013)
who found a significant decrease in the scores of total home
hazards and of all its items post-intervention.
Our findings were consistent with the study by Gillespie et
al. (2003) who stated that home modifications included re-
moval of tripping hazards, installing grab bars next to the toilet
and in the bathtub or shower, using non-slip mats in the bath-
tub and on shower floors, putting handrails on both sides of
stairways and improving home lighting may be effective in
reducing falls.
Limitations of the study
No control group was selected for comparison. A randomized
controlled study is required to confirm the effect of the
program.
Table 5 Comparison of participants’muscle strength and balance, compliance with Otago exercises at baseline, 6 months and 12 months after intervention
Variables Baseline
Median [IQR]
Post 6 months
Median [IQR]
Post 12 months
Median [IQR]
Friedman’s
test
Pvalue Baseline vs.
post 6 months
a
Baseline vs.
post 12 months
a
Post 6 months vs.
post 12 months
a
ZPvalue Z Pvalue Z Pvalue
TUGT 16 [11–22] 14 [11–20] 14 [11–20] 66 0.02* −2.14 0.03* −1.88 0.06 −1.94 0.85
30s-CST 14 [11–17] 15 [12–18] 15 [11–17] 67.5 < 0.001* −3.55 < 0.001* −6.48 < 0.001* −4.54 < 0.001*
Variable Baseline n (%) Post 6
months n (%)
Post 12
months n (%)
Cochran’sQ Pvalue McNemar Pvalue McNemar Pvalue McNemar Pvalue
Compliance with
Otago exercises
0 (0%) 38 (40.9%) 83 (89.2%) 125 < 0.001* 36.3 < 0.001* 74.1 < 0.001* 43.1 < 0.001*
Post hoc analysis of Cochran’s Q with McNemar’stest
IQR interquartile range, TUGT timed up and go test, 30s-CST = 30-s chair stand test
*Pvalue is significant if ≤0.05 or < 0.017 for multiple comparisons
a
Post hoc analysis of Friedman with Wilcoxon signed-rank test (Z)
J Public Health (Berl.): From Theory to Practice
Conclusion
The multifactorial fall prevention program, including shared
primary and secondary health care with home-based hazard
modification and exercise interventions reduced the frequency
of falls and improved functional performance, muscle strength
and walking abilities for community-dwelling older adults at
1-year follow-up. A randomized controlled study is required
to confirm the effect of the program. The results of the present
study could not be generalized because the study sample in-
volved those attending primary care and was not representa-
tive of all community-dwelling elderly populations.
Acknowledgements The research team would like to acknowledge the
cooperation of the cardiology, ophthalmology, physiotherapy and radiol-
ogy teams at Suez Canal University Hospital as well as the participants.
Compliance with ethical standards
Conflict of interest The authors declare that they have no conflict of
interest.
Ethical considerations The study protocol was approved by Suez Canal
University Research Ethics Committee with reference no. 802. All proce-
dures were in accordance with the 1964 Helsinki Declaration and its later
amendments or comparable ethical standards. The aim of the research was
explained to the participants and their informed consents obtained.
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Table 6 Baseline and post-
intervention changes in home
hazards (n=93)
Home hazard Baseline Median
(IQR)
Post 12 months Median
(IQR)
Wilcoxon signed-rank test
(Z)
P
value
Floors 6 (5–7) 5 (4–6) −2.62 0.009*
Furniture 2 (2–3) 2 (2–3) −1.86 0.06
Lighting 4 (3–5) 3 (3–4) −2.15 0.03*
Bathroom 8 (7–9) 8 (7–9) −1.07 0.28
Storage 2 (2–3) 2 (2–3) −2.13 0.03*
Stairways/steps 7 (5–8) 7 (5–8) −1.79 0.07
Mobility 4 (3–5) 3 (3–5) −2.61 0.009*
Tot al s co res 31 (29–33) 30 (28–33) −2.18 0.029*
IQR interquartile range
*Psignificant if ≤0.05
J Public Health (Berl.): From Theory to Practice
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