Comparison of falls and cost-effectiveness of the group versus individually delivered Lifestyle-integrated Functional Exercise (LiFE) program : final results from the LiFE-is-LiFE non-inferiority trial

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2023
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Jansen, Carl-Philipp
Gottschalk, Sophie
Nerz, Corinna
Labudek, Sarah
Kramer-Gmeiner, Franziska
Klenk, Jochen
Clemson, Lindy
Todd, Chris
Dams, Judith
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Age and Ageing. Oxford University Press. 2023, 52(1), afac331. ISSN 0002-0729. eISSN 1468-2834. Available under: doi: 10.1093/ageing/afac331
Zusammenfassung

Background:
the individually delivered Lifestyle-integrated Functional Exercise (LiFE) was shown to improve physical activity (PA) and reduce fall incidence, however being rather resource-consuming due to one-to-one delivery. A potentially less resource-intensive group format (gLiFE) was developed and compared against the original program, considering higher risk of falling due to possible PA enhancement.

Objective:
to investigate non-inferiority in terms of PA-adjusted fall risk and cost-effectiveness of gLiFE at 12-month follow-up.

Design:
single-blinded, randomised, multi-centre non-inferiority trial.

Setting:
community

Subjects:
in total, 309 adults aged 70+ years at risk of or with history of falling; n = 153 in gLiFE, n = 156 in LiFE.

Methods:
LiFE was delivered one-to-one at the participants’ homes, gLiFE in a group. PA-adjusted fall risk was analysed using negative binomial regression to compare incidence rate ratios (IRR). Cost-effectiveness was presented by incremental cost-effectiveness ratios and cost-effectiveness acceptability curves, considering quality-adjusted life years, PA and falls as effect measures. Secondary analyses included PA (steps/day) and fall outcomes.

Results:
non-inferiority was inconclusive (IRR 0.96; 95% confidence interval, CI 0.67; 1.37); intervention costs were lower for gLiFE, but cost-effectiveness was uncertain. gLiFE participants significantly increased PA (+1,090 steps/day; 95% CI 345 and 1.835) versus insignificant increase in LiFE (+569, 95% CI −31; 1,168). Number of falls and fallers were reduced in both formats.

Conclusion:
non-inferiority of gLiFE compared with LiFE was inconclusive after 12 months. Increases in PA were clinically relevant in both groups, although nearly twice as high in gLiFE. Despite lower intervention costs of gLiFE, it was not clearly superior in terms of cost-effectiveness.

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796 Sport
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fall prevention, non-inferiority trial, economic evaluation, fall risk, physical activity promotion, older people
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ISO 690JANSEN, Carl-Philipp, Sophie GOTTSCHALK, Corinna NERZ, Sarah LABUDEK, Franziska KRAMER-GMEINER, Jochen KLENK, Lindy CLEMSON, Chris TODD, Judith DAMS, Michael SCHWENK, 2023. Comparison of falls and cost-effectiveness of the group versus individually delivered Lifestyle-integrated Functional Exercise (LiFE) program : final results from the LiFE-is-LiFE non-inferiority trial. In: Age and Ageing. Oxford University Press. 2023, 52(1), afac331. ISSN 0002-0729. eISSN 1468-2834. Available under: doi: 10.1093/ageing/afac331
BibTex
@article{Jansen2023Compa-66676,
  year={2023},
  doi={10.1093/ageing/afac331},
  title={Comparison of falls and cost-effectiveness of the group versus individually delivered Lifestyle-integrated Functional Exercise (LiFE) program : final results from the LiFE-is-LiFE non-inferiority trial},
  number={1},
  volume={52},
  issn={0002-0729},
  journal={Age and Ageing},
  author={Jansen, Carl-Philipp and Gottschalk, Sophie and Nerz, Corinna and Labudek, Sarah and Kramer-Gmeiner, Franziska and Klenk, Jochen and Clemson, Lindy and Todd, Chris and Dams, Judith and Schwenk, Michael},
  note={Article Number: afac331}
}
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