63 Implementation strategies of fall prevention interventions in hospitals: A systematic review 3 Study characteristics The study characteristics of the 48 included studies are presented in Table 1. Included studies were published between 1997 and 2024. Most studies (n=30, 63%) originated from USA or Canada, the majority used an uncontrolled before-after design (83%). Median baseline period before implementation was 12 months (IQR 6 – 15), median implementation period lasted 9 months (IQR 2 – 24), and median period after the implementation was also 9 months (IQR 6 – 12). The implementation period was missing in 21 studies (44%), the before or after period were missing in 4 studies. Twenty-two (47%) studies were performed in teaching/academic hospitals, twentyone studies (45%) in general hospitals. Most studies concerned multiple wards in a single center (n=36; 75%). In all but one study (n=47), the intervention was primarily delivered by nurses, and in 31 studies (65%) nurses collaborated with allied healthcare professionals. Risk of bias assessment Risk of bias for each of the five controlled studies was high on two up to six of nine items of the Cochrane tool. The risk of bias for the uncontrolled studies (n=42), estimated with the NOS tool, was overall high. Almost all uncontrolled studies scored poor for the comparability component, as they did not control for possible confounders such as age, sex, or other factors. Five studies did report some kind of comparability control [24, 45, 52, 69, 72]. See additional file II and III. Fall prevention interventions An overview of the FPIs and their detailed description following the four domains of the ProFaNE taxonomy [16] is shown in additional file IV. The primary aim of most included studies (n=42; 88%) was to prevent falls, while three studies focused on different primary outcomes such as enhancing adherence or knowledge. Additionally, three studies aimed to prevent falls with injuries. Thirty-five studies concerned the implementation of multiple FPIs (73%), while seven studies (15%) utilized a single FPI, and six were multifactorial (13%). The majority of the studies applied a fall risk assessment (n=34; 71%), fourteen a medication review (n=15; 31%), and two others a comprehensive geriatric assessment (n=2; 4%). Most FPIs (90%) were educational such as distributing educational posters or videos, and conducting educational meetings. Others aimed at environmental factors (46%) such as movement alarms and footwear. The majority of the included studies described their control group, or before-group, as receiving care as usual, without providing any information regarding the existing FPIs (n=39; 81%).
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