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A randomized controlled trial of home injury hazard reduction: the HOME injury study.

ABSTRACT: To test the efficacy of installing safety devices in the homes of young children on total injury rates and on injuries deemed a priori modifiable by the installation of these devices.A nested, prospective, randomized controlled trial.Indoor environment of housing units.Mothers and their children from birth to 3 years old participating in the Home Observation and Measures of the Environment study. Among 8878 prenatal patients, 1263 (14.2%) were eligible, 413 (32.7%) agreed to participate, and 355 were randomly assigned to the intervention (n = 181) or control (n = 174) groups.Installation of multiple passive measures (eg, stair gates, cabinet locks, and smoke detectors) to reduce exposure to injury hazards. Injury hazards were assessed at home visits by teams of trained research assistants using a validated survey.Modifiable and medically attended injury (ie, telephone calls, office visits, and emergency visits for injury).The mean age of children at intervention was 6.3 months. Injury hazards were reduced in the intervention homes but not in the control homes at 1 and 2 years (P < .004). There was no difference in the rate for all medically attended injuries in intervention children compared with controls: 14.3 injuries (95% confidence interval [CI], 9.7-21.1 injuries) vs 20.8 injuries (95% CI, 14.4-29.9 injuries) per 100 child-years (P = .17); but there was a significant reduction in the rate of modifiable medically attended injuries in intervention children compared with controls: 2.3 injuries (95% CI, 1.0-5.5 injuries) vs 7.7 injuries (95% CI, 4.2-14.2 injuries) per 100 child-years (P = .03).An intervention to reduce exposure to hazards in homes led to a 70% reduction in the rate of modifiable medically attended injury.clinicaltrials.gov Identifier: NCT00129324.

SUBMITTER: Phelan KJ

PROVIDER: S-EPMC3693223 | biostudies-literature | 2011 Apr

REPOSITORIES: biostudies-literature

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A randomized controlled trial of home injury hazard reduction: the HOME injury study.

Phelan Kieran J KJ Khoury Jane J Xu Yingying Y Liddy Stacey S Hornung Richard R Lanphear Bruce P BP

Archives of pediatrics & adolescent medicine 20110401 4

<h4>Objective</h4>To test the efficacy of installing safety devices in the homes of young children on total injury rates and on injuries deemed a priori modifiable by the installation of these devices.<h4>Design</h4>A nested, prospective, randomized controlled trial.<h4>Setting</h4>Indoor environment of housing units.<h4>Participants</h4>Mothers and their children from birth to 3 years old participating in the Home Observation and Measures of the Environment study. Among 8878 prenatal patients, ...[more]

PMID: 21464382

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Project description:ImportanceFalls are the leading preventable cause of morbidity, mortality, and premature institutionalization for community-dwelling older adults.ObjectiveTo test the effectiveness of a behavioral intervention on fall risk among older adults receiving services from an Area Agency on Aging.Design, setting, and participantsThis randomized clinical trial examined a home hazard removal intervention in the community using a race- and sex-stratified randomization design. Older adults receiving services from the Area Agency on Aging in urban St Louis, Missouri, were assigned to a home hazard removal intervention delivered over 2 weeks with a 6-month booster or usual care control. Eligible participants were adults aged 65 years or older who did not have dementia, were at high risk for falling, and resided in the community. Enrollment occurred from January 2015 to September 2016; 12-month follow-up occurred from February 2016 to October 2017. Data were analyzed from February 2019 to July 2021.InterventionsThe intervention was a home hazard removal program delivered by an occupational therapist in the home that included a comprehensive clinical assessment and a tailored hazard removal plan. Usual care control consisted of annual assessments and community referral.Main outcomes and measuresThe primary outcome was the hazard of a fall over 12 months. Prespecified secondary outcomes included the rate of falls over 12 months, daily activity performance, falls self-efficacy, and self-reported quality of life.ResultsA total of 310 participants (mean [SD] age, 75 [7.4] years; 229 [74%] women; 161 Black participants [52%]) were randomized, with 155 participants assigned to the intervention and 155 participants assigned to usual care. Retention was 127 participants (82%) in the intervention group and 126 participants (81%) in the control group. There was no difference for our primary outcome of fall hazard (hazard ratio, 0.90; 95% CI, 0.66-1.27). There was a 38% reduction in the rate of falling in the intervention group compared with the control group (relative risk, 0.62; 95% CI, 0.40-0.95; P = .03). At 12 months, the rate of falls per person-year was 1.5 (95% CI, 1.32-1.75) in the intervention group and 2.3 (95% CI, 2.08-2.60) in the control group. There was no difference in daily activity performance (adjusted difference, -0.20; 95% CI, -0.95 to 0.55; P = .60), falls self-efficacy (adjusted difference, -0.12; 95% CI, -1.25 to 1.01; P = .84), or quality of life (adjusted difference, 0.84; 95% CI, -0.95 to 2.64; P = .35).Conclusions and relevanceThis randomized clinical trial found that a brief home hazard removal program did not reduce the hazard of falls among community-dwelling older adults at high risk for falling. The intervention was effective in achieving a reduced rate of falls, a prespecified secondary outcome. This effectiveness study has the potential for delivery through the national aging services network.Trial registrationClinicalTrials.gov Identifier: NCT02392013.

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A randomized controlled trial of home injury hazard reduction: the HOME injury study.

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A randomized controlled trial of home injury hazard reduction: the HOME injury study.

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