ArticlesHome modifications to reduce injuries from falls in the Home Injury Prevention Intervention (HIPI) study: a cluster-randomised controlled trial
Introduction
Home injuries are an important contributor to the global burden of disease. Almost 110 000 people die every year in Europe as a result of an injury at home or leisure, and an estimated 32 million injuries require admission.1 In the USA, more injuries happen at home than in any other setting.2 Falls are the main mechanism for home injuries. In 2012, more than 1 million medically treated injuries were recorded in home and community settings in New Zealand and almost half these injuries were attributable to falls.3
The home environment plays an important part in the occurrence of injuries, particularly falls. A relation seems to exist between the number of injury hazards in the home and the risk of home injury, although many factors could potentially confound this association.4 A few randomised controlled trials have assessed the safety benefits of home modification, all of which focused on either children or older people. In these trials, an initial home-safety assessment was done with subsequent modification interventions, and these alterations were effective at reducing the rate of falls among older people living in the community (relative rate 0·81, 95% CI 0·68–0·97; six trials, 4208 participants) and the risk of falling for this group (relative risk 0·88, 0·80–0·96; seven trials, 4051 participants).5 In a review of interventions to reduce falls among children, only three primary studies investigated prevention of falls or fall injuries and none included modifications to the home.6 Typically, home modification is made available to people with disabilities in the community and is delivered by non-governmental organisations, public health nurses, or charities. However, evidence showing the safety benefits of home modifications to avoid environmental hazards is sparse.7 In a Cochrane review, Turner and colleagues7 recommended that future studies should have large sample sizes and be undertaken as well-designed randomised controlled trials, with injury as the outcome measure.
We undertook the Home Injury Prevention Intervention (HIPI) study to investigate whether a package of home modifications could reduce the rate of injuries per person per year from falls at home needing medical treatment.
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Participants
The HIPI study is a single-blind cluster-randomised trial undertaken over a 4-year period in the Taranaki region of New Zealand. We designed the study based on findings of an earlier cross-sectional study, in which we formulated a package of home modifications that might be effective in preventing common injuries.8
We recruited participants from a list of people living in the Taranaki region who had recently received government-subsidised home insulation that was retrofitted to their homes. To
Results
The HIPI study was initiated on Sept 1, 2009, when the first participants were recruited, and it ended in October, 2013, which allowed an average observation period of 3 years. Home modifications were undertaken between Jan 15, 2010, and May 5, 2011. The trial period was extended by a year because home modifications took longer than expected to be completed. The median observation period was 1148 days (IQR 1085–1263).
842 households comprising 1848 occupants were recruited for the study (figure
Discussion
Home modifications focusing on fairly common hazards in the home can reduce injuries caused by falls. As we expected, the home-modification intervention had a strong benefit in reducing injuries most closely related to the modifications made (specific injuries). A smaller benefit was noted for all injuries caused by falls at home, but home modifications had no effect on injuries not resulting from a fall. In view of the large injury burden posed by falls at home globally, these results have
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