Seventeen studies were included in the systematic review (5,501 participants). Follow-up ranged from five to 18 months (the definition of follow-up varied across studies). Limited information that related to the quality assessment was provided. Allocation concealment was reported for one study, intention-to-treat analyses were conducted for six studies and none reported blinding.
There was a statistically significant reduction in overall fall rate for the fall prevention programmes compared with controls but very high heterogeneity (risk ratio 0.86; 95% CI 0.74 to 0.99; Ι² = 91.8%). Sensitivity analyses removing outliers reduced heterogeneity substantially and resulted in a slightly lower reduction (risk ratio 0.91; 95% CI 0.85 to 0.96; 13 studies; Ι²=35.4%).
There were large differences favouring studies conducted in nursing homes compared with studies in the community (Q=62.79, p<.001). No differences between study groups were found for subgroup analyses on intensity or type of intervention. Further subgroup analyses were conducted on the 13 studies after outliers were removed. No differences were found in this smaller sample of studies.
There was some evidence of asymmetry in the funnel plot suggesting potential publication bias, and the meta-regression suggested the effect estimate was impacted by sample size.