A Cochrane review [Abstract] 1 included 28 published studies and one unpublished study. Only two studies were sufficiently similar to allow pooling of data for statistical analyses. Studies were divided into three groups; children, older people and the general population/mixed age group. None of the studies focusing on children or older people demonstrated a reduction in injuries that were a direct result of environmental modification in the home. One study in older people demonstrated a reduction in falls and one a reduction in falls and injurious falls that may have been due to hazard reduction. One meta-analysis was performed which examined the effects on falls of multifactorial interventions consisting of home hazard assessment and modification, medication review, health and bone assessment and exercise (RR 1.09, 95% CI 0.97 to 1.23).
Comment: The quality of evidence is downgraded by imprecise results (limited study size for each comparison), by inconsistency (heterogeneity in interventions and outcomes) and by indirectness (multi-factorial origin of falls, injuries and fractures especially in older people).
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