Effectiveness of non-pharmaceutical interventions to prevent falls and fall-related fractures in older people living in residential aged care facilities - a systematic review and network meta-analysis protocol

Background: Preventing falls and fractures from falls in residents of aged care facilities are an eminent public health goal. Evidence on the effectiveness of non-pharmaceutical methods to prevent falls and fall-related fractures in residential aged care facilities (RACFs) is unclear. This review aims to assess and rank the effectiveness of the most common fall- and fracture prevention strategies of non-pharmaceutical nature in RACFs. Method: This systematic review with network-meta-analysis follows the guidelines from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol (PRISMA-P). We will conduct the systematic literature search across the medical databases MEDLINE, EMBASE, CINAHL and Cochrane Central Register of Controlled Trials (CENTRAL). We will conduct pairwise meta-analyses with a random effects model. When appropriate, we will construct a network graph and conduct network meta-analyses within a Bayesian framework for all outcomes and interventions. Bayesian network meta-analysis (random effects models) will be used to compare the relative effectiveness of the different interventions under investigation. Conclusion: Our review should provide a broader picture of the evidence of benefits and harms of exercise and other non-pharmaceutical interventions in fall- and fracture prevention in residents of residential aged care facilities (RACFs). Findings will benefit public and individual health by contributing in the beneficence of multidisciplinary care of institutionalized seniors through optimization of fall- and fracture prevention programs. Registration: Protocol registration: PROSPERO 2018 CRD42018116446; Registration on 28 November 2018.