APPENDIX A

Table A1a: Multifactorial Interventions Studies - Effective

Intervention components

Tinetti  1994

Clemson 2004

 Davison 2005

Day 2002

Campbell  1999

Whitehead 2003

Wagner 1994

Steinberg 2000

Close
1999

Hogan 2001

Newbury 2001

Nikolaus 2003

Environmental adaptation

X

X

X

X

 

X

X

X

X

 

 

X

Balance training

X

X

X

X

X

X

 

X

 

 

 

 

Strength training

X

 

 

X

X

 

 

 

 

 

 

 

Gait training

X

X

X

 

 

 

 

 

 

 

 

 

Assistive devices

X

X

X

 

 

 

 

 

 

 

 

X

Reduction in psychotropics

X

X

X

 

X

 

 

 

 

 

 

 

Reduction in other medications

X

X

X

 

 

 

X

 

 

 

 

 

Add medications as indicated

 

 

 

 

 

 

 

 

 

 

 

 

Vision

 

X

X

X

 

 

X

 

 

 

 

 

Address orthostasis

X

 

X

 

 

 

 

 

 

 

 

 

Other cardiovascular Tx

 

 

X

 

 

 

 

 

X

 

 

 

General medical evaluation/Tx

 

 

X

 

 

 

 

 

X

 

 

 

Self management

 

 

 

 

 

 

 

 

 

 

 

 

Physical activity level

 

 

 

 

 

 

X

 

 

 

 

 

RF assessment with advice and referral, no direct intervention

X

 

 

 

 

 

 

X

X

X

X

X

Cognitive behavioral

 

X

 

 

 

 

 

 

 

 

 

 

Table A1b: Multifactorial Studies – Not Effective


 Intervention components

Van-Haastregt,
2000

Lightbody  2002

Hornbrook 1994

Coleman  1999

Gallagher  1996

Vetter  1992

Kingston 2001

Huang  2004

Mahoney 2007

Shumway-Cook
 2007

Environmental adaptation

 

 

X

 

 

X

 

X

 

 

Balance training

 

 

 

 

 

 

 

 

 

X

Strength training

 

 

 

 

 

 

 

 

 

X

Gait training

 

 

 

 

 

 

 

 

 

 

Assistive devices

 

 

 

 

 

 

 

 

 

 

Reduction in medications

 

 

 

 

 

 

 

 

 

 

Vision

 

 

 

 

 

 

 

 

 

 

Address orthostasis

 

 

 

 

 

 

 

 

 

 

Other cardiovascular Tx

 

 

 

 

 

 

 

 

 

 

General medical evaluation/Tx

 

 

 

X

 

 

 

 

 

 

Self management

 

 

X

X

X

 

 

X

 

 

Physical activity level

 

 

 

 

 

 

 

 

 

 

RF assessment with advice and referral, no direct intervention

X

X

X

 

X

X

X

 

X

X

 

 

Table A2: Studies Evaluating Exercise Interventions

 

 

 

 

 

Component Type(s)  of program 

 

Single
Multiple

Target
/ high risk

N

Effective

Walking

Gait/
balance

Strength

Tai Chi/3D

Flexibility

Functional

Endurance

1-Individual
2-group
3-home

Tinneti et al., 1994

Multiple

Yes

 

YES

 

X

 

 

 

 

 

1

Day et al., 2002

Multiple

No

1090

YES

 

x

x

 

x

 

 

3

Barnett et al., 2003

Single

Yes

163

YES

 

x

x

x

 

x

x

2

Buchner, 1997

Single

Yes

105

YES

 

 

x

 

 

 

x

2

Hauer et al., 2001

Single

Yes

57

YES

 

x

x

 

x

 

x

2

Robertson et al., 2001a

Single

Yes

450

YES

x

x

x

 

x

x

x

1

Skelton et al., 2005

Single

Yes

81

YES

 

x

x

 

x

 

 

3

Weerdesteyn, 2007

Single

Yes

 

YES

 

x

 

 

 

 

 

2

Li et al., 2005

Single

No

256

YES

 

 

 

x (TC)

 

 

 

2

Lord et al., 2003

Single

No

551

YES

 

x

x

x(dance)

x

 

 

2

Means et al., 2005

Single

No

 

YES

 

 

 

 

 

 

 

 

Suzuki et al., 2004

Single

No

52

YES

 

x

x

x (TC)

 

 

 

3

Voukelatos, 2006

Single

No

684

YES

 

 

 

x

 

 

 

2

Woo, 2007 (a) Tai-Chi

Single

No

 

YES

 

 

 

x

 

 

 

2

Campbell et al., 2005

Multiple

Yes

391

NO

x

x

x

 

 

 

 

2+3

Lord et al., 2005

Multiple

Yes

620

NO

 

x

x

 

 

 

 

2

Steinberg et al., 2000

Multiple

No

252

NO

 

x

x

 

 

 

 

3

Latham et al., 2003a

Single

Yes

243

NO

 

 

x

 

 

 

 

1

Nitz et al., 2004

Single

Yes

73

NO

 

x

 

 

 

 

 

2

Rubenstein et al., 2000

Single

Yes

59

NO

x

x

x

 

x

 

 

2

Wolf, 2003

Single

Yes

 

NO

 

 

 

x

 

 

 

2

Liu-Ambrose et al., 2004a

Single

No

98

NO

 

 

x

 

 

x

 

2

Liu-Ambrose et al., 2004b

Single

No

 

NO

 

x

 

 

 

x

 

2

Lord et al., 1995

Single

No

197

NO

 

x

x

 

x

 

 

2

Morgan et al., 2004

Single

No

294

NO

x

x

x

 

x

 

 

2

Wolf., 1996 (a) Tai Chi

Single

No

 

NO

 

 

 

x

 

 

 

2

Wolf, 1996 (b) balance

Single

No

 

NO

x

 

 

 

 

 

 

?

Woo, 2007 (b) Balance

Single

No

180

NO

 

 

x

 

 

 

 

2

Whitehead et al., 2003

Multiple

Yes

140

HARMFUL

 

 

 

 

 

x

 

1


Appendix B:  Evidence Grading System

Table -1: Quality of Evidence (QE)

I

At least one properly done RCT

II-1

Well-designed controlled trial without randomization

II-2

Well-designed cohort or case-control analytic study, preferably from more than one source

II-3

Multiple time series evidence with/without intervention, dramatic results of uncontrolled experiment

III

Opinion of respected authorities, descriptive studies, case reports, and expert committees

Table -2: Overall Quality

Good

High grade evidence (I or II-1) directly linked to health outcome

Fair

High grade evidence (I or II-1) linked to intermediate outcome;
or
Moderate grade evidence (II-2 or II-3) directly linked to health outcome

Poor

Level III evidence or no linkage of evidence to health outcome

  

Table -3: Net Effect of the Intervention

Substantial

More than a small relative impact on a frequent condition with a substantial burden of suffering;
or
A large impact on an infrequent condition with a significant impact on the individual patient level.

Moderate

A small relative impact on a frequent condition with a substantial burden of suffering;
or
A moderate impact on an infrequent condition with a significant impact on the individual patient level.

Small

A negligible relative impact on a frequent condition with a substantial burden of suffering;
or
A small impact on an infrequent condition with a significant impact on the individual patient level.

Zero or Negative

Negative impact on patients;
or
No relative impact on either a frequent condition with a substantial burden of suffering; or an infrequent condition with a significant impact on the individual patient level.

 

 

 

  Table 4. Strength of Recommendation Rating System

A

A strong recommendation that the clinicians provide the intervention to eligible patients.
Good evidence was found that the intervention improves important health outcomes; the conclusion is made that benefits substantially outweigh harm.

B

A recommendation that clinicians provide this intervention to eligible patients.
At least fair evidence was found that the intervention improves health outcomes; the conclusion is made that benefits outweigh harm.

C

No recommendation for or against the routine provision of the intervention is made.
At least fair evidence was found that the intervention can improve health outcomes, but benefits and harms are too closely balanced to justify a general recommendation.

D

Recommendation is made against routinely providing the intervention to asymptomatic patients.
At least fair evidence was found that the intervention is ineffective or the conclusion is made that harms outweigh benefits.

I

Evidence is insufficient to recommend for or against routinely providing the intervention.
Evidence shows that the effectiveness of the intervention lacking, is of poor quality, or is conflicting;  the conclusion is that the balance of benefits and harms cannot be determined.

Based on the U.S. Preventive Services Task Force rating system (Harris et al, 2001)