Week 7 Project Analyzing and Synthesizing the Body of Evidence In this assignment, you will take a critical look at the Evaluation Table and develop a Synthesis Table, which is

First Author

Conceptual

Design/Method

Sample &

Major

Measurement

Data Analysis

Findings

Appraisal:

(Year)

Framework

Setting

Variables

Worth to

Studied (and

Practice

their

Definitions)

Hutton et al. (2009)

Transtheoretical Model of Behavioral Change

Qualitative, Focus Groups

20 participants (68–81 years) from falls prevention exercise classes

Perceptions of physical activity, barriers, self-efficacy, and motivation

Thematic analysis of focus group data

Thematic analysis

Older adults identified barriers to exercise, emphasizing the need for education, motivation, and peer support.

Results suggest interventions should focus on education, motivation, and accessible, safe exercise programs to improve participation and reduce fall risk, which is relevant to improving fall prevention strategies in clinical practice.

Barnett et al.,

(2003)

None

Randomized Controlled Trial (RCT)

163 community-dwelling older adults (65+) at risk of falling; South Western Sydney, Australia

Balance (postural sway, coordinated stability)

Muscle strength

Reaction time

Physical functioning

Falls incidence

Baseline and 6-month assessments of physical performance

Monthly surveys for 12 months to record falls

Comparative statistical analysis (IRR = 0.60, 95% CI 0.36–0.99); pre- and post-test comparisons

Exercise group improved significantly in 3 of 6 balance measures. No difference in strength, reaction time, or walking speed. 40% lower fall rate in intervention group.

High: Supports integrating supervised group + home exercises for fall prevention in clinical/community settings.

Chang et al. (2004)

None

Systematic review and meta-analysis of RCTs

40 randomized controlled trials involving older adults in various care settings

Interventions to prevent falls (e.g., multifactorial risk assessment, exercise, environmental modifications, education); Outcomes: risk of falling, fall rate

Fall risk ratios and incidence rate ratios (IRR)

Random effects meta-analysis and metaregression

Multifactorial interventions most effective (RR 0.82, IRR 0.63); Exercise also effective (RR 0.86); overall reduced fall risk and monthly fall rate

High – Supports evidence-based fall prevention strategies, especially multifactorial interventions and exercise, for older adults

El-Khoury et al.

(2013)

evidence-based practice and fall prevention theory

Systematic review and meta-analysis of RCTs

17 RCTs with 4,305 older adults living in the community

Independent variable: Fall prevention exercise programs. Dependent variables: Types of injurious falls — all injurious falls, those needing medical care, severe injuries, and fractures

Extraction and pooling of rate ratios from included trials

Random effects models to estimate pooled rate ratios; heterogeneity assessed with I² statistic

Exercise significantly reduced rates of all injurious falls (RR=0.63), falls requiring medical care (RR=0.70), severe injuries (RR=0.57), and fractures (RR=0.39). Some heterogeneity observed

High relevance to clinical practice; supports implementing exercise programs for older adults to reduce fall-related injuries

(Oh et al., 2012)

None

Randomized Controlled Trial (RCT)

65 elderly community-dwelling individuals in Korea who had fallen in the past year; 36 in Exercise Group (EG), 29 in Control Group (CG)

Independent Variable: Participation in 12-week intensive exercise program; Dependent Variables: Fear of falling, balance, flexibility, muscle strength

Fear of falling questionnaire, physical fitness tests (balance, flexibility, strength, walking speed)

Statistical analysis comparing pre- and post-intervention measures (e.g., p-values reported)

Exercise group showed significant improvements in balance (p=0.003), flexibility (p<0.001), lower body strength (p=0.004), and reduced fear of falling (p=0.02)

High – supports use of structured exercise to reduce fear of falling and improve physical function in elderly fallers

Sherrington et al.

(2008)

Falls prevention through exercise, with a focus on balance training and total exercise dose.

Systematic review with meta-analysis of randomized controlled trials.

Sample: 9,603 participants from 44 trials.

Setting: General community and residential care for older adults.

Independent Variable: Exercise program (including balance exercises, total exercise dose).

Dependent Variable: Fall rates in older people.

Fall rates, measured by the number of falls over the trial period.

Pooled estimate using meta-analysis (relative risk calculation, confidence intervals, and I2 statistic to assess variability).

Exercise reduced the rate of falling by 17% overall.

The greatest effects were seen in programs with higher total doses of exercise (450 hours) and challenging balance exercises, excluding walking programs.

Exercise, especially balance-focused and higher-dose programs, significantly reduces fall rates.

Service providers can apply these findings to design more effective exercise programs for fall prevention in older adults, emphasizing balance challenges and sufficient exercise duration.

Taylor et al., (2012)

Falls prevention, mobility, balance, and strength improvement in older adults.

Randomized controlled trial (RCT)

Sample: 684 community-residing older adults (mean age 74.5, 73% female) with at least one fall risk factor.

Setting: Eleven sites throughout New Zealand.

Falls: Number of falls recorded through monthly falls calendars.

Mobility: Assessed using the Timed-Up and-Go test.

Balance: Assessed through the step test (right and left legs).

Lower Limb Strength: Measured via the chair stand test.

Fall rates (primary outcome).

Mobility, balance, and lower limb strength (secondary outcomes).

Statistical Analysis: Adjusted incident rate ratios (IRR) for fall comparisons, multilevel mixed-effects Poisson regression, and fixed-effect analyses.

Significance: Falls rates reduced similarly in all groups (58% reduction), with no significant differences in falls, balance, or strength improvements between tai chi and low-level exercise groups.

No significant difference in fall rates between groups

All groups had significant balance & strength improvements

No mobility improvement

Supports inclusion of tai chi or similar exercise for strength and balance; however, tai chi was not superior to low-level exercise