Systematic review and Meta-analysis of Mobilization Alarms to Prevent Falls in Hospitals.
Abstract
Mobilisation alarms are commonly used in hospital settings as a means to reduce falls, making up 11% of resources consumed to prevent hospital falls. However, recent trials have concluded that use of mobilisation alarms may be a form of low-value care.
Design: Systematic review and meta-analysis of randomised and non-randomised trials.
Search strategy: MEDLINE, Embase, CINAHL and Scopus with additional reference list and Google Scholar searching. Screening and data extraction undertaken by two independent reviewers.
Risk of bias assessment: ROB-II for RCTs and ROBINS-I for non-RCTs.
Measurements: Outcome measures included rate of falls, rate of injurious falls, proportion of patients who fell during observation period. Explanatory measures for meta-regression included variables related to the intervention, to the comparison condition, the trial design, trial population, data analysis, trial setting and population, and relationship to industry.
Results: 1447 titles/abstracts were screened, 129 articles received full-text review, 56 (11 RCTs, 45 non-randomized) were included in meta-analyses with some reporting more than one comparison.
Pooled incidence rate ratio (95%CI) of falls when exposed to alarms when just considering RCTs (n=13 comparisons, 11 studies) was 0.93 (0.83 to 1.04); and for injurious falls (n=7, 6) was 1.00 (0.87 to 1.16); while mean difference (95% CI) in rate of falls/1000 OBD (n=9, 8) was -0.20 (-1.03 to 0.64); and odds ratio for becoming a faller (n=5, 5) was 1.11 (0.91 to 1.35). Multiple meta-regression analyses yielded result even more strongly indicating null-effect, and consistently identified prospective registration as the most protective factor against studies reporting over-optimistic results.
Discussion: Use of bed alarms appears to be a form of low-value care, with negligible effects evident from randomised trials. Widespread use of alarms could be being driven by findings from non-randomised studies which report substantially more beneficial results. Protection from these spurious results may arise from pre-registration of study details, which is a much lower-cost alternative than conducting a RCT though needs to be done in advance of data collection which may present challenges in some contexts.