Table 2 Study characteristics

Heung et al., 2010 [23]

Cohort study of

Outpatient

Hemodialysis Center

in USA

N-96

Gender-ND

Adult hemodialysis patients

Mean age of those who experienced a fall 62.6 ± 13.4 years, with 7 (58%) being females

Targeted interventions that included the following;

1. Formal staff education program

2. Implementation of fall risk assessment tool

3. Active and passive patient education programs

4. Construction of in-ground scale

5. Full lighting during shift change periods

6. Routine use of towels around dialysis

machines to wick leaked fluid

7. Installation of support bars in patient restroom

Period before the interventions (4-year baseline period)

Incidence of falls that occurred at dialysis center’s premises

Results: There were 2

patient-related falls in the postintervention period, a reduction

in fall incidence to 9 (95% CI 0 to 21) falls per 100,000 dialysis

treatments (P = 0.06)

Follow up:

21 months

Drop outs: ND

Sample size analysed: ND

Moderate^b

Malhotra et al., 2023 [24]. Randomised controlled trial conducted at single academic outpatient HD facility in the USA

N = 55

Male

IG-15

CG-13

Female

IG-13

CG-14

Participants with ESKD receiving hemodialysis who were able to walk with or without assistive devices

The wearable activity tracker plus structured feedback (intervention) arm. Patients received face-to-face goalsetting counseling in the dialysis facility along with feedback graphs and charts to visualise their progress

Patients had a wearable activity tracker

alone (comparator) arm

Step count and absolute change in daily step count, averaged per week, from baseline to completion of 12 weeks intervention

Results: There were 2 reported falls in the intervention arm and 1 fall in the comparator arm. Falls data was based on patient interviews

Follow up:

3 months

Drop outs:9

IG:5

CG:4

Sample size analysed: n = 46

IG: n = 23,

CG: n = 23

Moderate^c

Young et al., 2020 [25]

A mixed-methods

Randomised controlled trial conducted at

three HD centres within the UK East Midlands Renal

Network

N = 51

Male:

IG-17

CG-22

Female:

IG-7

CG-5

Prevalent adult HD patients

of the CYCLE-HD

trial with a Clinical Frailty Scale Score

of 4–7 (vulnerable to severely frail)

Mean age 63 ± 12 years

Patients in the intervention group had three times per week supervised, moderate-intensity exercises following a one month run-in. The duration of the intervention was six months. Cycling resistance was progressively increased to maintain the rate of perceived exertion in response to exercise adaptation. Progressive training was also allowed for patients unable to complete 30 min of continuous cycling until the set target was reached

Patients were managed according to the usual centre practice

Primary outcomes were related to feasibility. Secondary outcomes were falls incidence measured from baseline to 1 year following intervention completion, and exercise capacity, physical function, physical activity and patient-reported outcomes measured at baseline and 6 months

Results: 11 and 5 falls were observed in the CG and IG respectively. The crude falls incident rate ratio (IRR) was 1.95 (95% CI 0.63 to 7.18), suggestive of an almost two-fold increased incidence of falls within the usual care group. Falls data was obtained from medical records and hospital episode statistics

Follow up:

12 months

Drop out: n = 6

IG: n = 4

CG: n = 2

Sample size analysed: n = 45

IG: n = 20

CG: n = 25

Moderate^c

Hiroki et al., 2022 [27]. Single-center, prospective, non-RCT (Japan)

N = 65

IG-31

CG-34

Gender-ND

HD patients (79.3 ± 6.7 years

The exercise group was offered 3 years of intradialytic exercise training three times

a week. The training program involved both resistance and aerobic training exercises. Four types of resistance exercises were performed using an elastic tube. The aerobic exercise program consisted of 20 min of ergometer cycling. The grip strength (GS), leg extremity muscle strength (LES), short physical performance battery (SPPB) score and 10-min walk speed at baseline were evaluated in both groups. These physical functions were re-evaluated each year in the exercise group only

Patients were managed according to the usual centre practice

Physical functioning which was measured at baseline then 1-, 2- and 3-year time points and number of falls observed during follow up

Results: 8 (9.4%, 1 of exercise, and 7 of control group) falls were observed; one of the cases had a fracture. The exercise group showed no significant differences in any physical functioning between each measurement time point. However, the exercise intervention was significantly associated with a reduction in falls in the Kaplan–Meier survival analysis and log-rank test. Falls data was based on patient interviews at dialysis

Follow up:

35 months (interquartile range: 22–35 months)

Drop out: n = 12

IG: n = 12

CG: n = 0

Sample size analysed: n = 53

IG: n = 19

CG: n = 34

Moderate^b

Gengler et al., 2020 [26]. Before and after study within a dialysis unit in USA

N-ND

Gender-ND

All patients identified as having a high fall risk were placed on the Fall Prevention Bundle. Age-ND

Fall Prevention Bundle

This bundle includes evidence-based interventions such as nonskid socks, use of gait belts, bed and chair alarms,

hourly rounding, and safety education

Period before the intervention

Rate of falls

Results: The fall rate went from 4.56 (2018) to 2.98 (2019), a 35% reduction. The falls with injury rate decreased from a rate of 0.99 (2018) to 0.14 (2019), an 86% reduction. It is not clear how falls data was obtained

Follow up: 12 months

High^b