Evidence map›Paper›PMID 38861709›Full record

ArticleJMIR research protocols2024

Assessing the Efficacy of the ARMOR Tool-Based Deprescribing Intervention for Fall Risk Reduction in Older Patients Taking Fall Risk-Increasing Drugs (DeFRID Trial): Protocol for a Randomized Controlled Trial.

Rekha Priyadarshini, Madhavi Eerike, Sakthivadivel Varatharajan, Gomathi Ramaswamy, Gerard Marshall Raj, Jerin Jose Cherian, Priyadharsini Rajendran, Venugopalan Gunasekaran, Shailaja V Rao, Venu Gopala Rao Konda

Abstract readClinical Trial Protocol
In one paragraph

Article in JMIR research protocols, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Rekha PriyadarshiniDepartment of Pharmacology, All India Institute of Medical Sciences Bibinagar, Hyderabad, India.ORCID 0000-0002-7934-4978
Madhavi EerikeDepartment of Pharmacology, All India Institute of Medical Sciences Bibinagar, Hyderabad, India.ORCID 0000-0002-2049-8163
Sakthivadivel VaratharajanDepartment of General Medicine, All India Institute of Medical Sciences Bibinagar, Hyderabad, India.ORCID 0000-0002-5691-670X
Gomathi RamaswamyDepartment of Community Medicine and Family Medicine, All India Institute of Medical Sciences Bibinagar, Hyderabad, India.ORCID 0000-0001-7637-0292
Gerard Marshall RajDepartment of Pharmacology, All India Institute of Medical Sciences Bibinagar, Hyderabad, India.ORCID 0000-0001-7499-7219
Jerin Jose CherianDivision of Development Research, Indian Council of Medical Research Head Quarters, New Delhi, India.ORCID 0000-0002-9548-7004
Priyadharsini RajendranDepartment of Pharmacology, Jawaharlal Institute of Postgraduate Medical Education & Research, Pondicherry, India.ORCID 0000-0003-3538-6444
Venugopalan GunasekaranDepartment of Geriatric Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.ORCID 0000-0002-9379-2267
Shailaja V RaoGovernment Medical College, Aurangabad, India.ORCID 0009-0009-2468-9627
Venu Gopala Rao KondaDepartment of Pharmacology, TRR Institute of Medical Sciences, Hyderabad, India.ORCID 0000-0003-1127-5467

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundFalls in older patients can lead to serious health complications and increased health care costs. Fall risk-increasing drugs (FRIDs) are a group of drugs that may induce falls or increase the tendency to fall (ie, fall risk). Deprescribing is the process of withdrawal from an inappropriate medication, supervised by a health care professional, with the goal of managing polypharmacy and improving outcomes.

objectiveThis study aims to assess the effectiveness of a deprescribing intervention based on the Assess, Review, Minimize, Optimize, and Reassess (ARMOR) tool in reducing the risk of falls in older patients and evaluate the cost-effectiveness of deprescribing FRIDs.

methodsThis is an open-label, parallel-group randomized controlled academic trial. Individuals aged 60-80 years who are currently taking 5 or more prescribed drugs, including at least 1 FRID, will be recruited. Demographic data, medical conditions, medication lists, orthostatic hypotension, and fall history details will be collected. Fall concern will be assessed using the Fall Efficacy Scale, and fall risk will be assessed by the Timed Up and Go test and Tinetti Performance-Oriented Mobility Assessment tool. In this study, all treating physicians will be randomized using a stratified randomization method based on seniority. Randomized physicians will do deprescribing with the ARMOR tool for patients on FRIDs. Participants will maintain diaries, and monthly phone follow-ups will be undertaken to monitor falls and adverse events. Physical assessments will be performed to evaluate fall risk every 3 months for a year. The rationality of prescription drugs will be evaluated using the World Health Organization's core indicators.

resultsThe study received a grant from the Indian Council of Medical Research-Safe and Rational Use of Medicine in October 2023. The study is scheduled to commence in April 2024 and conclude by 2026. Efficacy will be measured by fall frequency and changes in fall risk scores. Cost-effectiveness analysis will also include the incremental cost-effectiveness ratio calculation. Adverse events related to deprescription will be recorded.

conclusionsThis trial will provide essential insights into the efficacy of the ARMOR tool in reducing falls among the geriatric population who are taking FRIDs. Additionally, it will provide valuable information on the cost-effectiveness of deprescribing practices, offering significant implications for improving the well-being of older patients and optimizing health care resource allocation. The findings from this study will be pertinent for health care professionals, policy makers, and researchers focused on geriatric care and fall prevention strategies.

trial registrationClinical Trials Registry - India CTRI/2023/12/060516; https://ctri.nic.in/Clinicaltrials/pubview2.php. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/55638.

Indexed as

Accidental FallsDeprescriptionsAgedAged, 80 and overCost-Benefit AnalysisFemaleHumansMaleMiddle AgedPolypharmacyRandomized Controlled Trials as TopicRisk Reduction BehaviorARMOR toolAssess, Review, Minimize, Optimize, and Reassessdeprescribingfall riskfall risk–increasing drugsfallsFRIDsgeriatricolder patients

Identifiers

PMID38861709
PMCPMC11200035

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LicenceCC BY
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.