Does Occupational Therapist led home environmental assessment and modification reduce falls among high risk older people? The Occupational Therapist Intervention Study (OTIS)

Associate Professor Alison Pighills1,2, Professor Avril Drummond3, Ms Shelley Crossland4, Ms Sarah Cockayne5, Professor David  Torgerson5

1Mackay Hospital And Health Service, Mackay, Australia, 2James Cook University, Townsville, Australia, 3School of Health Sciences, University of Nottingham, , Nottingham, UK, 4Community Mental Health Team, Leicestershire Partnership NHS Trust, Leicester, UK, 5York Trials Unit, Department of Health Sciences, University of York, York, UK

Background:Accidental falls are one of the leading causes of injury induced morbidity and mortality in older people, affecting around 30% of people over the age of 65 and 50% of those over 80. Environmental hazards are attributed as causal risk factors in 30-50% of falls,[1] thus, environmental assessment and modification (EAM) to prevent falls is intuitively sensible. National and international guidelines recommend interventions to reduce environmental hazards for older people at risk of falling. However, it remains uncertain whether EAM reduces falls in high risk older people and who can most effectively provide it.

The OTIS trial aims to determine whether Occupational Therapist (OT) led EAM leads to a reduction in falls among community dwelling people at high falls risk.[2]

Method: A pragmatic 2-arm, randomised controlled trial including a health economic evaluation. Intervention: A minimum of one home visit (1.5hrs) was provided by OTs, who used the Westmead Home Safety assessment tool to identify fall related hazards. Control: Usual care plus a falls prevention leaflet. The primary outcome was the rate of falls (falls/person/time) over 12 months. Secondary self-reported outcome measures included: the proportion single and multiple fallers, time to first fall over a 12-month period; quality of life (EuroQoL EQ-5D-5L), and health service utilisation at 4, 8 and 12 months.

Results: To date, 1331 community dwelling participants aged 65 and above, who are at an increased risk of falls have been randomised to receive either intervention or usual care.  Participants are currently in follow-up, so whilst baseline data is available, outcome data are still being collected. The final outcome of the trial will be reported in spring 2020.

Discussion: This study is the largest ever conducted evaluating the clinical effectiveness of OT led EAM. The outcome will influence international guidelines and an upcoming Cochrane Systematic Review.


  1. Rubenstein, L.Z., Falls in older people: epidemiology, risk factors and strategies for prevention. Age and Ageing, 2006. 35(Supplement 2): p. ii37-ii41.
  2. Cockayne, S., et al., Can occupational therapist-led home environmental assessment prevent falls in older people? A modified cohort randomised controlled trial protocol. BMJ Open, 2018. 8(9).


Alison completed her PhD in 2008 at the University of York, UK, which involved a RCT (n=238), to evaluate the clinical effectiveness of environmental assessment and modification to prevent falls in older people. She was awarded the University of York K M Stott prize for the best PhD thesis. She is currently a co-investigator on a multi-centre RCT in the UK (n=1333) which replicates her PhD research on a larger scale. Her research interests include: falls prevention, rural and remote models of care, professional skill sharing and delegation; and, research capacity development.

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