Print Email

BMJ Endgames

Controlled trials

Philip Sedgwick

Reader in medical statistics and medical education
Centre for Medical and Healthcare Education, St George’s, University of London, London, UK
BMJ 2013;347:f5718

The effectiveness of an interdisciplinary primary care approach for community dwelling frail older people in reducing disability and preventing further functional decline was investigated. A cluster randomized controlled superiority trial study design was used. The intervention was the so called prevention of care approach, which consisted of a multidimensional assessment and interdisciplinary care based on a tailor made treatment plan with regular evaluation and follow-up. The control treatment consisted of usual care.

In total, 346 frail older people (score ≥5 on Groningen frailty indicator) were recruited from 12 general practices in the south of the Netherlands. General practices were randomized to intervention or control. The primary outcome was disability, assessed at 24 months by means of the Groningen activity restriction scale. Secondary outcomes were depressive symptomatology, social support interactions, fear of falling, and social participation. Outcomes were measured at baseline and at 6, 12, and 24 months of follow-up.

No significant difference was found between the intervention and control groups with regard to disability (primary outcome) and the secondary outcomes. It was concluded that there was no evidence of a difference between the prevention of care approach and usual care in effectiveness.

Please click here for answer.


  1. Metzelthin SF, van Rossum E, de Witte LP, Ambergen AW, Hobma SO, Sipers W, et al. Effectiveness of interdisciplinary primary care approach to reduce disability in community dwelling frail older people: cluster randomised controlled trial. BMJ 2013;347:f5264.
  2. Sedgwick P. What is a superiority trial? BMJ 2013;347:f5420.

 BMJ Logo
This post is based on an article published in "Endgames" an educational series from The BMJ.  Other Endgames articles are available here. Copyright BMJ Publishing Group 2013