Research Analysis · Falls & independence
STRIDE did not significantly reduce serious fall injuries in primary care
In 5,451 older adults at increased fall-injury risk, a nurse-led multifactorial strategy did not significantly reduce the first adjudicated serious fall injury versus enhanced usual care. A secondary self-reported fall-injury outcome differed.
Evidence scope
What this trial can—and cannot—show
- Population or model
- 5,451 community-dwelling primary-care patients age 70 years or older at increased risk for serious fall injuries
- Design
- pragmatic cluster-randomized trial across 86 primary-care practices
- Comparator
- enhanced usual care with falls-prevention information
- Duration
- 24 to 44 months of participant follow-up
- Primary outcome
- time to first adjudicated serious fall injury
- Evidence maturity
- Human serious fall injuries · large pragmatic cluster-randomized trial
- Funding & conflicts
- PCORI and the National Institute on Aging supported STRIDE. The public report lists the participating institutions and investigators; no linked correction or retraction affecting the central result was identified.
- Safety & status
- Hospitalizations and deaths were similar. The secondary first self-reported fall-injury result does not replace the adjudicated primary outcome.
Bottom line: First serious fall-injury rates were 4.9 versus 5.3 per 100 person-years; HR 0.92 (95% CI 0.80–1.06), P=.25.
Not established: The trial did not establish a significant primary-outcome reduction, equivalence, longer independence, healthspan or lifespan.
The primary result comes first
STRIDE tested whether a nurse-led, individually tailored multifactorial strategy worked when embedded in routine primary care. The rate of first adjudicated serious fall injury was numerically lower, but the confidence interval crossed no difference and the comparison was not statistically significant.
A secondary outcome differed
Time to first self-reported fall injury favored the intervention, with a hazard ratio of 0.90 and a 99% confidence interval of 0.83 to 0.99. Because this was secondary and self-reported, it cannot replace the blinded adjudicated primary result.
Who the result fits
Participants were community dwelling, age 70 or older and screened as being at increased risk. The sample was more educated and less racially diverse than the wider population, included few people with substantial cognitive impairment and did not include small independent practices.
What remains uncertain
The study did not fully establish intervention fidelity across sites. It did not show clinically meaningful improvements across most well-being measures, and it did not test whether the strategy extended independence or life.
Sources and editorial method
Three research passes were completed before prose drafting. Every substantive statement maps to F71-STRIDE-01, F71-STRIDE-02, F71-STRIDE-03, F71-STRIDE-04 in the frozen evidence record. Primary identifiers, registry status, correction state, Funding and conflicts, safety context and limitations were reverified. See issue #144.
AI disclosure: AI-assisted research and drafting were used within the governed workflow; sources and claims were checked against the frozen evidence map. This article is educational and not medical advice.
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Publication history
Published August 26, 2026 after three documented research passes, claim-level evidence review and deterministic source checks. No correction or retraction affecting the central result was identified at publication.