{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T06:09:13Z","timestamp":1789711753138,"version":"4.0.1"},"reference-count":35,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T00:00:00Z","timestamp":1789603200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T00:00:00Z","timestamp":1789603200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health and Care Research","doi-asserted-by":"publisher","award":["NIHR203301"],"award-info":[{"award-number":["NIHR203301"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["agsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J American Geriatrics Society"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Controlled pain medications increase the risk of falls. Despite this, they are commonly prescribed for painful neurogenic claudication. Previously, we reported that the Better Outcomes for Older People with Spinal Trouble (BOOST) program improved walking and reduced overall falls at 12\u2009months. The aim of this study was to determine whether, in comparison to best practice advice, a physical and psychological group intervention (PPGI) changed pain medication use and to determine the mechanisms of fall reduction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Secondary and mediation analysis of the BOOST randomized controlled trial. There were 435 people enrolled at baseline. Follow\u2010up was at 6 and 12\u2009months after randomization. At baseline and follow\u2010up, we classified participants into three groups: (1) not using any pain medication; (2) using only non\u2010controlled medication; and (3) using at least one controlled pain medication, with or without other pain medications. Physical performance tests, patient\u2010reported outcomes, medication use, and falls were collected at all time points.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      At baseline, 63% (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009274\/435) of participants reported taking at least one pain medication, with 34% (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009149\/435) taking at least one controlled medication. At 6\u2009months, the PPGI was more effective than best practice in reducing the use of controlled medications [OR 0.62, 95% CI (0.40, 0.96)] although these differences narrowed by 12\u2009months. There was a modest treatment benefit in pain. Several factors mediated falls prevention at 12\u2009months, notably a reduction in controlled pain medication in the first 6\u2009months of follow\u2010up.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>PPGI reduced controlled pain drug use at 6\u2010months, and this contributed to reduced falls by 12\u2010months. Intervention refinements may improve the effect on controlled medication reduction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>ISRCTN 12698674<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jgs.70696","type":"journal-article","created":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T05:35:47Z","timestamp":1789709747000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Controlled Drug Use and Falls in Older People With Neurogenic Claudication: Secondary Analysis of the\n                    <scp>BOOST RCT<\/scp>"],"prefix":"10.1111","author":[{"given":"Helen","family":"Richmond\u2010Davies","sequence":"first","affiliation":[{"name":"Faculty of Health and Life Sciences University of Exeter  Exeter UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-6071-6209","authenticated-orcid":false,"given":"Paul","family":"Newell","sequence":"additional","affiliation":[{"name":"Faculty of Health and Life Sciences University of Exeter  Exeter UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Richmond","sequence":"additional","affiliation":[{"name":"Consultant  Rugby UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Javed","family":"Iqbal","sequence":"additional","affiliation":[{"name":"Sandwell and West Birmingham NHS Trust  Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0638-0406","authenticated-orcid":false,"given":"Esther","family":"Williamson","sequence":"additional","affiliation":[{"name":"Faculty of Health and Life Sciences University of Exeter  Exeter UK"},{"name":"Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences University of Oxford  Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3540-8052","authenticated-orcid":false,"given":"Cynthia","family":"Srikesavan","sequence":"additional","affiliation":[{"name":"Faculty of Health and Life Sciences University of Exeter  Exeter UK"},{"name":"Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences University of Oxford  Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Graham","family":"Boniface","sequence":"additional","affiliation":[{"name":"Healthcare Improvement Scotland  Edinburgh UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4349-7195","authenticated-orcid":false,"given":"Sarah E.","family":"Lamb","sequence":"additional","affiliation":[{"name":"Faculty of Health and Life Sciences University of Exeter  Exeter UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the BOOST Research Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,17]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/brs.0000000000003719"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00586\u2010020\u201006339\u20101"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpain.2021.03.147"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00586\u2010019\u201005987\u20102"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40266\u2010022\u201000929\u2010y"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s41999\u2010023\u201000824\u20108"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.15767"},{"key":"e_1_2_12_9_1","unstructured":"BMJ and Pharmaceutical Press. 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