Falls Prevention Evaluation and Development for Older Adults in the Community
Condition: Physical Performance; Fear of Falling
Study type: Interventional

Summary: 
      Exercise-based fall prevention programmes with strength and balance components have been
      shown to reduce the rate of falls, risk of falling, fractures and injuries. However, there is
      little evidence on the implementation of these programmes in real-world settings.

      This study aims to assess the effectiveness of exercise-based fall prevention interventions
      on fall risk (physical performance and fear of falling) among community-dwelling older adults
      who are at risk of falling in Singapore. A secondary aim is to assess the effectiveness of
      the programme on other health outcomes. The study will also evaluate the programme
      implementation from 3 perspectives of older adults, implementers and community partners.
    

Detailed description: 
      Two exercise-based fall prevention programmes (Otago Exercise Programme, OEP and the Stepping
      On Programme, SOP) have been shown to be effective to prevent and reduce falls in primarily
      non-Asian settings. The Otago Exercise Programme is a single component intervention that has
      been shown to reduce fall rate among older adults by 35%. The OEP is a group-based exercise
      programme based on strength and balance components. The Stepping-On Programme is a
      multi-component intervention that has been shown to reduce fall rate by 30%. The SOP consists
      of group-based series of weekly sessions to teach fall prevention strategies to
      community-dwelling older adults. Sessions comprise of strength-balance exercises and classes
      based on adult learning principles.

      However, there is little evidence of the effectiveness, feasibility and acceptability of
      locally-adapted community fall prevention interventions. Furthermore, studies on the
      effectiveness of fall prevention interventions among Asian populations are less robust due to
      the lack of well-designed studies with adequately powered sample sizes.

      In this study, exercise-based fall prevention programmes will be implemented based on
      geographic region where participants living in the North region will receive the modified SOP
      and participants in the Central region will receive the modified OEP.
    

Intervention name(s): Exercise-based fall prevention intervention (Modified Otago Exercise Programme and Modified Stepping On Programme); Wait-list control
Intervention type(s): Other; Other
Intervention description(s): The modified OEP is a group exercise programme that consists of progressive strength and balance exercises led by trained exercise leaders (fitness instructors or health coaches). The supervised sessions will be conducted twice a week (1 hour each) for 7 weeks. Participants will be given an exercise booklet and encouraged to exercise at home.
The modified SOP is a group fall prevention programme that consists of exercise sessions and discussions on various falls prevention aspects facilitated by a trained programme leader and supported by programme facilitators and peer facilitators. The supervised sessions will be conducted once a week (2 hours each) for 7 weeks. Participants will be given homework and encouraged to exercise at home. In addition, there will be an optional home visit (Week 11), a 1-hour booster session (Week 19) and a telephone call (Week 31).; To receive fall prevention resources while waiting for their programme to start
Allocation: Randomized
Intervention model: Sequential Assignment
Intervention model description: This is a stepped-wedge cluster randomized trial in which there will be a sequential crossover of clusters from the waitlist control to the intervention period where the sequence of crossover is randomized. The clusters are defined as groups with at least 5 participants. Each of the North and Central regions will have 6 clusters.
The intervention will be sequentially rolled out to 12 clusters that are randomized to 6 time periods (sequences). Each sequence has 6 steps where one step has a duration of 8 weeks. The intervention will be rolled out sequentially to 2 clusters (1 North, 1 Central) at every step until all 12 clusters have received the intervention by the end of the study. Each cluster will have 1-3 community sites and minimum 5 participants. Outcome assessors will be blinded to sequence allocation.
Masking: Single (Outcomes Assessor)
Primary purpose: Health Services Research
Keywords: Accidental fall; Older adult