104 | Chapter 6 fall prevention interventions that address multiple factors associated with falling rather than individual and/or mono-factorial programs. In Balance is such a program. Therefore, our aim was to evaluate the cost-effectiveness of the nationally implemented In Balance intervention for non-frail and pre-frail community-dwelling older adults in comparison with general physical activity recommendations (control) from a societal perspective (257). We hypothesized that the In Balance intervention will lead to lower costs and increased quality of life compared to exercise recommendations among both non- and pre-frail community-dwelling older adults with an increased risk of falls. Additionally, we expected In Balance to be more cost-effective compared to control in the pre-frail group than in the non-frail group. METHODS Study design This economic evaluation was conducted alongside a 12 month, single-blind, multicenter randomized controlled trial (RCT), which compared the cost-effectiveness of the In Balance fall prevention intervention (intervention) to written general recommendations on physical activity (control). The Medical Ethics Committee Brabant gave its approval for the RCT (project number P2055). For an in-depth description of the study design, we refer to the study protocol and the preprint of the effectiveness study (198, 254). Participants Community-dwelling non-frail and pre-frail adults aged 65 years and above who had an increased risk of falls, were eligible to participate. A person was considered at increased risk of falling if they had experienced a minimum of two falls in the past 12 months and/or had mobility impairments (i.e., difficulties with moving, balance or walking) (235). Frailty status was determined based on the indicators according to Fried et al. (29), which comprise unintentional weight loss, weak grip strength, slow gait speed, low physical activity, and exhaustion. Participants who met none of the criteria were classified as non-frail, whereas those meeting one or two criteria were classified as pre-frail. Participants who met three criteria or more were classified as frail and therefore excluded from the study. Other exclusion criteria were the inability to walk 100 meters independently or to perform activities of daily living without assistance, cognitive impairment defined as a score of 18 or lower on the Mini-Mental State Examination (104), self-reported contraindications (i.e., cardiovascular, neurological and orthopedic problems), the inability to understand or read Dutch, or participation in a fall prevention intervention within the last 6 months.
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