12 | Chapter 1 The In Balance fall prevention intervention Table 1.1 highlights that although the In Balance program is widely implemented, there is a knowledge gap concerning its effectiveness. In Balance aims to reduce falls by increasing awareness, balance, and strength in older adults with an increased risk of falling (55). The first four weeks consist of weekly counselling and education sessions to enhance knowledge and awareness of fall risk (55). The remaining ten weeks involve two one-hour exercise sessions per week, based on Tai Chi principles, focusing on physical balance and strength (55). The intervention is delivered by certified exercise and physical therapists (55). A 20-week during precursor of the current In Balance program is proven to be effective in pre-frail older adults living in care centres and subsequently has been implemented in the Netherlands (55). Figure 1.1 provides an overview of the current In Balance intervention. Figure 1.1. Overview of the In Balance fall prevention intervention. To address the knowledge gap regarding the effectiveness of In Balance, it is crucial to consider not only its effectiveness but also its cost-effectiveness and practical feasibility. (Cost-)Effectiveness There are gaps in our understanding of the real-world effectiveness of fall prevention interventions when implemented in the community (59). First, as intervention studies often focus on controlled settings or specific populations, they do not capture how these interventions perform in broader, more diverse community settings (59). Such interventions after implementation can therefore be less effective due to various practical challenges in a real-world environment, such as limited time, finances and staff (59).
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