8 General discussion and summary | 159 Primary outcomes were the number of falls and fall-related injuries over 12 months follow-up. Secondary outcomes consisted of physical performance measures, physical activity, confidence, health status, quality of life, and societal costs. A process evaluation was also performed in which we investigated the possibilities for further optimization and implementation of the In Balance intervention. Chapter 4 assessed the correlation between the Short Physical Performance Battery (SPPB) and wearable sensor-based gait quality and quantity variables measured in daily life. This observational, cross-sectional study used baseline data of the RCT described in Chapter 3 and included 229 community-dwelling adults of 65 years or older. We found that all correlations between the SPPB and gait quality and quantity variables were low (correlation coefficient < 0.3). A possible explanation is that the SPPB primarily assesses physical capacity, whereas gait quality and quantity in daily life reflect actual performance in real-world conditions. Since these measures capture distinct aspects of mobility, integrating objective inertial sensor measurements alongside the SPPB could provide complementary insights and enhance overall evaluation. Chapter 5 evaluated the effectiveness of the In Balance fall prevention intervention compared to usual care over a follow-up period of 12 months as described in the study protocol in Chapter 3. The In Balance group reported a mean of 1.67 falls per person per year and this was 1.98 for the control group. For fall-related injuries this was respectively 0.70 and 0.97. However, these differences were not statistically significant. For balance, muscle strength, physical function and emotional wellbeing we also saw improvements in the In Balance group compared to the control group, but again differences were not statistically significant. The absence of significant differences may be explained by the fact that the difference in falls was smaller than a priori expected, resulting in the study’s power being too low. The most pronounced impact was seen during the intervention period. Therefore, structural follow-up programs might enhance effectiveness, which should be addressed in future research. In Chapter 6, we investigated the cost-effectiveness of the In Balance intervention from a societal perspective as described in the study protocol in Chapter 3. Although the In Balance group had lower costs and gained more Quality Adjusted Life Years (QALYs, a measure that combines the quantity and quality of life: one QALY represents one year of life in perfect health) compared to the usual care group, these differences were not statistically significant. The Incremental Cost-Effectiveness Ratio (i.e., difference in costs between the intervention and control group divided by the difference in effects between the In Balance and control group) indicated that In Balance is less expensive and more effective than usual care for prevented falls, prevented injuries, and QALYs. At a willingness to pay threshold of €0 per
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