3 Protocol for the In Balance randomized controlled trial | 53 our study. Moreover, the social component of the In Balance intervention can be a facilitating factor to participate in this study. In a recent inventory among several In Balance therapists on conducting the In Balance intervention in times of COVID-19, therapists indicated that the In Balance intervention can be conducted while taking the COVID-19 measures into account. Drop out during follow-up is considered as a threat in this study, particularly in controls due to a lack of attention. To minimize attrition in both the intervention and control group, participants will be closely involved in the study by receiving regular newsletters and a personal advise on (changes in) physical performance after ending the study. In addition, we expect that older adults will appreciate the personal contact during the measurement moments and monthly telephone calls. This personal contact keeps participants involved in the study and lowers the risk of drop out (182). Another challenge is that even though In Balance therapists will be trained intensively to tailor the level of physical exercises to each individual participant, there will be variance in the training progression of participants in this trial. By training the In Balance therapists and by developing and using standard operating procedures, this variance will be limited. Moreover, this variance represents clinical practice and allows individualized training. This study includes a considerable number of outcome measures. To limit the burden for participants as much as possible, they will receive questionnaires in their own environment so that they can fill them in in their own time. The physical outcome measures will be assessed at a location in the municipality of the participant and will take about one hour. With the collection of data on the number of falls, we depend on the memory of the participants, with the risk of recall bias. However, we will use an approach consisting of monthly telephone calls in addition to a fall diary, which is considered the most optimal approach to minimize recall bias when reporting the number of falls and fall-related injuries (156). By personal calls, we will be able to collect detailed information on the causes, circumstances and consequences of falls. In summary, this trial will provide insight into the clinical and societal impact of an implemented and adjusted Dutch fall prevention intervention and thus has major benefits for older adults, society and health insurance companies. If the In Balance intervention is effective in reducing the number of falls, there are major potential benefits to older adults and the community. Preventing falls could reduce adverse health outcomes, such as disability, hospitalisation and the associated costs (122, 127-130, 134). Enhanced mobility is expected to improve functioning and result in higher quality of life (127-130). If cost-effectiveness can be shown, implementation of this intervention will result in more efficient utilisation of health services. Moreover, health insurance companies can make an informed decision on whether the intervention becomes
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