72 | Chapter 5 ABSTRACT Background Fall prevention programs effectively reduce falls and injuries in specific populations but often require adaptations for large-scale implementation. The In Balance intervention, previously effective in residential care, was adapted for community-dwelling older adults. This study evaluated its effectiveness compared to usual care in community-dwelling older adults. Methods In this single-blinded randomized controlled trial, 264 non- and pre-frail adults (≥65 years) with increased fall risk were recruited from eleven centers. Participants had either experienced ≥2 falls in the past year or had mobility/balance difficulties. The intervention group followed a 14-week group program, including educational sessions and Tai Chi-based balance and strength exercises, delivered by trained therapists. The control group received general physical activity recommendations. Primary outcomes were the number of falls and fall-related injuries over 12 months, recorded via fall diaries and follow-up calls. Secondary outcomes included balance, mobility, and general health. Data were analyzed using generalized linear- and mixed-effects models, with multiple imputation for missing data. To obtain a difference in the number of falls per year between the intervention and control group of 50%, 106 participants per group were required, increased to 264 to account for dropout. Results Mean age was 75.2 (SD 5.6) years in the intervention and 75.7 (SD 5.1) years in the control group. No significant differences were found in falls (IRR 0.85, 95% CI 0.51-1.43) or fall-related injuries (IRR 0.73, 95% CI 0.44-1.19). Secondary outcomes also showed no significant differences across time or frailty status. Attendance averaged 15.5 of 24 sessions. Conclusions The adapted In Balance program did not significantly reduce falls, injuries, or improve secondary outcomes compared to usual care. Impact statement Implementation of In Balance with program modifications from residential care to the community and/or insufficient adherence may have reduced its effectiveness. Trial registration Research with human participants: NL9248 (registered February 13 2021, URL: https://www. onderzoekmetmensen.nl/nl/trial/26195)
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