74 | Chapter 5 provided insights into participant adherence, perceived barriers, and facilitators of implementation, as well as variations in program delivery across municipalities (232). Last, in a third study, we examined the cost-effectiveness of the program since given limited healthcare resources, evaluating the cost-effectiveness of these interventions is essential (233). Therefore, this study aimed to assess the effectiveness of the modified In Balance fall prevention intervention compared to written general physical activity recommendations on the number of falls and fall-related injuries among community-dwelling adults of 65 years or older with an increased fall risk. METHODS Study design and setting This study was a single-blinded, multicentre randomized controlled trial conducted at various locations across the Netherlands. Eleven centres participated in this study. The In Balance intervention provided by physiotherapists and exercise therapists was assumed similar across sites, since all therapists followed the same education to become an In Balance therapist. The study protocol of this randomized controlled trial has been extensively described elsewhere (198). Also the accompanying cost-effectiveness analysis and process evaluation are reported elsewhere (232, 233). The report of the trial follows the recommendations of the CONSORT 2010 Statement (234). Participants The target population consisted of community-dwelling adults aged 65 years or older with an increased fall risk, defined by having experienced at least two falls in the past twelve months and/or having difficulties with moving, walking, or balance (235). All participants were required to independently execute activities of daily living and walk 100 meters. Participants were classified as non-frail or pre-frail based on the phenotype concept by Fried and colleagues (29). Frail participants were excluded from participation in this study, since the study of Faber and colleagues showed that this group had an increased fall risk after following the intervention (55). The target group of the In Balance intervention in the Netherlands shifted towards the non- and pre-frail population, but it is unknown for which of these two frailty levels the intervention is most suitable (55). The frailty phenotyping includes measures of weight loss, weak grip strength, exhaustion, slow gait speed and low physical activity, see the protocol paper for an elaboration how frailty status was determined (29, 198). Participants were considered as non-frail if they met none of the criteria, and classified as pre-frail when meeting 1 or 2 of the criteria. If participants met 3 or more of the criteria, they were classified as frail and excluded from participation in this study (29). Potential participants were also excluded if they participated in a fall prevention intervention in the
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