What are we trying to do?

Evaluating the effectiveness and cost-effectiveness of a digital exercise programme, known as KOKU (Keep-On-Keep-Up), for improving balance, function and reducing falls risk in community-dwelling older adults aged 60 years and over.

 

Why is this important?

Falls are the primary cause of fatal and non-fatal accidental injuries in older adults. The World Falls Prevention Guidelines recommend balance-challenging, functional exercise programmes as a key strategy for falls prevention but access, uptake and adherence to these programmes in community settings remain suboptimal. They may also be inaccessible to those who are homebound, without transport, and unavailable in some locations. A growing evidence base suggests that digital interventions may be a feasible tool for delivery of falls prevention and exercise awareness among older adults. Keep-On-Keep-Up (KOKU), a digital, National Health Service (NHS) approved programme was co-developed with older adults and therapists, to provide progressive, evidence-based exercises and to raise awareness of fall prevention strategies. Feedback from users and stakeholders in usability and acceptability studies in the UK and US have been very positive, warranting further evaluation and testing. Conducting a randomised controlled trial will allow us to rigorously evaluate the effectiveness of KOKU relative to usual care in improving strength, balance, falls risk, self-reported falls, health-related quality of life, mood, pain, fatigue and health care utilisation. The cost-effectiveness component of this study will also help us understand whether KOKU not only works better than usual care but also offers good value for money. This may generate evidence to inform future clinical practice and policy development in fall prevention.

 

How are we doing it?

A total of 196 community dwelling older adults aged 60 years and older will be randomised to either the intervention group comprising a digital strength and balance programme (KOKU) alongside standard care (strength and balance exercise advice and a falls prevention leaflet) or to a control group, receiving standard care only. Participants receiving the intervention will be asked to exercise three times per week following the tailored and progressive programme.

The trial’s primary outcome measure is balance function (Berg Balance Score) at twelve weeks post-randomisation. Secondary trial outcomes include: lower limb strength; healthcare utilisation and health-related quality of life; self-reported concerns about falling; self-reported physical activity; falls risk, pain, mood, fatigue, self-reported falls, acceptability and usability of the KOKU programme. A cost-effectiveness analysis will also be conducted. Qualitative interviews and focus groups will be undertaken with care provider staff members and study participants to further understand views of the intervention and trial processes.

 

Who are we working with?

• Participants have been recruited from a variety of organisations and social care providers based in community settings in Greater Manchester and Lancashire areas in the Northwest of England. These include adult social care teams, housing providers and charity organisations which support older adults to remain as independent as possible in their own home.
• We have so far been working with 47 organisations/social care providers across Greater Manchester and Lancashire to engage older adults at risk of falls and frailty in our trial.

 

 

More information

 

 

Programme Manager

 

Alison Littlewood
alison.j.littlewood@manchester.ac.uk