Remote versus Face-to-Face Fall-Prevention Training for Home-Dwelling Older Adults: Randomized Crossover Trial

Abstract

Abstract Background.Fall prevention exercise programs were shown to be effective. The COVID-19 pandemic advanced the accessibility of remote training methods for older adults. Consequently, digital training methods, such as mobile applications and exergames have been developed and studied, however, exploring the effectiveness of group programs via videoconferencing is still needed. This randomized crossover trial compared the feasibility and effectiveness of remote videoconferencing and face-to-face (FTF) fall-prevention exercise program. Methods. Eighty-one home-dwelling older adults (≥65 years) were randomly assigned to remote or FTF fall-prevention interventions. Group training was delivered twice weekly for 3 months in one modality, followed by a 2-week break, then 3 months of training in the other modality. Fall rate was measured monthly. Secondary outcomes included balance and function tests and self-reported measures of quality of life, fear of falling, satisfaction, and balance, collected at baseline (T0), after 3 and 6 months of training (T1, T2), and 6 months postintervention (T3). Results. Seventy (86%) participants completed the 12-month study. The mean monthly fall rate decreased during training (T1=0.12, T2=0.06) and increased during follow-up (T3=0.10), with no significant difference between remote and FTF (p=0.78). Similarly, secondary outcomes showed no significant differences between remote and FTF, but the order in which they were administered significantly affected 30-second Sit-to-Stand (STS) test (p=0.01); the FTF group demonstrated greater improvement at T1 than the remote group (Mean change=4.47 (4.09) and 1.66 (2.74) repetitions, respectively). However, after 6-months of training (all participants had received both modalities), no significant between-group changes were observed (p=0.12). For satisfaction and attendance rates, no significant differences between FTF and remote were observed. For satisfaction, T1: FTF=4.83/5.00(0.56), Remote=4.68/5.00(0.71); T2: FTF=4.86/5.00(0.46), Remote=4.75/5.00(0.44). For attendance, T1: FTF=78.8%, Remote=78.6%; T2: FTF=70.5%, Remote=68.4%. Conclusions.Remote fall-prevention interventions via videoconferencing are feasible and effective for home-dwelling older adults. The fall rate and STS showed clinically meaningful improvement following training. Disappearance of the advantage for those starting with FTF training after receiving both modalities may justify further research into alternating hybrid training. The improved fall rate deteriorated during follow-up, highlighting the importance of continuous fall-prevention interventions. Trial registration ClinicalTrials.gov, NCT05018455, 16/08/2021, https://clinicaltrials.gov/study/NCT05018455.