Comparing the immediate effects of remote versus face-to-face fall prevention training after three months. Evaluating the impact the delivery sequence of (remote followed by face-to-face, or vice versa) at 6-months, and the sustainability of the therapeutic effects 6-months post-intervention.
A randomized, assessor-blinded trial with 2-arms. Groups differed only in the sequences of training modalities. Each group received a 6-month Otago-based group program, consisting of two 3-month phases: remote and face-to-face. Modality (face-to-face vs. remote) was compared at 3 months, and the sequence of delivery (remote-first vs. face-to-face-first) at 6 months. Participants were community-dwelling adults (65+), walking independently and at risk of falling. Outcomes included adherence and satisfaction (Global Perceived Effect scale) and adverse events. Falls were tracked during 12-months using self-reported diaries. Efficacy was evaluated using six physical tests: Mini-BESTest, Timed Up and Go, Berg Balance Scale (BBS), 4-Meter Walk, 30-second Sit-to-Stand (STS), one-leg stance, plus self-reported quality of life and fear of falling. Assessments occurred at baseline, 3 months (T1), 6 months (T2), and 12-month (T3).
The face-to-face group showed significantly greater improvements in BBS and STS (p= 0.04, 0.01 respectively), compared to the remote group immediately after 3-months training. These differences disappeared after both groups completed the combined 6-months training, with no significant differences between-group in any outcomes. At 6-month follow-up, some improvements persisted while others diminished. No significant differences in fall rates or the proportion of fallers were observed between groups at any time point. Proportion of fallers at 12-month period: RR = 1.11, 95% CI 0.73-1.68, p = 0.66. Attendance rates were comparable between modalities (remote: 78.6%, 68.4%; face-to-face: 78.8%, 70.5% for T1 and T2, respectively). Satisfaction scores were high and similar for both modalities (GPE scale, -5 to 5): face-to-face vs. remote at T1: 4.84(0.55) vs. 4.67(0.71); at T2: 4.86(0.47) vs. 4.76(0.43). Differences were not statistically significant. Four falls (two per modality) occurred during training, none resulting in injury.
The findings support remote fall prevention training for community-dwelling older adults, with high satisfaction and adherence rates comparable to face-to-face training and no increase in adverse events. While face-to-face training showed greater initial improvements in lower-limb strength (STS) and balance (BBS, though not clinically significant) at 3-months, these differences equalized after 6-months of mixed training. The early advantage of face-to-face may stem from enhanced communication and motivation, particularly for challenging exercises like the STS. Future research should explore hybrid models combining remote and face-to-face sessions to optimize outcomes.
Remote fall prevention training offers safe and accessible alternative to face-to-face interventions. Clinicians can design flexible programs combining remote and face-to-face elements, tailoring interventions to individual needs. This approach may enhance program flexibility, adherence, and long-term engagement while maintaining quality of care for older adults.
remote training
community-dwelling older adults
