Abstract
BackgroundFalls are the leading cause of fatal and non-fatal unintentional injuries in older people. The use of Exergames (active, gamified video-based exercises) is a possible innovative, community-based approach. This study aimed to determine the effectiveness of a tailored OTAGO/FaME-based strength and balance Exergame programme for improving balance, maintaining function and reducing falls risk in older people.MethodsA two-arm cluster randomised controlled trial recruiting adults aged 55 years and older living in 18 assisted living (sheltered housing) facilities (clusters) in the UK. Standard care (physiotherapy advice and leaflet) was compared to a tailored 12-week strength and balance Exergame programme, supported by physiotherapists or trained assistants. Complete case analysis (intention-to-treat) was used to compare the Berg Balance Scale (BBS) at baseline and at 12 weeks. Secondary outcomes included fear of falling, mobility, fall risk, pain, mood, fatigue, cognition, healthcare utilisation and health-related quality of life, and self-reported physical activity and falls.ResultsEighteen clusters were randomised (9 to each arm) with 56 participants allocated to the intervention and 50 to the control (78% female, mean age 78 years). Fourteen participants withdrew over the 12 weeks (both arms), mainly for ill health. There was an adjusted mean improvement in balance (BBS) of 6.2 (95% CI 2.4 to 10.0) and reduced fear of falling (p = 0.007) and pain (p = 0.02) in the Exergame group. Mean attendance at sessions was 69% (mean exercising time of 33 min/week). Twenty-four percent of the control group and 20% of the Exergame group fell over the trial period. The change in fall rates significantly favoured the intervention (incident rate ratio 0.31 (95% CI 0.16 to 0.62, p = 0.001)). The point estimate of the incremental cost-effectiveness ratio (ICER) was £15,209.80 per quality-adjusted life year (QALY). Using 10,000 bootstrap replications, at the lower bound of the NICE threshold of £20,000 per QALY, there was a 61% probability of Exergames being cost-effective, rising to 73% at the upper bound of £30,000 per QALY.ConclusionsExergames, as delivered in this trial, improve balance, pain and fear of falling and are a cost-effective fall prevention strategy in assisted living facilities for people aged 55 years or older.Trial registrationThe trial was registered at ClinicalTrials.gov on 18 Dec 2015 with reference number NCT02634736.
Highlights
Falls are the leading cause of fatal and non-fatal unintentional injuries in older people
We investigated the effect of the Exergame intervention on fall rate by estimating the incidence rate ratio (IRR) using Mantel-Haenszel methods, stratified by match pair [71]
The assisted living facilities ranged from smaller facilities with 19 occupied flats to larger facilities with 80 occupied flats
Summary
Falls are the leading cause of fatal and non-fatal unintentional injuries in older people. This study aimed to determine the effectiveness of a tailored OTAGO/FaME-based strength and balance Exergame programme for improving balance, maintaining function and reducing falls risk in older people. Over 30% of community-dwelling people aged 65 and older and 50% of people aged 80 and over fall at least once per year [3, 4]. People living in retirement villages/assisted living facilities fall frequently [5]. Those identified as frail fall more frequently than those who are classified as vigorous [6, 7]. The direct and indirect costs of falls are substantial, for example, estimated costs in the UK NHS are in excess of £2.3 billion per year [8]
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