Clinical effectiveness of a digitally delivered balance program for older adults: a nonrandomized controlled trial.

Abstract

Aim: To evaluate the clinical effectiveness of a digitally delivered balance program relative to an attention-control comparison group in older adults at risk for falls. Materials & methods: This nonrandomized controlled trial recruited adults aged 65 years and older with moderate-to-high fall risk. Participants were assigned to a digital balance program (exercise therapy, education and health coaching) or an attention-control group (education materials). Outcomes were assessed via self-report surveys at baseline and 3 months. Analyses including all assigned participants evaluated changes in fall rate, fall severity, physical function and medical care utilization. Results: A total of 687 participants were included in the analysis (intervention: n = 344; attention-control: n = 343). The mean age was 68.8 years, and 74.1% of participants were female. In the primary analysis, adjusting for baseline factors, the intervention group demonstrated a 37% lower fall rate compared with the attention-control group at 3 months (IRR: 0.63, 95% CI: 0.48-0.82, p < 0.001). The intervention group also demonstrated significant improvement in physical functioning (β = 6.86, 95% CI: 3.80-9.92, p < 0.001) and lower odds of emergency department visits (OR: 0.43, 95% CI: 0.24-0.76, p = 0.004). Intervention participants engaged in an average of 25.2 exercise therapy sessions over the 12-week period. Conclusion: Findings suggest that participation in the digital balance program was associated with reductions in self-reported fall rates, improvements in self-reported physical function, and lower odds of emergency department utilization. High engagement levels further indicate that digitally delivered programs offer a viable option for improving health outcomes in this population. Trial Registration: Clinicaltrials.gov NCT06868680 retrospectively registered 6 March 2025. What is this article about? Falls are a major cause of injury for adults aged 65 and older. While exercise can help prevent falls, many older adults find it difficult to attend in-person classes due to transportation or mobility issues. This study looked at whether a digital balance program (delivered through an app on a smartphone or tablet) could help reduce falls. The program included exercise therapy, education and support from a health coach and physical therapist. Researchers compared 344 participants who used the app to 343 participants who received only educational emails to see if the app helped reduce falls and improve overall health. What were the results? After 3 months, participants using the digital program reported significantly fewer self-reported falls compared with the group that only received educational emails. As part of an exploratory analysis, participants using the app also reported significant improvements in their physical ability to move and do daily tasks. In another exploratory finding, those in the digital program group reported fewer emergency department visits during the study. Participants were highly engaged with the app, completing an average of two exercise sessions per week. What do the results mean? These findings suggest that digital exercise programs can be an effective and accessible way for older adults with baseline digital literacy and device access to improve their balance and physical health from home. By reducing patient-reported fall risks and emergency hospital visits, such programs may help tech-proficient older adults live independently for longer while reducing the burden on the healthcare system.