Home-Based Exercise and Fall Prevention in Older Adults: Development, Validation and Usability of the Mais Equilíbrio Mobile App

Abstract

Background: The global aging population and the high incidence of falls among this population highlight the need for effective preventive strategies. Home-based exercise programs, such as the Otago protocol, have demonstrated efficacy in reducing fall risk but often face barriers related to user adherence. Mobile health (mHealth) apps offer promising tools to support health promotion and enhance autonomy in older adults. Objective: This study aims to develop and validate a prototype mobile app, Mais Equilíbrio (More Balance), designed to guide older adults in performing home-based physical exercises adapted from the Otago protocol. Methods: This methodological study was conducted in two phases: (1) content validation by 22 experts in physical education and physiotherapy using the Suitability Assessment of Materials (SAM) scale, and (2) usability testing with 24 older adults (aged 60 to 80 y), using the System Usability Scale (SUS). An overall score above 70% on the SAM and above 85 on the SUS were considered indicators of high quality and excellent usability, respectively. Results: The Mais Equilíbrio (More Balance) app was developed based on the Otago protocol and tailored for independent home use. A Content Validity Index above 0.95 was observed for all items. An overall average score of 81.20 (SD 15.78) on the SAM scale was found, classifying the material as “superior.” Usability tests with older adults showed an average score of 95.98 (SD 5.58) on the SUS, indicating excellent usability. The highest scores were observed in “ease of use” and “user confidence.” Conclusions: The Mais Equilíbrio (More Balance) app, distinct for digitally adapting the Otago protocol to the Brazilian context and for its dual validation process with experts and older adults, has proven to be a valid and highly usable tool for guiding home-based physical exercise in older adults, with potential to promote fall prevention and autonomy.