# The effectiveness of a nation-wide implemented fall prevention intervention in the Netherlands in reducing falls and fall-related injuries among community-dwelling older adults with an increased risk of falls: a randomized controlled trial

## TL;DR

A national fall prevention program in the Netherlands did not significantly reduce falls or injuries in older adults at risk.

## Contribution

This study evaluates the real-world effectiveness of a scaled-up fall prevention program in older adults.

## Key findings

- The In Balance program did not significantly reduce the number of falls compared to usual care.
- There was no significant difference in fall-related injuries between the intervention and control groups.
- Secondary outcomes like balance and mobility also showed no significant improvement.

## Abstract

Fall prevention programs have been proven effective in reducing falls and fall-related injuries in specific target groups and settings. However, implementing these programs on a larger scale often requires adjustments for feasibility. This study assessed the effectiveness of the nationally implemented In Balance fall prevention intervention compared to usual care in community-dwelling older adults.

In this single-blinded randomized controlled trial, 264 non- and pre-frail adults of 65 years or older with an increased fall risk were recruited from eleven centers. The intervention group followed an adapted nation-wide 14-week group In Balance program, including educational sessions and Tai Chi-based balance and strength exercises, delivered by trained therapists. The control group received general physical activity recommendations. Primary outcomes were the number of falls and fall-related injuries over 12 months, recorded via fall diaries and follow-up calls. Secondary outcomes included balance, mobility, and general health. Data were analysed using generalized linear- and mixed-effects models, with multiple imputation for missing data. To obtain a difference in the number of falls per year between the intervention and control groups of 50%, 106 participants per group were required, increased to 264 to account for dropout.

The mean age was 75.2 (SD 5.6) years in the intervention and 75.7 (SD 5.1) years in the control group (p > 0.05). The mean number of falls per person over 12 months was not statistically different between the intervention and control group (1.67 (SE 0.24) and 1.98 (0.37), respectively; incidence rate ratio 0.85 (95% CI 0.51–1.43)), nor the mean number of fall-related injuries (0.70 (SE 0.11) and 0.97 (0.18), respectively; incidence rate ratio 0.73 (95% CI 0.44–1.19)). Secondary outcomes also showed no significant differences between groups, frailty status and over time. Attendance averaged 15.5 of 24 sessions.

The adapted In Balance program did not significantly reduce falls, injuries, or improve secondary outcomes compared to usual care. The implemented In Balance program appears to be less effective than a priori assumed, possibly due to limited adherence in practice or insufficient frequency and duration of the program.

Research with human participants: NL9248 (registered February 13 2021, URL: https://www.onderzoekmetmensen.nl/nl/trial/26195).

The online version contains supplementary material available at 10.1186/s12877-025-06967-6.