Feasibility and acceptability of a supervised and self-directed technology-based Dual Task training programme for older adults at risk of falling

Background Decreasing ability to multitask is associated with increasing risk of falling in older people.

Evidence suggests Dual Task (DT) training - training cognition and physical function simultaneously, to be superior to single-task training for improving mobility and balance, leading to reduced fall risks.

With appropriate digital tools, such as smartphones and mobile applications (apps), it is possible to deliver DT training unsupervised and in a home environment.

Research questions Ahead of conducting a full-scale trial evaluating the effectiveness and cost-effectiveness of a DT intervention for balance improvement in older adults, questions related to feasibility and acceptability of the intervention will need to be addressed: Is a 24-weeks, blended supervised and self-directed technology-based DT training programme (using a mobile app) acceptable to older people at risk of falling?

Is a 24-weeks, blended supervised and self-directed technology-based DT training programme feasible and deliverable with the potential to be adopted by falls prevention services in the NHS?

Aims and Objectives The study aims to examine how feasible it is to deliver a blended supervised and self-directed technology-based DT training programme for older adults at high risks of falling.

Objective 1 (O1): To evaluate the acceptability of the blended DT programme delivered to older adults living in the community who have had recurrent falls in the past 12 months. Objective 2 (O2): To assess the feasibility of study recruitment via NHS falls prevention services.

Objective 3 (O3): To evaluate the feasibility of the proposed programme to be adopted by the NHS falls prevention services.

Methods Fifty older adults with a history of falls will be recruited from NHS falls clinics in the West Midlands into a single-arm, non-randomised feasibility study.

They will participate in a 24-weeks DT programme consisting of two phases: Phase 1 - 12 weeks of supervised, group-based DT programme delivered via a mobile app in the community led by a physiotherapist that aligns to standard care.

Participants will also undertake the self-directed programme at home, in preparation for the second phase of the programme. Phase 2 - 12 weeks of self-directed programme, with participants independently exercising at home using the mobile app.

Acceptability and feasibility of the blended DT programme will be assessed via: Adherence Usage and usability of the app Recruitment/retention rates Focus groups with the participants and clinical teams will be conducted at the end of the DT programme, allowing for in-depth analysis and interpretation of findings regarding feasibility and acceptability of the study.

Anticipated impact and dissemination The findings of this study will inform the design of a larger-scale randomised controlled trial evaluating the clinical and cost-effectiveness of the DT programme in older people at risk of falling.

The long-term impact will be the provision of an evidence-based programme via falls prevention services throughout the country that supports older people to reduce falls risk.

We will disseminate project findings through diverse routes including academic conferences and peer-reviewed publications, patients and public involvement and engagement events, clinical-focused meetings and workshop, and social media to reach wider audiences.