Implementation of an eHealth fall prevention program into community aged care

StandingTall is a technology-driven exercise program for older people that has proven effective in preventing falls and improving balance (Delbaere et al 2021 BMJ). The program is provided via a tablet or desktop computer and can be used independently at home. StandingTall incorporates (i) evidence-based, individually tailored and progressive balance exercise and cognitive-motor training to improve balance ability and reduce fall risk in older people and (ii) behavioural change techniques to enhance exercise uptake and long-term adherence. The exercises comprise standing balance, transferring (e.g. sit-stand transitions), walking (e.g. walking in circles or to targets in a grid), stepping (e.g. step and lift) and obstacle negotiation (e.g. stepping up and over a box) exercises. Concomitant cognitive tasks, relying primarily on executive function (i.e. inhibition, working memory, task-shifting), are added to the balance exercises to train the brain using auditory and visual cues. The program starts with a detailed inbuilt assessment to identify the optimal set of exercises from the StandingTall exercise library of over 6000 exercise variations for each user. Exercises are performed by following an onscreen avatar. Exercise intensity is monitored using a self-reported rating of perceived exertion and progresses as performance changes over time. The program incorporates a paced approach and goal setting to increase exercise dose and is suitable for long-term independent use at home for 2 hours or more per week. Together with aged care providers, we have co-designed and continue to refine a delivery model, which relies on training resident experts and healthcare professional referrals, for providing StandingTall to older people receiving community aged care, where healthcare professionals will provide clients with access to the program and support continued usage. This study will evaluate the implementation of this delivery model over six months. Healthcare professionals will be offered online or in-person training (1 hr for referring healthcare professionals and 4 hrs for resident experts) and ongoing support as required to provide StandingTall to their clients. Outcomes will focus on the adoption of the program by healthcare professionals. Secondary outcome measures include reach, effectiveness, adoption (uptake), implementation, and maintenance.