Effectiveness and cost-effectiveness of the Keep-On-Keep-Up digital falls prevention programme in community-dwelling older adults: results of a randomised controlled trial
In brief
Digital falls-prevention program boosts older adults' balance scores by 6.35 points
In a 202-person randomized trial, older adults using Keep-On-Keep-Up had balance scores 6.35 points higher than those receiving standard care alone after 12 weeks. The program also showed a small quality-of-life gain, but estimated savings were uncertain, and the trial does not establish that it prevents falls.
- Journal
- Age and ageing (Q1)
- Published
- 4 September 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Chloe French, Amelia Parchment, Bolanle Odebiyi, Chunhu Shi, Saima Bashir, Dawn Dowding, et al.
- PMID
- 42784541
- DOI
- 10.1093/ageing/afag291
Why clinicians should know about it
- Picked for Family Practice (paper of the day, 25 September 2026): Digital falls prevention improves balance in older adults
Abstract
BACKGROUND: Falls are a leading cause of injury-related hospital admissions among older adults with substantial burden on health and social care systems. Digital exercise programmes may improve physical function at scale and complement traditional services. Keep-On-Keep-Up (KOKU) is an National Health Service (NHS)-approved digital programme offering progressive, evidence-based exercises and education on fall prevention.We aimed to evaluate the effectiveness and cost-effectiveness of KOKU for improving balance, physical function and reducing fall risk among community-dwelling older adults. METHODS: A two-arm, parallel group randomised controlled trial was conducted with community-dwelling older adults (≥60 years). Participants were randomised (1:1) to receive KOKU alongside standard care (strength and balance exercise advice and a falls prevention leaflet) or standard care alone. The primary outcome was balance function at 12 weeks (Berg Balance Score). Secondary outcomes included lower limb strength, concerns about falling, falls, mood, pain, fatigue, healthcare utilisation, health-related quality of life and usability. A modified intention-to-treat approach was used to analyse effectiveness and cost effectiveness. RESULTS: A total of 202 older adults (mean age 76.8 years, 72.8% female) were enrolled (102 intervention; 100 control). Retention at 12-weeks was 89.1% (91 intervention; 89 control). Compared with standard care, KOKU significantly improved balance function at 12 weeks after adjusting for baseline scores (mean difference: 6.35, 95% confidence interval [CI]: 4.48, 8.22). KOKU was associated with lower mean falls related costs (incremental cost: -£62.98, 95% CI -£218.54 to £40.22) and a quality-adjusted life year gain of 0.020 (95% CI 0.003 to 0.035). CONCLUSION: The KOKU programme improves balance with preliminary evidence of cost-effectiveness among community-dwelling older adults. These findings support the integration of digital innovation into routine care to improve balance and strength, thereby reducing functional decline while delivering value for money.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.