{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T08:18:02Z","timestamp":1765613882827,"version":"3.48.0"},"reference-count":46,"publisher":"BMJ","issue":"6","license":[{"start":{"date-parts":[[2023,6,1]],"date-time":"2023-06-01T00:00:00Z","timestamp":1685577600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001349","name":"National Medical Research Council","doi-asserted-by":"publisher","award":["MOH\/NIC\/F1\/2017"],"award-info":[{"award-number":["MOH\/NIC\/F1\/2017"]}],"id":[{"id":"10.13039\/501100001349","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2023,5,19]]},"published-print":{"date-parts":[[2023,6]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Falls are an important public health issue with consequences that include injuries, quality of life reduction and high healthcare costs. Studies show that falls prevention strategies are effective in reducing falls rate among community-dwelling older adults. However, the evaluation for effectiveness was usually done in a controlled setting with homogeneous population, and thus may not be generalisable to a wider population. This study aims to evaluate the impact of community falls prevention programmes with group-based strength and balance exercises, on falls risk and health outcomes for older adults with falls risk in Singapore.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>This is a pragmatic closed cohort stepped-wedge cluster randomised trial design study, which involves sequential crossover of clusters from the waitlist control condition to the intervention condition, with the sequence of crossover randomly determined. The intervention will be sequentially rolled out to 12 clusters (a minimum of 5 participants\/cluster), over 6 time periods with 8-week intervals in Central and North regions of Singapore. The primary analysis will be conducted under the intention-to-treat principle. A general linear mixed model or generalised estimating equation analysis appropriate for a multilevel longitudinal study incorporating an appropriate error distribution and link function will be used. Markov model will be developed to estimate the incremental cost per quality-adjusted life years and incremental cost per fall prevented from the implementation of falls prevention strategies from a societal perspective. Conditional on there being clinically relevant differences in short-term outcomes, we will implement simulation modelling to project the long-term divergence in trajectories for outcomes and costs using the Markov model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>Ethics approval has been obtained. Results will be disseminated in publications and other relevant platforms.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT04788251\">NCT04788251<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2023-072029","type":"journal-article","created":{"date-parts":[[2023,6,1]],"date-time":"2023-06-01T10:38:10Z","timestamp":1685615890000},"page":"e072029","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Pragmatic multicentre stepped-wedge cluster randomised trial to investigate the effectiveness of community-based falls prevention programme for older adults with falls risk in Singapore: a protocol paper"],"prefix":"10.1136","volume":"13","clinical-trial-number":[{"clinical-trial-number":"nct04788251","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"Pey June","family":"Tan","sequence":"first","affiliation":[{"name":"Geriatric Education and Research Institute, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0319-8097","authenticated-orcid":false,"given":"Mimaika Luluina","family":"Ginting","sequence":"additional","affiliation":[{"name":"Geriatric Education and Research Institute, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zoe Zon Be","family":"Lim","sequence":"additional","affiliation":[{"name":"Geriatric Education and Research Institute, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nivedha","family":"Balachandar","sequence":"additional","affiliation":[{"name":"Geriatric Education and Research Institute, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rehena","family":"Sultana","sequence":"additional","affiliation":[{"name":"Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mumtaz Mohamed","family":"Kadir","sequence":"additional","affiliation":[{"name":"Geriatric Education and Research Institute, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tianma","family":"Xu","sequence":"additional","affiliation":[{"name":"Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Noor Hafizah","family":"Ismail","sequence":"additional","affiliation":[{"name":"Department of Continuing and Community Care, Tan Tock Seng Hospital, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joyce Kwee Yong","family":"Yap","sequence":"additional","affiliation":[{"name":"Department of Continuing and Community Care, Tan Tock Seng Hospital, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sweet Fun","family":"Wong","sequence":"additional","affiliation":[{"name":"Population Health & Community Transformation, Khoo Teck Puat Hospital, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joanne","family":"Yoong","sequence":"additional","affiliation":[{"name":"Center for Economic and Social Research, University of Southern California, Los Angeles, California, USA"},{"name":"Research for Impact, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3020-2108","authenticated-orcid":false,"given":"David Bruce","family":"Matchar","sequence":"additional","affiliation":[{"name":"Health Services and Systems Research, Duke-NUS Medical School, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Keith","family":"Hill","sequence":"additional","affiliation":[{"name":"Rehabilitation Aging and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Melbourne, Victoria, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3048-0477","authenticated-orcid":false,"given":"Chek Hooi","family":"Wong","sequence":"additional","affiliation":[{"name":"Geriatric Education and Research Institute, Singapore"},{"name":"Health Services and Systems Research, Duke-NUS Medical School, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2023,6,1]]},"reference":[{"key":"2025121300154531000_13.6.e072029.1","doi-asserted-by":"crossref","unstructured":"Hill KD , Suttanon P , Lin S-I , et al . What works in falls prevention in Asia: a systematic review and meta-analysis of randomized controlled trials BMC Geriatrics. BMC Geriatr 2018;18. doi:10.1186\/s12877-017-0683-1","DOI":"10.1186\/s12877-017-0683-1"},{"key":"2025121300154531000_13.6.e072029.2","unstructured":"World Health Organization . WHO global report on falls prevention in older age. France, 2007."},{"key":"2025121300154531000_13.6.e072029.3","doi-asserted-by":"crossref","DOI":"10.1093\/geroni\/igz038.1762","article-title":"Cognitive appraisal and knowledge as risk factors for high fear of falling in older and middle-aged adults in Singapore innovation in aging","volume":"3","author":"Tan","year":"2019","journal-title":"Innovation in Aging"},{"key":"2025121300154531000_13.6.e072029.4","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0137127","article-title":"The low fall as a Surrogate marker of frailty predicts long-term mortality in older trauma patients","volume":"10","author":"Wong","year":"2015","journal-title":"PLoS ONE"},{"key":"2025121300154531000_13.6.e072029.5","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.2010.03234.x"},{"key":"2025121300154531000_13.6.e072029.6","article-title":"Exercise for preventing falls in older people living in the community","volume":"1","author":"Sherrington","year":"2019","journal-title":"Cochrane Database Syst Rev"},{"key":"2025121300154531000_13.6.e072029.7","article-title":"Multifactorial and multiple component interventions for preventing falls in older people living in the Community (review)","volume":"7","author":"Hopewell","year":"2018","journal-title":"Cochrane Database Syst Rev"},{"key":"2025121300154531000_13.6.e072029.8","first-page":"149","article-title":"Exercise interventions and prevention of fall-related fractures in older people: a meta-analysis of randomized controlled trials","volume":"46","author":"Zhao","year":"2017","journal-title":"Int J Epidemiol"},{"key":"2025121300154531000_13.6.e072029.9","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.f6234","article-title":"The effect of fall prevention exercise programmes on fall induced injuries in community dwelling older adults British Journal of sports medicine","volume":"49","author":"El-Khoury","year":"2015","journal-title":"Br J Sports Med"},{"key":"2025121300154531000_13.6.e072029.10","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.13925"},{"key":"2025121300154531000_13.6.e072029.11","unstructured":"Stevens JA , Burns E . A CDC compendium of effective fall interventions: what works for community-dwelling older adults. Atlanta, Georgia Centers for Disease Control and Prevention; 2015."},{"key":"2025121300154531000_13.6.e072029.12","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.n2061","article-title":"A new framework for developing and evaluating complex interventions: update of medical research council guidance","volume":"374","author":"Skivington","year":"2021","journal-title":"BMJ"},{"key":"2025121300154531000_13.6.e072029.13","doi-asserted-by":"crossref","first-page":"1044","DOI":"10.1080\/09638288.2017.1419293","article-title":"Developing a falls prevention program for community-dwelling stroke survivors in Singapore: client and caregiver perspective disability and rehabilitation","volume":"41","author":"Xu","year":"2019","journal-title":"Disabil Rehabil"},{"key":"2025121300154531000_13.6.e072029.14","doi-asserted-by":"publisher","DOI":"10.1046\/j.1532-5415.2002.50218.x"},{"key":"2025121300154531000_13.6.e072029.15","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.2004.52411.x"},{"key":"2025121300154531000_13.6.e072029.16","doi-asserted-by":"crossref","DOI":"10.1186\/s13063-015-0839-2","article-title":"Stepped wedge randomised controlled trials: systematic review of studies published between 2010 and 2014","volume":"16","author":"Beard","year":"2015","journal-title":"Trials"},{"key":"2025121300154531000_13.6.e072029.17","doi-asserted-by":"crossref","DOI":"10.1186\/s13063-015-0842-7","article-title":"Designing a stepped wedge trial: three main designs, carry-over effects and randomisation approaches","volume":"16","author":"Copas","year":"2015","journal-title":"Trials"},{"key":"2025121300154531000_13.6.e072029.18","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.h391","article-title":"The stteped wedge cluster randomised trial: rationale, design, analysis","volume":"350","author":"Hemming","year":"2015","journal-title":"BMJ"},{"key":"2025121300154531000_13.6.e072029.19","first-page":"220","article-title":"The CDC\u2019s STEADI initiative: promoting older adult health and independence through fall prevention","volume":"96","author":"Lee","year":"2017","journal-title":"Am Fam Physician"},{"key":"2025121300154531000_13.6.e072029.20","unstructured":"Health Promotion Board . Falls prevention among older adults living in the community. Singapore, 2015."},{"key":"2025121300154531000_13.6.e072029.21","unstructured":"Clemson L , Swann M . Stepping on: building confidence and reducing falls, a community-based program for older people. Sydney: University Press Sydney, 2008."},{"key":"2025121300154531000_13.6.e072029.22","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.g1687","article-title":"Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide BMJ","volume":"348","author":"Hoffmann","year":"2014","journal-title":"BMJ"},{"key":"2025121300154531000_13.6.e072029.23","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.1991.tb01616.x"},{"key":"2025121300154531000_13.6.e072029.24","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.2011.03336.x"},{"key":"2025121300154531000_13.6.e072029.25","first-page":"466","article-title":"Predicting the probability of falls in community-residing older adults using the 8-foot up-and-go: a new measure of functional mobility","volume":"10","author":"Rose","year":"2002","journal-title":"J Aging Phys Act"},{"key":"2025121300154531000_13.6.e072029.26","doi-asserted-by":"publisher","DOI":"10.1093\/geronj\/49.2.M85"},{"key":"2025121300154531000_13.6.e072029.27","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1089\/rej.2013.1491","article-title":"Association between short physical perforamance battery and falls in older people: the Progetto Veneto Anziani study rejuvenation research","volume":"17","author":"Veronese","year":"2014","journal-title":"Rejuvenation Res"},{"key":"2025121300154531000_13.6.e072029.28","doi-asserted-by":"publisher","DOI":"10.1093\/geronj\/48.Special_Issue.35"},{"key":"2025121300154531000_13.6.e072029.29","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/afh106"},{"key":"2025121300154531000_13.6.e072029.30","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.2005.53455.x"},{"key":"2025121300154531000_13.6.e072029.31","unstructured":"World Health Organization . Falls. 2021. Available: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/falls [Accessed 08 Sep 2022]."},{"key":"2025121300154531000_13.6.e072029.32","doi-asserted-by":"publisher","DOI":"10.1007\/s11136-011-9903-x"},{"key":"2025121300154531000_13.6.e072029.33","doi-asserted-by":"crossref","unstructured":"Clemson L , Cumming RG . The falls behavioural (FaB) scale for the older person. Sydney: The University of Sydney, 2003.","DOI":"10.1037\/t40503-000"},{"key":"2025121300154531000_13.6.e072029.34","doi-asserted-by":"publisher","DOI":"10.5014\/ajot.57.4.380"},{"key":"2025121300154531000_13.6.e072029.35","doi-asserted-by":"publisher","DOI":"10.1080\/09638280701355546"},{"key":"2025121300154531000_13.6.e072029.36","doi-asserted-by":"publisher","DOI":"10.1177\/0164027504268574"},{"key":"2025121300154531000_13.6.e072029.37","unstructured":"Personal Social Services Research Unit . What is the CSRI? 2022. Available: https:\/\/www.pssru.ac.uk\/csri\/what-is-the-csri\/ [Accessed 22 Aug 2022]."},{"key":"2025121300154531000_13.6.e072029.38","unstructured":"WPAI . General information. 2019. Available: http:\/\/www.reillyassociates.net\/WPAI_General.html [Accessed 08 Sep 2022]."},{"key":"2025121300154531000_13.6.e072029.39","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1097\/JGP.0b013e3181f61ec9","article-title":"Validation of a brief seven-item response bias-free geriatric depression scale","volume":"19","author":"Broekman","year":"2011","journal-title":"Am J Geriatr Psychiatry"},{"key":"2025121300154531000_13.6.e072029.40","doi-asserted-by":"publisher","DOI":"10.1016\/0091-7435(87)90022-3"},{"key":"2025121300154531000_13.6.e072029.41","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1186\/s12877-020-1498-z","article-title":"The modified functional Comorbidity index performed better than the Charlson index and original functional comorbidity index in predicting functional outcome in geriatric rehabilitation: a prospective observational study","volume":"20","author":"Kabboord","year":"2020","journal-title":"BMC Geriatr"},{"key":"2025121300154531000_13.6.e072029.42","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1002\/jcsm.12048","article-title":"SARC-F: a symptom score to predict persons with Sarcopenia at risk for poor functional outcomes","volume":"7","author":"Malmstrom","year":"2016","journal-title":"J Cachexia Sarcopenia Muscle"},{"key":"2025121300154531000_13.6.e072029.43","doi-asserted-by":"publisher","DOI":"10.1016\/0895-4356(93)90053-4"},{"key":"2025121300154531000_13.6.e072029.44","doi-asserted-by":"publisher","DOI":"10.1002\/da.10113"},{"key":"2025121300154531000_13.6.e072029.45","doi-asserted-by":"crossref","DOI":"10.1186\/s13063-015-0840-9","article-title":"Sample size calculation for a stepped wedge trial","volume":"16","author":"Baio","year":"2015","journal-title":"Trials"},{"key":"2025121300154531000_13.6.e072029.46","doi-asserted-by":"publisher","DOI":"10.1016\/j.cct.2006.05.007"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2023-072029","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T08:15:54Z","timestamp":1765613754000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2023-072029"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,6]]},"references-count":46,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2023,6,1]]},"published-print":{"date-parts":[[2023,6]]}},"alternative-id":["10.1136\/bmjopen-2023-072029"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2023-072029","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"type":"print","value":"2044-6055"},{"type":"electronic","value":"2044-6055"}],"subject":[],"published":{"date-parts":[[2023,6]]}}}