{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T18:10:41Z","timestamp":1784139041676,"version":"3.55.0"},"reference-count":29,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T00:00:00Z","timestamp":1784073600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100014434","name":"Narodowa Agencja Wymiany Akademickiej","doi-asserted-by":"publisher","award":["BPN\/BEK\/2023\/1\/00354\/U\/00001"],"award-info":[{"award-number":["BPN\/BEK\/2023\/1\/00354\/U\/00001"]}],"id":[{"id":"10.13039\/501100014434","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Falls are a major health concern among older adults, leading to injury, reduced independence, and increased healthcare cost. Reactive balance training can reduce fall risk, but barriers such as fear, joint discomfort, and harness burden limit its use \u2013 barriers that training in aquatic environment \u00a0may help overcome.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To design an aquatic reactive balance training (AquaReBal) program for older adults, integrating end-user perspectives to enhance safety, accessibility, and engagement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using a participatory design approach grounded in Participatory Action Research principles, we engaged three older adult partners, physiotherapists, and researchers in iterative phases including literature review, stakeholder consultations, practical pool sessions, and feedback meetings. Data collected through online meetings, surveys, field notes, and observations were reviewed using an inductive qualitative content analysis approach to inform iterative refinement of the intervention, following the Guidance for Reporting Involvement of Patients and the Public 2 framework.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Three older adult partners and a multidisciplinary team co-designed the AquaReBal protocol through two participatory design sessions, one practical pool session, and two internal team sessions. Key recommendations from partners included using a vest instead of a hip belt for perturbations, addressing pool depth visibility, and creating an introductory package with practical information for participants. Partners emphasized safety, instructor support, and social engagement as critical for adherence and satisfaction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec005\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The co-design process enabled the development of an AquaReBal protocol tailored to older adults\u2019 needs and preferences, providing initial insights relevant to future feasibility and implementation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0345435","type":"journal-article","created":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T17:28:56Z","timestamp":1784136536000},"page":"e0345435","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Using a co-design approach to develop aquatic reactive balance training for fall prevention"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3318-6513","authenticated-orcid":true,"given":"Anna","family":"Ogonowska-Slodownik","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia O.","family":"Faria","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shanuga","family":"Thavarajah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karina","family":"Pacholczyk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Birgit","family":"Blain","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Myra","family":"Wiener","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane","family":"Walker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0396-5815","authenticated-orcid":true,"given":"Avril","family":"Mansfield","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3977-0523","authenticated-orcid":true,"given":"Soo","family":"Chan Carusone","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,7,15]]},"reference":[{"issue":"1","key":"pone.0345435.ref001","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1007\/s43465-019-00037-x","article-title":"Falls in older adults are serious","volume":"54","author":"R Vaishya","year":"2020","journal-title":"Indian J Orthop"},{"issue":"1","key":"pone.0345435.ref002","doi-asserted-by":"crossref","DOI":"10.1093\/ptj\/pzac154","article-title":"The effect of reactive balance training on falls in daily life: an updated systematic review and meta-analysis","volume":"103","author":"AJ Devasahayam","year":"2022","journal-title":"Phys Ther"},{"issue":"2","key":"pone.0345435.ref003","article-title":"Acceptability of a perturbation-based balance training programme for falls prevention in older adults: a qualitative study","volume":"12","author":"MHG Gerards","year":"2022","journal-title":"BMJ Open"},{"issue":"1","key":"pone.0345435.ref004","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1186\/s11556-024-00349-4","article-title":"Comparing the effects of aquatic-based exercise and land-based exercise on balance in older adults: a systematic review and meta-analysis","volume":"21","author":"Y Deng","year":"2024","journal-title":"Eur Rev Aging Phys Act"},{"issue":"3","key":"pone.0345435.ref005","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0171972","article-title":"Does aquatic exercise reduce hip and knee joint loading? 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older adults: initial validation using rasch analysis","volume":"99","author":"MK Farlie","year":"2019","journal-title":"Phys Ther"},{"issue":"1","key":"pone.0345435.ref022","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1186\/s12961-020-0528-9","article-title":"Research co-design in health: a rapid overview of reviews","volume":"18","author":"P Slattery","year":"2020","journal-title":"Health Res Policy Syst"},{"issue":"1","key":"pone.0345435.ref023","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1016\/j.archger.2012.08.003","article-title":"A water-based training program that includes perturbation exercises improves speed of voluntary stepping in older adults: a randomized controlled cross-over trial","volume":"56","author":"O Elbar","year":"2013","journal-title":"Arch Gerontol Geriatr"},{"issue":"2","key":"pone.0345435.ref024","doi-asserted-by":"crossref","first-page":"156","DOI":"10.2174\/0118746098254991231125143735","article-title":"Perturbation-based balance 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