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. 2019 Jan 31;2019(1):CD012424. doi: 10.1002/14651858.CD012424.pub2

Halvarsson 2016.

Methods Study design: RCT
 Number of study arms: 3
 Length of follow‐up: 3 months
Participants Setting: Stockholm, Sweden
Number of participants: 96
 Number analysed: 69
 Number lost to follow‐up: 27
Sample: community‐dwelling
Age (years): Intervention mean 76 (range 67 ‐ 86), Control mean 75 (range 66 ‐ 84)
Sex: 98% female
Inclusion criteria: age ≥ 65 years afraid of falling or having experienced at least one fall in the last 12 month s, or both, and independence in ambulation
Exclusion criteria: fractures during the last year, MMSE score < 24, severely decreased vision, or other diseases or constraints that might interfere with participation in the exercise programme
Interventions 1. Group‐based progressive balance training: supervised and tailored exercises, 45 minute sessions, 3 a week for 12 weeks
2. Group‐based progressive balance training plus walking: supervised and tailored exercises, 45‐minute sessions, 3 a week for 12 weeks, plus walking (preferably with poles) for ≥ 30 minutes, 3 a week for 12 weeks
3. Control group: no intervention, offered the same balance training at the end of the study
Outcomes 1. Number of people who experienced 1 or more falls (risk of falling)
Duration of the study 60 weeks
Adherence Adherence measured in sessions attended
Participants attending ≥ 66% sessions included in follow‐up. Adherence rate to the training sessions was 89% (range 66 ‐ 100%)
2. Group‐based progressive balance training plus walking: all except 1 participant fulfilled the added physical activity intervention
Notes Source of funding: Stockholm County Council, Karolinska Institutet (ALF), Swedish Research Council, Health Care Sciences Postgraduate School at Karolinska Institutet
 Economic information: not reported
3‐month data used due to proportion of fallers not being clear for longer follow‐up period
Risk of bias
Bias Authors' judgement Support for judgement
Random sequence generation (selection bias) Low risk Quote: "Subjects were randomised...using web‐based software"
Allocation concealment (selection bias) Unclear risk Allocation concealment not reported
Blinding of participants and personnel (performance bias) 
 All outcomes High risk Participants not blind to allocated group. Research personnel were not blind to group, yet delivered the intervention to both groups and assessed fall outcome, which increases the risk of bias
Blinding of outcome assessment (detection bias) 
 Falls High risk Quote: "The test leaders were blinded to group allocation at baseline; however, it was no longer possible after baseline testing, because some of the test leaders were also involved in the balance training"
Blinding of outcome assessment (detection bias) 
 Fractures Unclear risk Not applicable
Blinding of outcome assessment (detection bias) 
 Hospital admission, medical attention and adverse events Unclear risk Not applicable
Blinding of outcome assessment (detection bias) 
 Health related quality of life (self report) Unclear risk Not applicable
Incomplete outcome data (attrition bias) 
 Falls and fallers Unclear risk Less than 20% of fall outcome data are missing (3%). Loss of fall data was unbalanced in balance (n = 9) balance + walking (n = 13) and control (n = 5) groups; reason for loss of fall data was unbalanced
Selective reporting (reporting bias) High risk Falls measured but number of falls not reported.
Method of ascertaining falls (recall bias) High risk Quote: "Participants reported .. at each follow‐up whether they had fallen during the time since the previous follow‐up session". Follow‐up was at 3, 9 and 15 months