Smulders 2010.

Methods	Study design: RCT Number of study arms: 2 Length of follow‐up: 12 months
Participants	Setting: Nijmegan, Netherlands Number of participants: 96 Number analysed: 92 Number lost to follow‐up: 4 Sample: identified from databases of DXA scans, mail out to members of Dutch Osteoporosis Patient Council; advertising Age (years): mean 71.0 (SD 4.7) Sex: 94% female Inclusion criteria: community‐dwelling; aged > 65; osteoporosis (DXA; femoral neck or lower‐back T score ≤ −2.5); ≥ 1 falls in previous year; able to walk 15 minutes without walking device Exclusion criteria: severe cardiac, pulmonary, or musculoskeletal disorders or disorders associated with higher fall risk (e.g. neurologic disorders)
Interventions	1. Group‐based balance and gait training using an obstacle avoidance course: 11 sessions between 1 ‐ 2½ hours including education, balance, gait training using obstacle course, for 5½ weeks 2. Control: usual care
Outcomes	1. Rate of falls 2. Number of people who experienced 1 or more falls (risk of falling) 3. Number of people who experienced 1 or more fall‐related fractures 4. Health‐related quality of life
Duration of the study	52 weeks
Adherence	Adherence measured by session attendance 1. Group‐based balance and gait training using an obstacle avoidance course group: 93% attendance at total number of sessions. More than half (53%) of the participants did not miss a session
Notes	Source of funding: Center for Organization of Healthcare Research Economic information: not reported
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Quote: "After a baseline assessment M1, the researcher performed block randomization using non–see‐through envelopes. The probability of allocation to the exercise group was independent of recruitment method"
Allocation concealment (selection bias)	Unclear risk	Non‐see‐through envelopes but not sequentially numbered
Blinding of participants and personnel (performance bias) All outcomes	Unclear risk	Participants and personnel not blinded to allocated group but impact of non‐blinding unclear
Blinding of outcome assessment (detection bias) Falls	Low risk	Quote: "Fall calendars were scored by an independent researcher who was blinded to group allocation"
Blinding of outcome assessment (detection bias) Fractures	Unclear risk	Method of reporting fractures is unclear
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)	High risk	Participants not blind to group allocation
Incomplete outcome data (attrition bias) Falls and fallers	Low risk	Less than 20% of fall data were missing (4%) with missing data balanced between groups and balanced reasons for missing data
Selective reporting (reporting bias)	Unclear risk	Minimum set of expected outcomes not reported (adverse events not reported)
Method of ascertaining falls (recall bias)	Low risk	Quote: "After the intervention had ended, participants registered their falls for 1 year on fall calendars that had to be returned every month… When no fall calendar was received within 2 weeks after the start of the month, the participant was reminded by telephone"