Effectiveness and cost-effectiveness of the Keep-on-Keep-up (KOKU) digital falls prevention programme in community-dwelling older adults: Results of a randomised controlled trial.

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 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% CI: 4.48, 8.22). KOKU was associated with lower mean falls related costs (incremental cost (GBP): -62.98, 95% CI -218.54 to 40.22) and a QALY 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.