Introduction of a 'Strong and Steady' class for patients with recurrent falls

INTRODUCTION

Falls represent a significant problem faced by older people, with around a third of people aged 65 and over, and half of those over 80 falling at least once a year. Falls can lead to serious injury, loss of independence, and significant emotional distress. The financial cost to the NHS is estimated as £2.3 billion annually, making fall prevention a crucial public health issue. National guidance (NICE, 2025) recommends Interventions such as fall’s prevention programmes should be offered targeting balance, co-ordination, strength and power. 

The planned community therapy team historically provided a ‘falls class’ to meet these recommendations, although as with many outpatient services these were stopped as a result of the COVID pandemic. The restoration of services post pandemic provided an opportunity to bring the class up to date with the latest evidence and assess the effectiveness of the intervention.

As a collective within the planned therapy team a quality improvement project was created to improve the content of the previous class to improve patients and staff experience. 

METHOD

The Planned Therapy team split into groups to look at current evidence around the best format for delivery of falls interventions and recommended outcome measures to evaluate effectiveness. Local benchmarking was also completed with other services across the west midlands. 

From this we were able to identify all initial assessments should be completed in the patient’s home environment. This would reduce DNA’s and duplication of appointments, whilst also allowing therapists to identify those patients suitable for class attendance and those who would likely benefit from a more individualised intervention at home.

A six week ‘Strong and Steady class’ was created.  The class provided a mixture of strength and balance exercises using the Otago programme as a point of reference (Fthenos, G, 2020) . Education sessions were shown at the end of each class. 

Data was collected for all patients who attended the classes between September 2023 to September 2025. Outcomes were assessed at initial assessment and immediately following completion of the class. Outcomes selected to include measures of balance, gait and confidence were Berg Balance Scale Timed up and Go and the short functional efficacy scale. 

RESULTS

Data was available for 96 patients (65 Female, 31 Male) who completed the strong and steady class over the evaluation period. Significant improvements were seen in both berg balance (45,5 vs 37, p<0.00001) and Timed up and Go scores (16.7 vs 22.9, p<0.05). A reduction was also seen for clinical frailty scores, although this did not reach statistical significance. Patient feedback was extremely positive, with patients reporting they felt really improvements from the exercise and one describing the class as ‘life changing’. 

Table 1 - Results

Pre

Post

P

Berg Balance

37.6

45.4

<0.00001

Clinical Frailty Score

4

3

0.54

Falls Efficiency score (FESI)

16

12.5

<0.05

Timed up and Go

20.7

16.4

<0.01

CONCLUSION

The introduction of the strong and steady class was associated with significant improvements in gait and balance for patients at risk of falling. Future work is now looking to develop links across the wider community and further improve patient access to the service. 

REFERENCES

Falls: Assessment and Prevention of Falls in Older People. London: National Institute for Health and Care Excellence (NICE); 2025, April.

Fthenos, G. The Otago Exercise Program: A Home-Based, Individually Tailored Strength and Balance Retraining Program. In: Volpe, R. (eds) Casebook of Traumatic Injury Prevention. Springer, Cham. 2017.