RFA-CE-22-006, Process and Outcome Evaluation of the Walk with Ease program for Fall Prevention

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Summary The proposed project will evaluate the effectiveness of incorporating physical therapy exercises (primary prevention strategy) within an established physical activity intervention called Walk with Ease (WWE) to reduce incidence and risk of falls in community-dwelling older adults. The proposed study will be done in direct collaboration with an integrated hospital (Mary Greeley Medical Center - MGMC) and clinical network (McFarland Clinic). The commitment to collaboration and data sharing are documented in formal letters of support and this partnership will directly enable and facilitate the proposed research. The physical therapists will be specifically involved to facilitate broad community-based screens to recruit individuals at high risk for falls and to conduct robust evaluations of fall risk for all enrolled participants. A randomized controlled design we will used to systematically test the standard WWE implementation model that provides generic exercise recommendations against an enhanced version that will provide individually-prescribed, physical therapy exercises. The factorial design will enable us to also evaluate the relative effectiveness of the standard WWE behavior change modules against an enhanced set of modules based on theory-based, habit formation approaches. The primary hypothesis is that the participants receiving the Enhanced WWE program (i.e. individually prescribed exercises) will have lower incidence of falls and larger reductions in fall risk than those in the Standard condition (i.e. generic exercises). The secondary hypothesis is that participants receiving Enhanced behavior change modules (based on habit formation) will have greater compliance to the prescribed exercise, higher levels of physical activity, and better fall risk reduction outcomes than those in the Standard modules. Consistent with guidelines in the RFA we will conduct a robust process evaluation (Aim 1) and outcome evaluation (Aim 2) to provide a comprehensive perspective of the potential utility of WWE as a fall prevention program. The process data will be used in both summative and formative ways to enhance the evaluation. The formative evaluation of the process data will enable our team to monitor and adjust program implementation to ensure alignment with the standardized guidelines for WWE implementation. The refined procedures could then be incorporated into training materials to build capacity in other community-based organizations to implement the enhanced WWE for falls prevention. The summative evaluation of the process data will also be used to help explain differences in program outcomes across individuals, groups or over time. Thus, the process data will be directly incorporated into the