Among 202 community-dwelling adults aged 60+ (mean 76.8 years, 73% female), the NHS-approved Keep-on-Keep-Up (KOKU) digital falls-prevention programme produced a clinically meaningful 6.35-point improvement in Berg Balance Scale scores at 12 weeks (95% CI: 4.48–8.22) compared to standard care alone. KOKU users also gained 0.020 QALYs and incurred £62.98 lower falls-related costs on average, though that cost estimate's confidence interval crossed zero, tempering certainty on cost savings.
Falls are the leading cause of injury-related hospitalisation in older adults globally, costing health systems billions annually, yet uptake of traditional supervised exercise programmes remains stubbornly low. A scalable, home-based digital alternative that demonstrably moves the Berg Balance Scale — a validated clinical tool where differences of 3–4 points are considered meaningful — represents a genuinely encouraging signal. The 0.020 QALY gain is modest but non-trivial in health-economic terms if replicable at population scale.
Several caveats deserve weight. The trial enrolled just 202 participants across 12 weeks — too short and too small to confirm sustained fall-rate reductions, the clinically decisive outcome. The sample skews female and may not generalise to frailer or cognitively impaired populations. Adherence data and long-term durability remain unreported here. Crucially, this is a preprint posted on medRxiv and has not yet undergone peer review — findings and conclusions may change materially. That said, as a randomised controlled trial with strong retention (89%), this is confirmatory, not merely exploratory, and merits attention from clinicians designing scalable falls-prevention pathways.
