***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objective : To develop and assess the efficacy of a multimodal balance-enhancing exercise program ( BEEP ) design ed to be regularly self-administered by community-dwelling elderly . The program aims to promote sensory reweighting , facilitate motor control , improve gaze stabilization , and stimulate continuous improvement by being constantly challenging . Method : Forty participants aged 60 to 80 years performed 6 weeks of BEEP training , on average for 16 min four times weekly , in a r and omized one-arm crossover design . Results : One-leg st and ing time improved 32 % with eyes open ( EO ) , 206 % with eyes closed ( EC ) on solid surface , and 54 % EO on compliant surface ( p < .001 ) . Posturography confirmed balance improvements when perturbed on solid and compliant surfaces with EO and EC ( p ≤ .033 ) . Walking , step stool , and Timed Up and Go speeds increased ( p ≤ .001 ) , as did scores in Berg Balance and balance confidence scales ( p ≤ .018 ) . Discussion : Multimodal balance exercises offer an efficient , cost-effective way to improve balance control and confidence in elderly Background : Although the optimization of behavioral interventions offers the potential of both public health and research benefits , currently there is no widely agreed-upon principled procedure for accomplishing this . Purpose : This article suggests a multiphase optimization strategy ( MOST ) for achieving the dual goals of program optimization and program evaluation in the behavioral intervention field . Methods : MOST consists of the following three phases : ( a ) screening , in which r and omized experimentation closely guided by theory is used to assess an array of program and /or delivery components and select the components that merit further investigation ; ( b ) refining , in which interactions among the identified set of components and their interrelationships with covariates are investigated in detail , again via r and omized experiments , and optimal dosage levels and combinations of components are identified ; and ( c ) confirming , in which the result ing optimized intervention is evaluated by means of a st and ard r and omized intervention trial . To make the best use of available re sources , MOST relies on design and analysis tools that help maximize efficiency , such as fractional factorials . Results : A slightly modified version of an actual application of MOST to develop a  smoking cessation intervention  is used to develop and present the ideas . Conclusions : MOST has the potential to husb and program development re sources while increasing our underst and ing of the individual program and delivery components that make up interventions . Considerations , challenges , open questions , and other potential benefits are discussed Background : Falling and fear of falling are among the most common problems of the elderly , which can cause illness , isolation , dependency and reduced quality of life in elderly . Exercise is recommended to prevent falling injuries in the elderly . Aim : This study aim ed to examine the effect of Tai Chi exercise on the risk and fear of falling in older adults . Material s and Methods : In this r and omized clinical trial , a total of 60 male and female elderly were r and omly divided into two groups : Tai Chi exercise and control ( daily activities ) groups . Tai Chi exercise protocol in the intervention group consisted of 3 sessions per week for 10 weeks . The risk and fear of falling were assessed in subjects by using st and ardized question naires , including Berg ’s Balance Scale and Fall Efficacy Scale-International ( FES-I ) before initiating the protocol , at the end of 4th , 8th weeks and at the end of exercise period . Results : Two groups were matched in terms of age , gender , education , and body mass index . Baseline values of risk of falling and fear of falling were not significantly different between the two groups ( P>0.05 ) . The score of fear of falling at the end of 4th , 8th weeks and at the end of exercise period was significantly different between the two groups ( P<0.05 ) and it decreased in the intervention group , but the risk of falling reduced after 8 and 10 weeks in the intervention group ( P<0.001 ) . Conclusion : Performing Tai Chi exercises for at least four weeks could reduce fear of falling and reduce the risk of falls in older adults after 8 weeks Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Abstract Objective : To evaluate whether a programme of multifactorial home visits reduces falls and impairments in mobility in elderly people living in the community . Design : R and omised controlled trial with 18 months of follow up . Setting : Six general practice s in Hoensbroek , the Netherl and s. Participants : 316 people aged 70 and over living in the community , with moderate impairments in mobility or a history of recent falls . Intervention : Five home visits by a community nurse over a period of one year . Visits consisted of screening for medical , environmental , and behavioural factors causing falls and impairments in mobility , followed by specific advice , referrals , and other actions aim ed at dealing with the observed hazards . Main outcome measures : Falls and impairments in mobility . Results : No differences were found in falls and mobility outcomes between the intervention and usual care groups . Conclusion : Multifactorial home visits had no effects on falls and impairments in mobility in elderly people at risk who were living in the community . Because falls and impairments in mobility remain a serious problem among elderly people , alternative strategies should be developed and evaluated OBJECTIVE We attempted to determine whether multimedia fall prevention education using different instructional strategies increases older adults '  knowledge of fall threats and their fall prevention behaviors . METHOD Fifty-three community-dwelling older adults were r and omized to iwo educational groups or a control group . Multimedia-based educational interventions to increase fall threats knowledge and encourage fall prevention behaviors had two tailoring strategies : ( 1 ) improve content realism for individual learners ( authenticity group ) and ( 2 ) highlight program goals and benefits while using participants ' content selection s ( motivation group ) . Knowledge was measured at baseline and 1-mo follow-up . Participants recorded prevention behaviors for 1 mo . RESULTS Intervention group participants showed greater knowledge gains and posttest knowledge than did control group participants . The motivation group engaged in more prevention behaviors over 1 mo than did the other groups . CONCLUSION Tailoring fall prevention education by addressing authenticity and motivation successfully improved fall threats knowledge . Combining motivational strategies with multimedia education increased the effectiveness of the intervention in encouraging fall prevention behaviors BACKGROUND Falls cause fear , anxiety and loss of confidence , result ing in activity avoidance , social isolation and increasing frailty . The umbrella term for these problems is ' fear of falling ' , seen in up to 85 % of older adults who fall . Evidence of effectiveness of physical and psychological interventions is limited , with no previous studies examining the role of an individually delivered cognitive-behavioural therapy ( CBT ) approach . OBJECTIVES Primary objective To develop and then determine the effectiveness of a new CBT intervention ( CBTi ) delivered by health-care assistants ( HCAs ) plus usual care compared with usual care alone in reducing fear of falling . Secondary objectives To measure the impact of the intervention on falls , injuries , functional abilities , anxiety/depression , quality of life , social participation and loneliness ; investigate the acceptability of the intervention for patients , family members and professionals and factors that promote or inhibit its implementation ; and measure the costs and benefits of the intervention . DESIGN Phase I CBTi development . Phase II Parallel-group patient r and omised controlled trial ( RCT ) of the new CBTi plus usual care compared with usual care alone . SETTING Multidisciplinary falls services . PARTICIPANTS Consecutive community-dwelling older adults , both sexes , aged ≥ 60 years , with excessive or undue fear of falling per Falls Efficacy Scale-International ( FES-I ) score of > 23 . INTERVENTIONS Phase I Development of the CBTi . The CBTi was developed following patient interviews and taught to HCAs to maximise the potential for uptake and generalisability to a UK NHS setting . Phase II RCT . The CBTi was delivered by HCAs weekly for 8 weeks , with a 6-month booster session plus usual care . MAIN OUTCOME MEASURES These were assessed at baseline , 8 weeks , 6 months and 12 months . Primary outcome measure Fear of falling measured by change in FES-I scores at 12 months . Secondary outcome measures These comprised falls , injuries , anxiety/depression [ Hospital Anxiety and Depression Scale ( HADS ) ] , quality of life , social participation , loneliness and measures of physical function . There were process and health-economic evaluations alongside the trial . RESULTS Four hundred and fifteen patients were recruited , with 210 patients r and omised to CBTi group and 205 to the control group . There were significant reductions in mean FES-I [ -4.02 ; 95 % confidence interval ( CI ) -5.95 to -2.1 ] , single-item numerical fear of falling scale ( -1.42 ; 95 % CI -1.87 to 1.07 ) and HADS ( -1 ; 95 % CI -1.6 to -0.3 ) scores at 12 months in the CBTi group compared with the usual care group . There were no differences in the other secondary outcome measures . Most patients found the CBTi  acceptable . Factors affecting the delivery of the CBTi as part of routine practice were identified . There was no evidence that the intervention was cost-effective . CONCLUSIONS Our new CBTi delivered by HCAs significantly improved fear of falling and depression scores in older adults who were attending falls services . There was no impact on other measures . FURTHER WORK Further work should focus on a joint CBTi and physical training approach to fear of falling , more rational targeting of CBTi , the possibility of mixed group and individual CBTi , and the cost-effectiveness of provision of CBTi by non-specialists . TRIAL REGISTRATION Current Controlled Trials IS RCT N78396615 . FUNDING This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment ; Vol . 20 , No. 56 . See the NIHR Journals Library website for further project information Objective To evaluate the effects of Tai chi exercise on balance , sleep quality , and cognitive performance in community-dwelling elderly in Vinh city , Vietnam . Design A r and omized controlled trial . Participants One hundred two subjects were recruited . Intervention Subjects were divided r and omly into two groups . The Tai chi group was assigned 6 months ’ Tai chi training . The control group was instructed to maintain their routine daily activities . Outcome measures The Falls Efficacy Scale ( FES ) , Pittsburgh Sleep Quality Index ( PSQI ) , and Trail Making Test ( TMT ) were used as primary outcome measures . Results Participants in the Tai chi group reported significant improvement in TMT ( part A ) ( F [ 1 , 71 ] = 78.37 , P < 0.001 ) and in TMT ( part B ) , ( F [ 1 , 71 ] = 175.00 , P < 0.001 ) in comparison with the control group . Tai chi participants also reported better scores in FES ( F [ 1 , 71 ] = 96.90 , P < 0.001 ) and in PSQI ( F [ 1,71 ] = 43.69 , P = 0.001 ) than the control group . Conclusion Tai chi is beneficial to improve balance , sleep quality , and cognitive performance of the elderly OBJECTIVES To determine the long-term effects of three strength and balance exercise interventions on physical performance , fall-related psychological outcomes , and falls in older people . DESIGN A single-blinded , four-group , r and omized controlled trial . SETTING Community , Germany . PARTICIPANTS Community-dwelling adults aged 70 to 90 who had fallen in the past 6 months or reported fear of falling . INTERVENTION After baseline assessment , 280 participants were r and omly assigned to the control group ( CG ; no intervention ; n = 80 ) or one of three strength and balance exercise interventions ( the strength and balance group ( SBG ; strength and balance only ; n = 63 ) , the fitness group ( FG ; strength and balance plus endurance training ; n = 64 ) , or the multifaceted group ( MG ; strength and balance plus fall risk education ; n = 73 ) . The interventions consisted of 32 one-hour group sessions in 16 weeks . MEASUREMENTS Data on physical performance , fall-related psychological outcomes , and falls were collected for 24 months . RESULTS Mixed-effects regression analyses showed improved short- and long-term ( 12 and 24 months , respectively ) physical performance for the SBG and FG , particularly regarding mobility , balance , and walking speed ( P < .05 ) . The improvements in physical performance outcomes were most prominent in the FG . Fall-related psychological outcomes , number of falls , and injurious falls were not significantly different from in the control group . CONCLUSION Training focusing on strength , balance , and endurance can enhance physical performance for up to 24 months in community-dwelling older adults . These findings did not translate to improved fall-related psychological outcomes or reduced incidence of falls . This demonstrates the need for a different approach ( e.g. , regarding intervention dose and components ) to gain intervention benefits in the multiple domains that contribute to independence and well-being in older adults BACKGROUND Falls and fall-related injuries are common in community-dwelling elderly people . Effective multifactorial fall prevention programs in the primary care setting may be a promising approach to reduce the incidence rate of falls . METHODS In a cluster r and omized trial in 33 general practice s 378 people living independently and at high risk of falling ( 65 to 94 years old ; 285 women ) were allocated to either a 16 
    Output:
    
Most intervention characteristics and intervention types were not associated with the intervention effect .