Impact case study database

FaME+, designed to reduce falls and improve the health and physical activity of older people, is delivered by PSIs in community settings in the UK. Independently published service evaluations have demonstrated life changing impacts on physical health, physical activity and confidence in those older people accessing FaME+. This has been achieved through a pathway of impact on falls guidelines and policy, the provision of education and implementation materials and demonstrable return on investment for commissioners of these services.

Life-changing health impacts to older people taking part in FaME+ sessions

FAME+ has a significant reach in the UK. An independent ROSPA impact report showed wide implementation and reach in three areas (Devon, Greater Manchester and Leicestershire, Rutland and Derby) [S1]. A survey of PSIs (n=656, 18% of qualified PSIs) suggested that FaME+ reached 10,729 older adults in an average week and over a one-year period (Jan 2019-Jan 2020) 68,796 people [S2], as sessions run in 12-24 week blocks. Extrapolating to 50% of all trained PSIs and with programmes throughout the year, over 2 million older people a year would be receiving FaME+ [S2]. The MIRA platform has extended the reach of FaME+ with more than 4904 patients using it since its release [S3], and since 2018 there are over 10 licences specifically for falls prevention in older people used in rehab facilities, care homes and sheltered housing facilities.

Significantly, there have been multiple service evaluations of ‘effectiveness’ by independent community and health organisations demonstrating the physical, mental and social health impacts to FaME+ participants. These include reductions in falls of 43-58% [S4;S6], improvements in balance confidence of 55-100% [S2,S5-S7] and quality of life (42%) [S6], >10% reduced fear of falling [S4;S2;S5], improvement in timed up and go (20-50%) [S4-S6;S10], balance [S2;S5;S10], and functional skills such as getting off the floor [S5], increased self-reported physical activity [S2;S5;S7], improved mental wellbeing [S4;S6], and increased social interaction and participation [S2;S4-S6] leading to a reduction in social isolation.

Impact on Falls Guidelines and Policy to increase adoption and improve implementation

Due to the efficacy and cost-effectiveness of FaME+ [R1], it is one of only two structured exercise programmes supported by PHE Cost-effective Commissioning (2018) for falls prevention. Local providers implement FaME+ as evaluations show a greater return on investment than PHE suggested (£2.28 for every £1) (PHE 2018). Dance to Health reported a return on investment of £2.89 for every £1 invested [S4] whereas, Staying Steady (Gateshead) reported that for every £1 spent on FaME+ returned £50.59 [S7] to the public purse and Steady Steps (Edinburgh Leisure) estimated that every £1 used on FaME+ saved £18 [S6].

In 2019, FaME+’s efficacy led to adoption by the CMO Physical Activity Recommendations for Health, Public Health Wales and the National Prudent Healthcare Falls Prevention Taskforce, The Royal Osteoporosis Society in ‘Strong, Steady, Straight’, the Chartered Society of Physiotherapy ‘Physiotherapy Works – Falls: A Community Approach and Prevention and Management of Falls in the Community: A Framework for Action for Scotland (2014/2016). The Centre for Ageing Better report ‘Raising the bar on strength and balance’ (2019) recommended FaME+ as the best public health programme for prevention of falls and maintenance of physical function.

Impact on Education to increase adoption and improve implementation

Skelton is a Founding Director of Later Life Training Ltd (LLT), a not for profit national training provider. Since Aug 2014, LLT has trained 1200 PSIs [S2]) to use FAME+ [R1;R2;S8]. The syllabus, informed by Skelton’s research, was updated in 2017 to reflect the verbal and adapted delivery skills required to work with visually impaired older adults [R3;S8]; allowing inclusion of people with sight loss into FaME+ classes. In 2016-2018, LLT trained 30 Dance Choreographers in the UK in principles and delivery of FaME+ to support the Dance to Health initiative, reaching a wider audience in public health [R1;S4].

Skelton adapted the FaME+ Implementation Toolkit quality assurance (QA) checklist for PSI self-reflection and assessment to improve quality and fidelity to the delivery of FaME+ [R5;S9] and in 2019 LLT provided this to all qualified PSIs [S8]. The FaME+ Implementation Toolkit for Commissioners, endorsed by NICE in October 2019 [R5;S9], has been downloaded >800 times and 94% found it useful and rated it 4/5 for building the case for investment, planning for implementation and monitoring and evaluation [S10].

Beyond LLT, Skelton, with MIRA Health, delivered a webinar on Exergames based on FaME+ to >200 people and the recording attracted over 350 views [R4;S3]. In 2015, she was invited to initiate a strategic rollout of FaME+ [R1] by the Norwegian University of Science and Technology, establishing core trainers for the Norwegian National Falls Prevention Programme, Sterk og stødig, (462 instructors trained in 59 Norwegian municipalities), reaching 4000 older people [S11]. They now have 75 municipalities (out of 422 across Norway) (Oct 2020) signed up for continued strategic roll-out.