This longitudinal intervention study was undertaken in community dwelling people over the age of 70 years who had fallen in the previous year. We compared 2 groups: an intervention group who attended for WiiFit exercise sessions and a standard care group who attended the local falls group.
Inclusion and Exclusion Criteria
Age 70 years or older, living locally in the community (in sheltered accommodation or own home), fallen at least once in the preceding 12 months and have an abbreviated mental test (AMT)  of seven or over (maximum score 10).
Wheelchair bound individuals, people living in a care homes or long-term hospital care and current enrolment in an exercise or rehabilitation programme.
A press release was issued to recruit members to the intervention group. This resulted in widespread press coverage. Fifty-three potential participants contacted the research team, of these 14 were excluded as they had not fallen in the preceding 12 months. The first 15 eligible people were included in the study.
People referred to the local falls group were approached by the research team. Of 13 potential recruits, one was excluded as a result of low AMT, two refused to participate in standard care and four declined to participate in the study. Thus six participants were recruited. Due to poor uptake/high drop-out rates recruitment was abandoned after three months.
Ethical Approval and Trial Registration
The North of Scotland Research Ethics Committee granted ethical approval (Ref No. 08/S0801/186). The study was registered with ClinicalTrials.gov (NCT01082042).
At an initial interview baseline information was obtained. Balance was assessed by a physiotherapist at weeks 0, 4 and 12. Functional balance was assessed by the Berg Balance Scale (BBS), a performance based measure using 14 activities of daily living (range 0-56) . A Tinetti Balance Assessment Tool (part of the Performance Orientated Mobility Assessment) was also undertaken (range 0-16) . Higher scores on both scales indicate better balance and both appear to have good inter- and intra- rater reliability [8, 9].
The Falls Efficacy Scale - International (FES-I), which is reliable and valid , was undertaken at weeks 0, 4 and 12 to assess the degree of concern about falling in certain situations. Higher scores indicate more concern about an individual falls risk (range 16-64).
Acceptability of the intervention was assessed by monitoring attendance, completion of an Attitude to Falls-Related Interventions Scale (AFRIS) and a qualitative interview. The AFRIS is a validated measure of the acceptability of falls-related interventions (range 6-42, higher scores reflect a greater degree of positivity about the intervention) . All members of the intervention group were interviewed on completion or withdrawal from the study to determine acceptability of the WiiFit (appendix 2). The interview was undertaken, and transcribed, by one of the researchers. Two independent raters undertook thematic analysis of these interviews.
Intervention group only
The intervention group had their WiiFit Age calculated by the WiiFit software (based on the user's current age, weight and athletic ability) undertaken at weeks 0 and 12 .
The Exercise Programme
The intervention group attended individual exercise visits supervised by a member of the research team twice weekly for 12 weeks. A walking frame was placed in front of the balance board, if the participant deemed this necessary. The exercise programme included balance and aerobic exercises on the WiiFit (appendix 1) and was modified at weeks 4 and 8. Participants were allowed to stop and move onto the next exercise at any point (including if they could not manage a particular exercise) and were allowed to terminate the session at any point. They were advised not to play the Wii out with the study. The actual time exercised was measured for each session.
Standard Care group
The standard care group was recruited from the local falls group, which is run by the local NHS Hospital. Patients attend a 12-week exercise/education programme supervised by NHS physiotherapists.
SPSSv16.0 (Chicago, IL) was used to analyse the data. Normally distributed data were compared using Independent samples T-Test between groups and equal variances were assumed. AMT scores were compared using Mann-Whitney U-Test. Fisher's exact test was used to compare living situation and use of walking aid, and Pearson-Chi Squared test was used to compare number of falls. Paired samples T-Test was used to assess change in the formal balance scores following the exercise programmes.