摘要：Objectives. To evaluate the impact of implementing an evidence-based fall prevention intervention in community senior centers. Methods. We used a single-group design to evaluate the Tai Ji Quan: Moving for Better Balance (TJQMBB) program’s adoption, population reach, implementation, effectiveness, and maintenance among 36 senior centers in 4 Oregon counties between 2012 and 2016. The primary outcome measure, as part of the effectiveness evaluation, was number of falls as ascertained by self-report. Trained TJQMBB instructors delivered the program to community-dwelling older adults for 48 weeks, with a 6-month postintervention follow-up. Results. TJQMBB was adopted by 89% of the senior centers approached and reached 90% of the target population. The program resulted in a 49% reduction in the total number of falls and improved physical performance. Participation was well maintained after the program’s completion. The average cost-effectiveness ratio for the 48-week program implementation was $917 per fall prevented and $676 per fall prevented for multiple falls. Conclusions. TJQMBB is an effective public health program that can be broadly implemented in community senior centers for primary prevention of falls among community-dwelling older adults. There is now an array of proven exercise interventions that can be used by public health and clinical practice communities to reduce the risk and incidence of falls 1–3 and that have the potential for a positive return on investment. 4 One type of intervention, tai ji quan, 5 has been shown to be especially effective in improving strength and functional balance, thus reducing fear of falling and the risk of falls in populations of older adults and people with balance problems. 6–8 Although some fall prevention interventions 3 have proven to be highly efficacious in rigidly controlled trials, it remains to be determined whether they can reach their target population of older adults in the diverse circumstances that make up public health practice. 9 In this study, which built on prior developmental work 10,11 that showed the feasibility of our Tai Ji Quan: Moving for Better Balance (TJQMBB) program (formerly, Tai Chi: Moving for Better Balance), we assessed the implementation of TJQMBB in community senior centers. Specifically, our primary aim was to evaluate the program’s adoption and reach, with a secondary aim of focusing on the effectiveness and maintenance of the program’s implementation. Our tertiary aim was to assess the program’s cost-effectiveness in senior center settings.
