A progressive three-level functional rehabilitation model for fall prevention in older adults: Integrating sport-inspired physiotherapy in African health care systems

Abstract

Background: Sub-Saharan Africa faces a growing epidemic of falls among older adults, with sarcopenia affecting 5% to 13% of those aged 60 years or older. Despite evidence that muscle plasticity persists into advanced age, rehabilitation infrastructure remains severely limited across African health care systems. Objectives: To develop and validate a progressive 3-level physiotherapy model integrating sport-inspired principles for fall prevention in older adults, specifically designed for resource-limited African health care settings. Methods: At the beginning, a narrative review of muscle plasticity literature was conducted by searching PubMed, Scopus, and regional databases, focusing on articles published after 2010. Thereafter, a progressive intervention model was developed incorporating level 1 (physiotherapist-supervised community health worker training), level 2 (simple technological enhancements), and level 3 (exploratory innovations for research centers). Data on functional mobility (timed-up-and-go test), lower body strength and endurance (chair stand test), walking speed (mention the tool used for this assessment), adherence, adverse events, and cost of implementation were collected on older adults. Results: Clinical implementation demonstrated significant functional improvements: functional mobility improved by 2.4 seconds (Cohen d = 0.89, P < 0.001), lower body strength and endurance by 4.2 seconds (Cohen d = 1.02), and walking speed by 0.19 m/s (Cohen d = 0.85). Community-based delivery achieved superior adherence rates (78% vs 54% facility-based, P < 0.001) with zero serious adverse events across 2400 supervised sessions. Implementation costs averaged $25 to $40 per participant for 12-week interventions. Conclusions: The progressive 3-level model seems to offer a solution for fall prevention that can be used in African contexts. This is because the physiotherapist-supervised community health worker training maintains clinical effectiveness while addressing resource limitations, and providing immediate implementation potential across diverse health care settings.