Balance Workshops Focusing on Learning to Stand Up From the Floor for Older Adults Living at Home: A Pilot Study Sol'Up

• Intervention group: balance workshops with a "ground scanning" module Participants in the intervention group take part in the same core set of workshops, with the addition of a specific module dedicated to learning ground scanning.

To ensure that the total session duration remains the same for both groups, certain sequences of the standard program are adapted or replaced by a module lasting approximately 20 minutes that focuses on getting up from the floor.

Participants take part in the standard program, which includes one-hour group sessions designed to improve balance, mobility, coordination, muscle strength, confidence in moving around, and fall-prevention behaviors.

The sessions include:

• static and dynamic balance exercises;
• muscle-strengthening exercises;
• coordination and dual-task exercises;
• joint mobility exercises;
• educational sessions on physical activity, the environment, nutrition, and fall prevention;
• discussion and wrap-up sessions to identify simple actions participants can take between sessions.

This 20 minutes module includes a safe progression covering:

• lower-body mobility, particularly the ankles, knees, and hips;
• weight shifts;
• gradual transitions to the floor;
• exercises in intermediate positions: lunge, knight's stance, all fours;
• strategies for turning and moving on the floor;
• learning to transition from the floor to a standing position;
• identifying secure points of support;
• managing apprehension;
• applying what has been learned to everyday situations. Progression is tailored to each participant's level. Moving to the floor is never required. In cases of apprehension, pain, functional limitations, or identified risks, the physical therapist suggests adaptations: exercises with support, use of a stable chair, partial exercises, movement simulation, or identifying possible steps without fully lowering oneself to the floor.

Participants take part in the standard program, which includes one-hour group sessions designed to improve balance, mobility, coordination, muscle strength, confidence in moving around, and fall-prevention behaviors.

The sessions include:

• static and dynamic balance exercises;
• muscle-strengthening exercises;
• coordination and dual-task exercises;
• joint mobility exercises;
• educational sessions on physical activity, the environment, nutrition, and fall prevention;
• discussion and wrap-up sessions to identify simple actions participants can take between sessions.

The acceptability of the intervention will be assessed based on the following factors:

• Participants' satisfaction with the program, measured using a satisfaction questionnaire administered at the end of the intervention.

The satisfaction survey for participants in the control group alternates between multiple-choice questions (to assess overall satisfaction, sense of safety, trust built, and organization) and open-ended questions (to gather their personal feedback on the benefits, challenges they faced, and areas for improvement).

The satisfaction survey for participants in the intervention group alternates between multiple-choice questions (to assess overall satisfaction, organization, sense of safety, and confidence regarding falls) and open-ended questions (to gather personal impressions on benefits, challenges, and areas for improvement).

The acceptability of the intervention will be assessed based on the following factors:

• Physical therapists' satisfaction with the program, measured using a satisfaction questionnaire administered at the end of the intervention.

The questionnaire for physical therapists in the control group alternates between multiple-choice questions (to assess the module's usefulness, satisfaction, ease of use, and relevance) and open-ended questions (to gather feedback, identify difficulties observed, and collect suggested adaptations from the instructor).

The questionnaire for physical therapists in the intervention group combines multiple-choice questions (to assess the time spent, progress, ease of implementation, and relevance of the module) and open-ended questions (to gather feedback on participants' reactions, challenges, adjustments made, and areas for improvement).

The acceptability of the intervention will be assessed based on the following factors:

• Program adherence, assessed by the attendance rate (number of sessions attended relative to the total number of sessions offered) as well as the dropout rate during the program.

Ability to get up from the floor, assessed using a standardized floor-to-standing test, which allows for an evaluation of the level of assistance required (0: cannot get up, 1: with assistance, 2: without assistance) and the time required to get up.

The floor-to-standing test will be used to assess the functional ability to get up after a fall. Participants will be asked to lie down on the floor in a standardized position and then get up as quickly as possible, without assistance, according to the instructions. The time taken to get up will be recorded, along with the strategy used (support, external aids). This test is considered a relevant indicator of impaired health, fall risk, and fall severity

Functional strength of the lower limbs, assessed using the Five-Time Sit-to-Stand Test.

The Five-Time Sit-to-Stand Test (FTSST) will be administered to assess lower-limb strength and functional mobility. Participants will be asked to stand up and sit down on a chair five times as quickly as possible, with their arms crossed over their chest. The total time required to complete the task will be recorded.

Postural balance: Static balance will be assessed using the Romberg test, the tandem stance test, and the single-leg stance test.

For the Romberg test, participants stand with their feet together and arms at their sides, maintaining the position for up to 20 seconds-first with their eyes open, then with their eyes closed, and finally with their eyes open and their head tilted back.

For the tandem stance test, participants stand with one foot directly in front of the other, heel to toe, for up to 20 seconds. Performance will be recorded separately for the right-foot-forward and left-foot-forward positions For the single-leg balance test, participants must stand on one leg without support, with the non-weight-bearing foot positioned at calf height without touching the leg. The time spent maintaining balance, up to 20 seconds, will be recorded for each leg.

Perceived self-efficacy for getting up from the floor, assessed using a direct question (scale from 0 to 10).

"I am confident in my ability to get up from the floor while lying on my back, on my own." Based on the general self-efficacy scale and the confidence survey, we will ask patients to rate their level of confidence in their ability to get up from the floor using a numerical scale from 0 to 10 (0 = I am not confident and 10 = I am very confident).

Perceived self-efficacy for getting up from the floor, assessed using a direct question (scale from 0 to 10).

"I am confident in my ability to get up from the floor while lying on my back, on my own." Based on the general self-efficacy scale and the confidence survey, we will ask patients to rate their level of confidence in their ability to get up from the floor using a numerical scale from 0 to 10 (0 = I am not confident and 10 = I am very confident).