Research shows that a third of people over the age of 65 fall at least once a year. Falls cost the NHS over £2bn per year and over 4 million bed days. The emotional impact of falling frequently leads to reduced mobility, fear of falling again and social isolation. An ageing population and increasing demands on services means that finding a solution to this issue is critical.
Nymbl is a balance measurement and improvement programme with apps and an intelligent portal designed to reduce the risk of falls in older people. The idea was born when Caroline Owen Jones and Tom Virden met retired spine surgeon, Dr Jean-Pierre Farcy who wanted to communicate his clinical experience as widely as possible with the people who needed it most.
Part of the knowledge he wanted to share was around the importance of balance as an indicator of a person’s state of health, as well as the ability to predict someone’s future state of health. He knew there was an opportunity to use smartphone technology to deliver the dual-task interventions, combining isometric poses with cognitive load, that had proved successful amongst his patients but needed support to see this vision through to reality. Caroline and Tom together with Jim Cook, Ed Likovich and a team of experts in technology and science, created Nymbl.
How does it work?
With funding and grants, the team developed two mobile apps. One of these, Nymbl Pro, evaluates balance based on CDC Steadi protocols and Dr Farcy’s expertise, and the other is for balance training.
Health and care providers use Nymbl Pro, a balance evaluation app, to assess a person’s current abilities. This assesses the person’s strength and static and dynamic stability. The user is then given a numerical baseline score which they should see improve over time as they train.
Once they have established their baseline, the user will move onto either the Nymbl Training app or take part in Nymbl Classes, or both. The training app allows a person to carry out dual-task training exercises in their own home. It progresses the person’s training levels based on their performance and engagement with the app. If the user prefers to engage in group activities, they can attend a Nymbl Class, which focuses on dual-task training as a shared experience. Nymbl has found that the average engagement in traditional balance classes is less than 10%, whereas a Nymbl Class boasts more than three times that figure.
The person’s progress is trackable remotely, so family and professionals can see engagement and improvements. The app also has an intelligent alerting system, which can provide warning if someone is at a high risk of falling. This approach improves outcomes at an individual level, encouraging intervention before emergency situations arise.
A difficult sector
The roll-out of Nymbl has seen some challenges. ‘We are fortunate compared with many other businesses in that the problem we are addressing is universally agreed upon and we were very quickly able to show the effectiveness of our solution,’ says Caroline, Nymbl Co-Founder.
Chief Executive Officer, Ed Likovich goes on to describe the difficulty of targeting the social care sector, saying, ‘One challenge is the adoption of technology in this market, but the company’s progress has been helped by the increasing penetration of older adults owning smart devices in their home, passing the 50% threshold in 2018.
‘A further challenge lies in designing apps in a way that older adults understand and are comfortable with.
‘There was a pervasive market belief that older adults were fearful of technology. What we found through focus groups is that the fear was based more on the complexity of the interface and the fear of breaking the device. We initially had three buttons and we found that it produced anxiety. Moving to a single button design brought dramatic results, for example a greater than 90% adoption by those who tried using it.’
The design of the apps was pivotal in ensuring engagement, and the Nymbl team have paid close attention to the experience of the users. Caroline says, ‘Working in older adult focused design is more than interface, even the colour palette matters for those with macular degeneration, requiring careful design regarding contrast, font size, leading and tracking.
Many of the conventions, common across all IOS/Android apps, are well understood in the younger population but entirely foreign to older adults. This means every aspect of the client engagement with the technology has to be thoroughly interrogated.’
The results from users so far is promising. Studies into user engagement conducted by Imperial College London have found that more than 25% of those offered the programme started using it. At 21 days of participation, the users can expect improvements in their balance and postural sway area reduced by 37%. At 30 days, studies amongst care home cohorts show a 28.3% numerical baseline score improvement, resulting in a 50% reduction in the number of people at an increased risk of falling.
Participation tends to be sustained, with 87% of independent living and care home residents completing at least three days a week of training, and at six months, over two thirds of those community members are still participating.
Nymbl’s aim for the future is to continue to develop and improve balance and prevent falls, particularly in older adults who don’t go to the gym.
Over to the experts…
How can Nymbl be applied in different care settings? What are the drawbacks? How does it differ from systems that are already being used?