Referral and recruitment process

Prior to implementation of the study, the research team met with the leadership team of the rehabilitation outpatient services to determine a strategy for recruiting participants. When an individual was referred to outpatient PT, the office administrator provided a study flyer to the patient, and at the same time, informed the research team about the new patient. The research team was authorized to review the patient's electronic medical record to identify the primary reason for PT referral. If the referral reason was related to falls or poor gait or balance, the research team would contact the patient, introduce the study, and determine their interest in study participation.

Interested patients completed a standardized screen process to determine study eligibility. Informed consent was obtained at the beginning of the in-person screening visit. Inclusion criteria were men and women aged 65 years and above who were referred to PT for gait and balance training due to recurrent falls or high risk of falling at the outpatient geriatric physical therapy clinic within the senior health care organization.

Exclusion criteria were designed to ensure safety and optimize compliance, while minimizing confounders due to overt disease or conditions that may significantly influence study outcomes. Specific criteria included inability to stand or walk unassisted for 60 seconds, Montreal Cognitive Assessment (MoCA) score <18, unstable medical condition, recent myocardial infarction, active cancer, psychiatric co-morbidity, chronic use of any sedating medications, legal blindness, on vasodilators, or contraindications to tDCS.