Implementing an Evidence-based Exercise Program to Reduce Falls in Community-dwelling Older Adults (Otago)

University of British Columbia

Status: Active, not recruiting

Conditions: Old Age; Debility; Fall

Treatments: Behavioral: Otago Exercise Programme+ (OEP+); Behavioral: Otago Exercise Programme (OEP)

Study type: Interventional

Funder types: Other

Identifiers

NCT04851405

H19-01760

Details and patient eligibility

About

Falls are a major health care problem for seniors. The Otago Exercise Program, which consists of strength and balance training delivered by a physiotherapist, can reduce falls in this population. We will test two methods to deliver the Otago program. These will include a new coaching approach by a physiotherapist with the use of a Fitbit to provide feedback versus the traditional delivery. The degree to which the program is delivered as intended by physiotherapists as well as the number of falls, risk of falling, and participation in walking activities in older adults will be assessed over 24 months. Lastly, we will assess if the coaching approach is a cost-effective option.

Full description

Falls are a major health care problem for older adults (i.e., those aged ≥ 65 years) and health care systems. Falls account for 50% of injury-related admissions to hospital, 40% of admissions to nursing homes, and a 10% increase in home care services. They are also the leading cause of fatal injury among Canadians over 65 years old. This represents a significant health burden. Fortunately, falls are preventable. There is strong evidence that the Otago Exercise Program (OEP), physiotherapist (PT)-led home-based exercise program of strength and balance training, is effective at preventing falls in older adults with complex medical conditions. Originally developed in New Zealand the OEP has been implemented worldwide, but adherence to the program is a challenge. We propose that the suboptimal adherence is partly due to a lack of focus on behaviour change techniques such as self-monitoring and action planning in the delivery of OEP.

The investigators will use a mixed-methods approach, involving a RCT and in-depth interviews. The delivery of OEP+ vs OEP, from PTs, and its recipients, the older adults, will be determined at random. The training for the PT's will be provided by the Centre for Collaboration Motivation & Innovation (CCMI), a non-profit organization with a mandate to support the use of behaviour change techniques to improve health care. Prior to data collection, the PTs will attend a 2-hour workshop on the coaching protocol using the OEP app.

The goal of this project is to assess OEP+ as an implementation strategy to improve OEP delivery (by PTs) and adherence (by older adults).

Enrollment: 35 patients

Sex: All

Ages: 70+ years old

Volunteers: No Healthy Volunteers

Inclusion and exclusion criteria

Inclusion Criteria (Older Adults):

• over 70 years of age
• self-report a non-syncopal fall corroborated by an informant, in the previous six months
• are able to walk three meters with or without an assistive device
• have a Mini-Mental State Examination score > 24/30
• have a Physiological Profile Assessment composite score of at least 1.0 standard deviation above age-normative value or have a Timed Up and Go test > 15 seconds, or had one additional non-syncopal fall in the previous 12 months
• live in an area served by Vancouver Coastal Health
• understand, speak, and read English proficiently
• have access to a mobile device
• are willing to have their OEP sessions audio-recorded
• able to provide written informed consent

Exclusion Criteria (Older Adults):

• people not meeting the criteria above

Inclusion Criteria (Physiotherapists):

• willing to participate in training on the OEP
• complete the BAP training
• be audio-recorded during the OEP sessions
• be randomized to the OEP group with coaching or without coaching

Exclusion Criteria (Physiotherapists):

• not willing to participate in the above criteria

Trial design

Primary purpose: Supportive Care

Allocation: Randomized

Interventional model: Crossover Assignment

Masking: Single Blind

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35 participants in 2 patient groups, including a placebo group

Otago Exercise Programme+ Intervention Group (OEP+)

Active Comparator group

Description:

Physiotherapists receive OEP training, a 2 hour workshop on the coaching protocol using the OEP app, and online training on the Brief Action Plan Approach with 2 telephone practice sessions with an experienced Brief Action Plan counsellor. Each PT will deliver exercise program to 8 older adults. PTs will help older adults to set-up OEP app and Fitbit. PT will return bi-weekly over the course of two months (four visits total) for follow-up. During months 3-5, PTs will call participants three times times to review the exercise plan. The last visit will be an at-home visit which will occur 6 months after the initial visit. Between Months 7-12, PTs will continue to a phone call follow-up once a month to review the exercise routine. Older Adults will receive an OEP manual and cuff weights to be used with the strength training. They will also have access to the OEP app which allows the PT to prescribe exercises and record the participant's exercise goal.

Treatment:

Behavioral: Otago Exercise Programme+ (OEP+)

Otago Exercise Programme Group (OEP)

Placebo Comparator group

Description:

Physiotherapists receive OEP Training and a 2 hour workshop on just the counselling protocol. Each PT will deliver exercise program to 8 older adults. PTs will help older adults to set-up the Fitbit. For the first two months, PTs will provide bi-weekly home visits. During months 3-5, PTs will call participants three times times to review the exercise plan. The last visit will be an at-home visit which will occur 6 months after the initial visit. Older Adults will receive an OEP manual and cuff weights to be used with the strength training. They will also receive a Fitbit. Between Months 7-12, older adults will receive follow-up phone calls from the research staff.

Treatment:

Behavioral: Otago Exercise Programme (OEP)