The Otago Exercise Program: Implementation …2019/01/23 · J Appl Gerontol. 2018 Jan;37(1):79-...

Improving the lives of 10 million older adults by 2020

The Otago Exercise Program:Implementation Strategies

Key PartnershipsLessons Leanred

January 23, 2019

Tiffany E. Shubert, PhD, MPT

Improving the lives of 10 million older adults by 2020 | © 2017 National Council on Aging 2

Objectives

Introduce the Otago Exercise Program Discuss implementation strategies & key partnerships Review lessons learned


Oh – TAAG – OhThe Otago Exercise Program

• Selected by CDC as an evidence-based fall prevention program in 2010– https://www.cdc.gov/homeandrecreationalsafety/falls/co

mpendium.html• Implementation Guide published in 2012• Online training launched March 2013;

Updated March 2016– Online training, videos & tools– http://www.med.unc.edu/aging/cgec/exercise-program

Online training

$35

6000+ Providers Trained

18 Countries

Represented

https://www.cdc.gov/homeandrecreationalsafety/falls/compendium.html


The Otago Exercise Program-A structured and progressive balance improvement program

Evidence-based fall prevention program from New Zealand Implemented in the home 5 visits over 8 weeks Monthly phone calls when there is no face to face interaction Follow up visits at 6 months and 1 year

Exercises A series of warm up exercises Up to 17 strength and balance exercises for up to 30

minutes/day, three times/week Three exercises use ankle weights to provide added

progressive resistance A walking program done for up to 30 minutes/day, three

times/week


Why the Otago Exercise Program???

Randomized controlled trial demonstrated a 35% reduction in falls (Campbell, 1995)

This outcome was sustained for 2 years after the trial (Campbell, 1997) Reduced risk of death (Thomas, 2010) Cost effective (Carande-Kulis, 2015)

► Persons aged 65 and older, the ROI was 36% for each dollar invested► Persons aged 80 and older, the ROI was 127%

Resource efficient► One physical therapist or PT Assistant► 6 visits

Effective for the population most likely to experience hip fracture or death from a fall in a potentially effective environment for adherence and compliance


The OEP Experienc

6

Month 1 2 3 4 5 6

Week 1 2 4 6 8

Start1

Visit2

Visit3

Visit4

Visit5 Visit

Call Call Call

Month 7 8 9 10 11 12

Week

Visit/DC

Call Call Call Call Call

Clinical/Supervised Phase Self- Management Phase


Who should do Otago??

Older adults who have experienced at least one fall Older adults who have significant balance impairments Older adults who are more medically complex or frail Older adults who would have challenges participating in a

community-based program


Otago1-on-1 therapy

Stepping On

A Matter of Balance

Tai Chi: Moving for Better Balance

Traditional Forms of Exercise

Source: Adapted from Mahoney, et al.

“Menu” of Fall Prevention Programs


Progressive Strength Exercises


Progressive Balance/Strength Exercises


Progressive Static Balance Exercises


Progressive Balance Exercises

Supported & Unsupported

Squats

Supported UnsupportedBackward Walking


Progressive Balance Exercises

Sideways Walking Walking and Turning Around

Supported UnsupportedHeel – Toe Walking


Progressive Dynamic Balance Exercises15

Supported & UnsupportedToe Walking

Backward walking

Stair Walking


Translation Challenges!

Developed and implemented in a small country with nationalized healthcare

OEP in-home visits and phone calls not aligned with Medicare documentation and reimbursement policies and procedures

Program is still relatively unknown


Implementation Strategies & Partnerships


US Implementation – Critical Questions

Setting – Big challenge► Home ► Outpatient (?)► Group (?)

Duration► Difficult to manage in home health and Part B

Patients► Often too frail to participate ► If strong enough to participate, may no longer be appropriate for therapy

Providers► Does Otago truly require a skilled clinician?► What is the role of the PT? PTA? Patient/Caregiver?

Phone calls


US Modifications

The OEP works when the older adults do the exercises! This allows a bit more flexibility in implementation than other evidence-based programs

Implement in the home, outpatient clinic, or community setting

Participants can exercise on their own, in a class, or using online applications, videos, or virtual programs

Participants can use a variety of tools to track participation rates and progress


US Modifications

Delivered by a PT or a Physical Therapy Assistant (PTA) and reimbursed by Medicare as long as the participant meets the requirements for physical therapy under Medicare Part A, B, or C

Required 8 week participation with a recommendation of a minimum of 6 months

Delivered by a community-based organization (by an individual with an exercise background and experience working with older adults)


Guidance Statementhttps://www.ncoa.org/wp-content/uploads/2017-OEP-Guidance-Statement.pdf


Overview of The Otago Exercise Program

Questions?


Partnerships & Implementation Models

Area Agencies on Aging Senior Centers Meals On Wheels PACE programs Group Exercise Classes

►ALF►Senior Housing

Virtual Programs


Lessons Learned

• DO THE EXERCISES & DO NOT MODIFY EXERCISES

• Weights are necessary do not ignore• Start slow – 1 or 2 participants and then grow

it from there• Get buy-in from providers• Be creative with your partnerships• Let participants learn that they can get

stronger


Updates

National Council on Aging & Academy of Geriatric Physical Therapy MOU AGPT Initiative – Educate PTs & PTAs to

Build Better Connections► The benefits of community evidence-based

programs/aging service organization and physical therapy partnerships

► How to create effective partnerships► The business case for these partnerships


The Otago Exercise ProgramPartnerships & Models

Questions?


Contact Information

Tiffany E. Shubert, PT, PhDClinical Architect, Shubert Consulting, [email protected]

mailto:[email protected]


Resources

OEP implementors are required to complete the Otago Exercise Program Online Training at http://www.med.unc.edu/aging/cgec/exercise-program(cost $35).

Other information about training, resources, and marketing materials is available at http://www.med.unc.edu/aging/cgec/exercise-program.

http://www.med.unc.edu/aging/cgec/exercise-program

http://www.med.unc.edu/aging/cgec/exercise-program


Relevant Publications

Shubert, T.E, Smith, M.L., Goto, L, Jiang, L., Ory, M.G. (2017). "Otago Exercise Program in the United States: Comparison of Two Implementation Models." Phys Ther 97.

Shubert TE, Goto LS, Smith ML, Jiang L, Rudman H, Ory MG.(2017). The Otago Exercise Program: Innovative Delivery Models to Maximize Sustained Outcomes for High Risk, Homebound Older Adults. Front Public Health. 2017 Mar 23;5:54. doi: 10.3389/fpubh.2017.00054.

Shubert TE, Smith ML, Jiang L, Ory MG. Disseminating the Otago Exercise Program in the United States: Perceived and Actual Physical Performance Improvements From Participants. J Appl Gerontol. 2018 Jan;37(1):79-98. doi: 10.1177/0733464816675422.

Shubert TE, Smith ML, Ory MG, Clarke CB, Bomberger SA, Roberts E, Busby-Whitehead J. Translation of the otago exercise program for adoption and implementation in the United States. Front Public Health. 2015 Apr 27;2:152. doi: 10.3389/fpubh.2014.00152

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