exercise-based physiotherapy in residential aged care ......dr kate scrivener1,2, nicholas young2,...
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DR KATE SCRIVENER1,2, NICHOLAS YOUNG2, BRETT GREELY1, MATTHEW HEIDEMA1 AND KATHERINE ALAVA-BRAVO2
1. Macquarie University
2. Concentric Rehabilitation Centre
Exercise-based Physiotherapy in residential aged care: feasibility, outcomes and satisfaction
Ageing population
Increased population living in Residential Aged Care Facilities
Increased Care costs
Background
2
Role for Physiotherapy
Limited funding
Figure adapted from: https://stock.adobe.com/ee/images/medical-pills-and-money-health-care-cost-cost-of-medicine/65222473
• Declines attenuated• Improved strength and
balance• Lessen carer burden
• Exercise based physiotherapy interventions improve:
• Strength
• Balance
• Physical function and mobility
• Physiotherapy has the potential to:
• Attenuate functional decline
• Reduce care burden
• Slow increasing health care costs
Background: Exercise for aged care residents
3
1. Chou et al. (2012) Archives of physical medicine and rehabilitation. 93(2):237-244.
2. Valenzuela et al. (2012) Journal of the American Medical Directors Association. 13(5):418-
428. .
3. Forster (2010) Age and ageing. 39(2):169-175.
4. Hewitt et al. (2018) Journal of the American Medical Directors Association. 19(4):361-369.
• Centres that are co-located
within an aged care facility
• Low cost access to ongoing
rehabilitative programs
Concentric Rehabilitation Centre
FACULTY OF MEDICINE AND HEALTH SCIENCES
DEPARTMENT OF HEALTH PROFESSIONS | DISCIPLINE OF PHYSIOTHERAPY4
The specific research aims were to
document:
1. Acceptability of an on-site RACF
exercise-based physiotherapy
program
2. Physical ability and quality of life
before and after participating in an
on-site exercise-based
physiotherapy program
Aims
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- Residents of Opal Cardinal
Freeman Aged Care Facility
- Opted to participate in Opal
Rehabilitation Package
(Physiotherapist-led exercise
program)
- Able to safely participate in
exercise
Methods - Participants and recruitment
6
Initial assessment by physiotherapist - participants divided into one of three program types:
1. Orthopaedic
2. Functionality
3. Falls and Balance
Combination of weekly group and individual sessions with a physiotherapist depending on
resident function
Methods - Study Protocol
7
Ongoing enrolment
(January 2018)
Initial Assessment & Outcome Measures
Ongoing physiotherapy
exercise sessions
Outcome measures re-assessed at 6
months
Final Data Collection
(March 2019)
Orthopaedic
* 3 sessions per fortnight
* Combination of groups and 1-1 training
Functionality
* Weekly 1-1 sessions
Falls and Balance
* 2 weekly group classes
Methods - Programs
FACULTY OF MEDICINE AND HEALTH SCIENCES
DEPARTMENT OF HEALTH PROFESSIONS | DISCIPLINE OF PHYSIOTHERAPY8
Walking Speed
Methods - Physical outcome measures
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https://bit.ly/2DjKAC2
Timed Up and Go (TUG)
https://bit.ly/2OH21OM
5 Meter Walk Test
https://bit.ly/2FnpmpH
Ability to stand &
Walking Speed recorded in
metres per second (m/s)
Time recoded in seconds
Number of steps counted Recorded as a yes/no criterion
Ability to stand unsupported
http://bit.ly/2FvKuaJ
1. Kuys et al. (2014) J Am Med Dir Assoc.15(3):194-200.
2. Brooks et al. (2006) Archives of physical medicine and rehabilitation. 87(1):105-110.
3. Cruz-Jentoft et al. (2010). Age and ageing. 39(4):412-423.
4. Peters et al. (2013) Journal of geriatric physical therapy. 36(1):24-30.
Functional Mobility Balance
Methods – Satisfaction and quality of life measures
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• Purpose built satisfaction
survey
• Exercise Self-Efficacy Scale
• London Handicap Scale
• Community Integration Measure
39 participants
Average Age: 83 years (range 45 – 103)
Gender: 68% female
Moderate to Severe Cognitive Impairment: 63%
Assistance of 1 or more for mobilisation: 61%
Results
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PARTICIPANTS
Results
12
9792
0
10
20
30
40
50
60
70
80
90
100
Said the program was worth their time Would recommend the program to others
• Average number of exercise
sessions per week = 1.5 (SD 0.6)
• 94% compliance with session
attendance (SD 42%)
• No withdrawals from the program
• High satisfaction on survey results
Results
Social Atmosphere Improved Mobility Staff expertise“Social aspects, excellent
physios (great staff)”
“It has greatly helped with
my severe pain. It has also
greatly improved my mobility
both in and out of the
residence”
“The caring and respectful
approach of staff. The leader
treats the whole person, the
cheerful atmosphere and
gentle supervision”
“Worth it to come, you can
meet people there”
“I would advise other
residents to participate in
rehab. It can have many
great benefits. I with physio,
was able to walk again after
months of being immobile
and having lost my
confidence”
“Variety of exercises,
awareness of my limitations,
pleasant staff”
FACULTY OF MEDICINE AND HEALTH SCIENCES
DEPARTMENT OF HEALTH PROFESSIONS | DISCIPLINE OF PHYSIOTHERAPY13
Key themes from participant feedback:
• Majority of participants improved their walking speed (55%)
• Mean change in walking speed was an improvement of 0.04
metres per second (SD 0.22)
• No overall difference in walking speed from initial to final
assessment (MD -0.2, 95% CI -0.1 to 0.07, p = 0.7)
Results
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WALKING SPEED
https://bit.ly/2OH21OM
• No difference in participants ability
to stand up from a chair or stand
unsupported for 10 seconds between
initial and final assessments
• No difference in timed up and go
(TUG) test times from initial to final
assessment (MD 4.5, 95% CI -3.1 to
12, p = 0.2)
Results
15
https://bit.ly/2DjKAC2
https://bit.ly/2FnpmpH http://bit.ly/2FvKuaJ
Timed Up and Go (TUG)
Ability to stand & Ability to stand unsupported
Results – Quality of life measures
• No change from baseline scores
• Presence of chronic pain associated
with a higher final LHS score (p=0.03)
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Initial
score
Mean
(SD)
Final
Score
Mean
(SD)
Mean difference
p-value
Community
Integration
Measure (/50)
38 (6) 39 (7) +1
p=0.46
Exercise Self
Efficacy Scale
(/40)
London Handicap
Scale (/1)
25 (7)
0.6
(0.1)
25 (8)
0.6 (0.1)
0
p=0.95
0
p=0.71
Note: SD = Standard deviation
• More sessions per week
associated with greater change in
walking speed (R2 = 24%, p<0.01)
• More sessions per week
associated with a better final London
Handicap Scale score (p=0.01)
Results
17
• The mean change in walking speed was an
improvement of 0.04m/s (SD 0.22)
• This is despite the evidenced expected decline in gait
speed of 0.03 – 0.05 m/s per year1,2
• More sessions per week associated with better walking
and quality of life
Discussion
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1. Auyeung et al. (2014) Geriatrics & gerontology international. 14:76-84.
2. Onder et al. (2002) The Journals of Gerontology Series A: Biological Sciences and Medical
Sciences. 57(5):M289-M293.
• Physiotherapist-led exercise programs
are acceptable and feasible for
residents of aged care facilities
• Exercise can maintain or improve the
physical outcomes of aged care
residents reversing the expected
decline in physical function
Conclusion
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