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Training Physical Therapists in Evidence-Based Outcome Measures The Otago Exercise Program Training Webinar April 17, 2013 Tiffany E. Shubert, PhD, MPT Carolina Geriatric Education Center 1

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Acknowledgements Carolina Geriatric Education Consortium Content Webinar Platform Eastern Area Health Education Center Contact Hours Archived webinar 2

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What we want to understand about the Otago Exercise Program The research & rollout in the US How to implement Discuss evidence-based protocols for outcome measures How to use the database to track patient outcomes 3

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US Implementation 1.CDC identifies Otago as an evidence-based fall prevention program 1.CDC Pilots in CO, NY, OR 2.Online training program 3.CDC Partners, Policies, and Programs for Fall Prevention 4.Evaluation of implementation 4

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Otago True or False? You must start Otago on Day 1 You have to prescribe all 17 exercises on Day 1 You need to modify the exercises for your patient Your patient will not succeed if you see them so infrequently But my exercises are better than Otago 5

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Myths of Standardization & Variation 6

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Otago In a nutshell Evidence-based fall prevention program from New Zealand 6 8 visits over a year Standard set of balance and strength exercises Best for community-dwelling but frail Patient does exercises INDEPENDENTLY Progressed by physical therapist 30-40% reduction in falls in high risk fallers Can it work in the United States? 7

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Before You Start Is the patient ready? Is the patient compliant? Do we start on day 1??? 8

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Before You Start Is the therapist ready? Is the therapist compliant? Is the therapist proficient in the outcome measures? Has the therapist registered with the database? Has the therapist registered the patient with the database? 9

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Quick Review Outcome Measures Timed Up and Go 30-second Chair Rise Standing balance sequence Walking speed* Walking speed is optional, only input if your agency already collects the data http://www.cdc.gov/homeandrecreationalsafety/Fal ls/steadi/videos.html#TUG 10

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Lets go! Register your patient (anytime before start) Enter baseline info (Otago Day 1) Follow up info @ 8 weeks & 6 months Discharge when appropriate 11

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Otago Visit 1 What info is collected? What happens? When is next visit? 12

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Otago Visits 13 Month123456 Week123468 Initial Visit Visit* Visit Call Month789101112 Week Visit Call PT Management Phase Self- Management Phase

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Visit 4 and After Visit 4 Outcome measures Phone calls Visits 5, 6, 7 (Months 6, 9, 12) Final Otago Visit/Discharge: Discharge at 12-Month point or WHEN APPROPRIATE When to discharge: Patient no longer challenged by Otago OR Patient mastered exercises and independently exercising 6 days per week OR Patient met goals Resources and Reminders 14

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Reminders and Resources Phone calls Email reminders Where to go if you have questions www.Phconnect.org 15

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How am I doing? You (or your agency) can request Average number of visits Improvements in outcome measures Fall history 16

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Summary Provide your email to access the database You will receive an email inviting you to join For each patient Enter into the database Complete Patient Information and Baseline Survey tabs within 5 days of starting Otago Receive e-mail reminders for 3-Month 6-Month Follow-Up visits Complete Discharge Survey when patient is discharged from Otago (can be done at ANY time) 17

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Questions? otago@unc.edu Phconnect.org 919-360-1970 if you get really stuck! 18

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Appendix Screen shots to demonstrate database use 19

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OTAGO EXERCISE PROGRAM: Outcome Measures Database Form Completion Navigation Instructions to Therapist 20

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