None listed
Conditions
Brief summary
The TOP UP Trial will investigate the effectiveness, value for money, and acceptability of physiotherapy-led exercise programs delivered via telehealth for older Australians. This research will answer key questions about how technology can be used to reduce falls, enhance mobility and quality of life of older people receiving aged care services in their home or in residential aged care. The study hypothesis is that the TOP UP intervention will result in significantly higher mobility performance at 6 months compared to usual care. This trial will recruit 240 people aged 65 years and older who are receiving aged care services, can walk at least 10m, with and without dementia, and who have sufficient English language and sensory skills to participate in the trial. The intervention group will receive 10 video conferencing physiotherapy sessions over 6 months and will receive an individual balance and strengthening exercise program based on previous successful exercise programs. The physiotherapists will introduce the participants to online exercise programs that aim to improve their adherence to the required exercise dosage of 2 hours per week. The control group will continue with usual care during the trial period and be offered the intervention in 2022. The trial outcomes will investigate the effect of the intervention on mobility, falls, and quality of life. Participants, physiotherapists, carers, and other aged care staff will be interviewed to explore the barriers and facilitators that would influence the roll-out and sustainability of this program if the trial were proven to be effective.
Interventions
Arm 1: Participants allocated to the telehealth physiotherapy group will be offered 10 video-conferencing sessions with a physiotherapist over 6-months via zoom using a mobile tablet device. Participants will use their own mobile tablet device such as an iPad or will be provided one by the research team.
Participants will have an exercise program designed by a physiotherapist and will be asked to exercise for 4 times per week, 20 -30 minutes per session, up to 2 hours per week over 6 months.
Arm 1: Participants allocated to the telehealth physiotherapy group will be offered 10 video-conferencing sessions with a physiotherapist over 6-months via zoom using a mobile tablet device. Participants will use their own mobile tablet device such as an iPad or will be provided one by the research team. Participants will have an exercise program designed by a physiotherapist and will be asked to exercise for 4 times per week, 20 -30 minutes per session, up to 2 hours per week over 6 months. Participant's will be given a home exercise program booklet that has been specifically designed for this study as well as access to the trial's website to follow prescribed on-line exercise programs designed by physiotherapists to assist them to achieve the prescribed exercise dosage. Dosages will be individually prescribed to challenge the participants to work at a moderate level of intensity and will be assessed via the Borg CR10 scale. Each participant will aim to achieve 2–3 sets of 10–15 repetitions of each exercise. Dosages will be gradually adjusted as participants’ abilities change throughout the course of the program. Exercise content will contain a mix of balance and lower limb strengthening exercises based on the Otago Exercise Program. The program will be tailored to participant ability and progression of difficulty for the exercise program will occur as skills and confidence increase. Intervention adherence will be recorded by participants and/or their carers in exercise diaries. Strengthening exercises will include seated knee extension, standing knee flexion, standing hip abduction and extension, and squats. Strengthening exercises will be upgraded by adding ankle weights. Balance exercises will include a combination of heel and toe raises, stepping in different directions, single-leg standing, and sit-to-stand practice. Balance exercises will be upgraded by: 1) reducing hand support and/or 2) narrowing the base of support. Participants will be supported to access their physiotherapy telehealth sessions and follow their exercise programs by the care staff of the participant's aged care service provider (TOP UP coaches).
Sponsors
Concord Repatriation General Hospital
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Prevention
Masking
Blinded (masking used) (Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
65 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Eligible participants will: a) Age: 65 + years b) Living in the community or in residential aged care facilities receiving Commonwealth funded aged care services c) Able to walk 10 m +/- walking aid d) Have internet connectivity to access mobile device/tablet e) Life expectancy > 6 months and sufficient sensory, neurological , cognitive, and English language skills for exercise and video-based interventions f) Participants will need to be assessed by their aged care provider as having normal or mild cognitive impairment by one of the following cognitive assessments: attain a score of 18 or more on the Mini State Mental Examination (MMSE), or 20 or more on the Rowland Universal Dementia Assessment Scale (RUDAS), or 10 or less on the Psychogeriatric Assessment Scales Cognitive Impairment Scale (PAS-Cog) or 4 or more on the Memory Impairment Scale (MIS) g) Obtain participant consent or from their person responsible if the participant has mild cognitive impairment
Exclusion criteria
The trial will exclude adults who: a) are expected to live for less than 6 months b) Having participated in a similar physiotherapy program in the last 12 months c) Having physical, sensory, mental health or behavioural issues that would prevent participation in the intervention as identified by our aged care partners d) People who are unable to cooperate with an intervention program. Cognitive impairment per se is not an exclusion criterion but older people with moderately severe dementia assessed by a score of 17 or less on the MMSE, a score of 19 or less on the RUDAS, a score more than 10 on the PAS-Cog, or a score of 20 or less on the Modified Telephone Interview Cognitive Status may not be able to participate.
Outcome results
None listed