Falls-EDU: An 8-week falls and balance program delivered by physiotherapy and osteopathy students for adults aged 55+

Based on feedback from participants in focus groups from Phase 1, the protocol has been amended to extend the program duration and incorporate supervised group exercise classes, consistent with best-practice recommendations for falls prevention and the known benefits of group-based exercise for older adults. An interprofessional education component has also been introduced through the inclusion of physiotherapy students alongside osteopathy students, to better reflect contemporary models of collaborative, team-based allied health care for community-dwelling older adults; and also to provide authentic clinical placement experience for students to reflect real-world models of care. ---------------------------------------------------------------- Interprofessional education component: The interprofessional education (IPE) component is delivered through a structured framework in which osteopathy and physiotherapy students engage in asynchronous online microlearning (across multiple formats; i.e., video, short reading, reflective prompts) and synchronous activities, including co-design and delivery of the group falls and balance sessions,, and structured reflection on group-based falls prevention exercise programs. The framework was co-designed by an expert working group (n=10) comprising academics, falls prevention clinicians, and students, and is aligned with the WHO definition of interprofessional education and the IPEC Core Competencies within a falls prevention context. The IPE component occurs during the intervention period (Weeks 2–7 of the 8-week program). It is delivered weekly as part of scheduled clinic sessions, consisting of between 1-2 hours of facilitated synchronous IPE activities integrated within 3-hour sessions in the clinic. Optional asynchronous online microlearning (5–10 minutes per week) is also provided to support learning. ----------------------------------------------------------------- The intervention consists of two core components: 1. Falls Risk Screening/Assessment/Stratification 2. Tailored Falls Risk Management Who delivers the intervention: Senior (4th/5th year) osteopathy students and Master of physiotherapy students; under the direct supervision of experienced, registered osteopaths and physiotherapists (clinical educators) at the university clinical teaching setting Mode of delivery: - Face-to-face. There will be 2 x individual consultations within a supervised clinical teaching setting, eight weeks apart apart (week 1 and week 8) - Group exercise classes: There will be the option of attending up to three group falls and balance exercise classes within a supervised clinical teaching setting in week 3, 5 and 7. - Additional follow-up one phone call between individual sessions (at around 4 weeks after initial consultation) Duration/frequency: - Two x 1-hour in-person consultations in week 1 and week 8. - Three x supervised 60-minute classes delivered in a supervised clinical teaching setting which includes 5 min welcome, 5 min warm up, 35-40 minute main set, 5 min cool down and 5 min exit (total = 60 mins per session) - One follow-up phone call four weeks after the initial consultation - approximately 5-10 minutes - to support adherence and address issues with the home exercise program. INTERVENTION: (1) Falls Risk Screening/Assessment/Stratification. a) Screening and Assessment i. Case history including history of falls and falls risks; medical history ii. Patient-Reported Outcome Measures (Short FES-I) b) Assessment: iii. Physical Performance Measures - QuickScreen© Clinical Falls Risk Assessment; Timed Up and Go (TUG) test c) Stratification Using the results from the Falls Risk Screening and Assessment protocol elements (QuickScreen© Clinical Falls Risk Assessment, TUG and falls history) participants will be stratified into one of three risk categories: Low Risk, Intermediate Risk or High Risk. (2) Management Plan All participants will receive education and printed resources, a letter of communique to their GP regarding the program and their individual falls risk, and access to up to three supervised, group falls and balance (FAB) exercise classes based on the Otago Exercise Program, delivered in weeks 3, 5 and 7. These classes form part of an integrated intervention that also includes falls risk assessment/stratification, semi-individualised home exercise management (for low- and intermediate-risk participants only), and educational materials. All participants, regardless of risk category, are offered the group FAB classes; however, only low- and intermediate-risk participants receive an additional home exercise program. Risk-specific components include: a) Low Risk: - Education on falls risk factors (https://cdn.activeandhealthy.nsw.gov.au/assets/Healthy-ageing-resources/Falls-prevention.pdf)- e.g., polypharmacy, vision issues (https://cdn.activeandhealthy.nsw.gov.au/assets/Healthy-ageing-resources/Eye-health.pdf), incontinence (https://cdn.activeandhealthy.nsw.gov.au/assets/Healthy-ageing-resources/Bladder-and-bowel-health.pdf), footwear, fear of falling. - Flyers: >> home safety checklist (https://www.cdc.gov/steadi/pdf/steadi-brochure-checkforsafety-508.pdf), >> get-up-from-floor technique (https://www.injurymatters.org.au/wp-content/uploads/2021/06/Up-Off-The-Floor-Arms-and-Knees.pdf) >> footwear checklist (https://www.cec.health.nsw.gov.au/__data/assets/pdf_file/0011/258536/Falls-Prevention-Foot-Care-and-Footwear.pdf) - Self-monitoring exercise diary for home exercise program - Semi-individualised Modified Otago Exercise Program (OEP) (e.g. strength exercises sit-to-stand, heel and toe raises; and balance exercises such as tandem stand, one leg stand).* *>> Individualisation is informed by each participant’s falls risk stratification (low or intermediate risk) based on screening and assessment results, including the QuickScreen© Clinical Falls Risk Assessment, TUG, and a brief functional history. Students, under clinical supervision, will assess each participant’s functional capacity and select a maximum of 2 lower limb strength and 2 balance exercises from the modified OEP menu that are safe and appropriate for home use. The exercises and prescription is based off level A and B of the OEP, and have deliberately been chosen to suit a student-led, feasibility trial format within a clinical education setting. >> Mode of administration: face-to-face, with the osteopathy and allied health students (under clinical supervision) prescribing a home-based exercise program for the participant to complete independently at home. This occurs in consultation 1 (baseline). Then participants can choose to complete the exercises at home. The student team will conduct a follow-up telephone call to the participant at 4 weeks to check in and see if the participants have any questions/ challenges with the home exercises. At the second individual consultation (week 8), the student team will run through the previously prescribed exercises with the participant, and then make an informed decision (under clinical supervision) about whether to progress the participant in terms of repetitions, sets or other exercises. >> Intensity: Low to moderate, assessed informally via functional performance and self-reported exertion. >> Frequency: Participants will be recommended to perform their prescribed exercises up to 2-3 times per week. >> Duration: The program runs over an 8-week period. >> Monitoring adherence: A self-monitoring exercise diary is provided to track completion. It will also be discussed during a follow-up phone call at week 4 and reviewed again during the second clinic visit at week 8. - GP letter suggesting periodic monitoring and other recommendations as per the World Falls Guidelines (such as onward referral, if required). b) Intermediate Risk: - Includes all low-risk strategies - Additional recommendation in GP letter to continue OEP for 12 months, preferably under allied health supervision. This recommendation is up to the GP and patient to organise. c) High Risk: - Education materials only – no home exercise prescribed due to safety concerns and risk mitigation in a student clinic setting - GP letter strongly recommending further multidisciplinary assessment - Example referrals: physiotherapist, exercise physiologist, falls clinics (e.g. community Falls and Balance Service or similar). To be organised by the GP within the patient's local setting and within their care preferences. d) Non-risk based management (i.e., ALL participants): Non–risk-based management (i.e. all participants) will also include the option to attend up to three supervised 60-minute group falls and balance classes in weeks 3, 5 and 7. These Otago-based classes follow a standardised format (welcome, warm up, strength and balance block, cool down, closing discussion) and typically include lower limb strengthening (e.g. sit-to-stand, mini squats, heel and toe raises, hip abduction, step-ups), static balance tasks (e.g. feet together, tandem and single-leg stance, with optional head turns), and dynamic/reactive balance tasks (e.g. forward/backward and side stepping, tandem walking, heel/toe walking, marching on the spot, light perturbations, step-and-reach tasks). The design of each class is co-produced by the students with oversight from the clinical educator in the week prior to delivery. Session planning explicitly considers which participants are expected to attend and their falls risk classification, to allow appropriate exercise progressions and regressions and to ensure safety. Classes are delivered in a supervised clinical teaching setting with up to six older adults per group, two students leading the session and one clinical educator providing oversight. Monitoring adherence: - Face-to-face session attendance checklist - both individual and group exercise classes - Telephone call attendance - Exercise diary (self-monitoring) for home exercise program