Physiotherapy-led Telehealth and Exercise Intervention to Improve Mobility in Older People Receiving Aged Care Services (TOP UP): Protocol for a Randomised Controlled Type 1 Hybrid Effectiveness-implementation Trial

Overview

Journal BMJ Nutr Prev Health

Date 2024 Apr 15

PMID 38618537

Authors

Rik Dawson

Marina Pinheiro

Vasikaran Nagathan

Morag Taylor

Kim Delbaere

Juliana Olivera

Abby Haynes

Jenny Rayner

Leanne Hassett

Catherine Sherrington

Affiliations

Soon will be listed here.

Abstract

Introduction: Deteriorating mobility and falls reduce independence and quality of life for older people receiving aged care services. This trial aims to establish effectiveness on the mobility of older people, and explore cost-effectiveness and implementation of a telehealth physiotherapy programme.

Method And Analysis: This type 1 hybrid effectiveness-implementation randomised controlled trial will involve 240 people aged 65+ years receiving aged care services in community or residential settings. Participants will be randomised to either: (1) the Telehealth Physiotherapy for Older People (TOP UP) Program or (2) a wait-list control group. The 6-month intervention includes 10 physiotherapy sessions delivered by videocall (Zoom). The intervention will include the local support of an aged care worker and online exercise resources. Primary outcome is mobility at 6 months post randomisation measured by the Short Physical Performance Battery. Secondary outcomes include rate of falls, sit-to-stand, quality of life, and goal attainment at 6 months after randomisation. Regression models will assess the effect of group allocation on mobility and the other continuously scored secondary outcomes, adjusting for baseline scores. The number of falls per person over 6 months will be analysed using negative binomial regression models to estimate between-group differences. An economic analysis will explore the cost-effectiveness of the TOP UP programme compared with usual care. Implementation outcomes and determinants relating to the intervention's reach, fidelity, exercise dose delivered, adoption, feasibility, acceptability, barriers and facilitators will be explored using mixed methods.

Conclusion: This is the first trial to investigate the effectiveness, cost-effectiveness and implementation of a physiotherapy intervention in aged care delivered solely by telehealth internationally. The study has strong aged care co-design and governance and is guided by steering and advisory committees that include staff from aged care service providers and end-users. Trial results will be disseminated via peer-reviewed articles, conference presentations and lay summaries.

Trial Registration Number: The trial is registered with the Australian New Zealand Clinical Trials Registry (ACTRN 12621000734864).

References

Haynes A, Sherrington C, Wallbank G, Lester D, Tong A, Merom D . "Someone's Got My Back": Older People's Experience of the Coaching for Healthy Ageing Program for Promoting Physical Activity and Preventing Falls. J Aging Phys Act. 2020; 29(2):296-307. DOI: 10.1123/japa.2020-0116. View

Turner-Stokes L . Goal attainment scaling and its relationship with standardized outcome measures: a commentary. J Rehabil Med. 2010; 43(1):70-2. DOI: 10.2340/16501977-0656. View

Musich S, Wang S, Ruiz J, Hawkins K, Wicker E . The impact of mobility limitations on health outcomes among older adults. Geriatr Nurs. 2017; 39(2):162-169. DOI: 10.1016/j.gerinurse.2017.08.002. View

Carty C, van der Ploeg H, Biddle S, Bull F, Willumsen J, Lee L . The First Global Physical Activity and Sedentary Behavior Guidelines for People Living With Disability. J Phys Act Health. 2021; 18(1):86-93. DOI: 10.1123/jpah.2020-0629. View

Lord S, Castell S, Corcoran J, Dayhew J, Matters B, Shan A . The effect of group exercise on physical functioning and falls in frail older people living in retirement villages: a randomized, controlled trial. J Am Geriatr Soc. 2003; 51(12):1685-92. DOI: 10.1046/j.1532-5415.2003.51551.x. View

Fisk M, Livingstone A, Pit S . Telehealth in the Context of COVID-19: Changing Perspectives in Australia, the United Kingdom, and the United States. J Med Internet Res. 2020; 22(6):e19264. PMC: 7286230. DOI: 10.2196/19264. View

Borg G . Psychophysical bases of perceived exertion. Med Sci Sports Exerc. 1982; 14(5):377-81. View

Slade S, Dionne C, Underwood M, Buchbinder R, Beck B, Bennell K . Consensus on Exercise Reporting Template (CERT): Modified Delphi Study. Phys Ther. 2016; 96(10):1514-1524. DOI: 10.2522/ptj.20150668. View

Oliveira J, Sherrington C, Amorim A, Dario A, Tiedemann A . What is the effect of health coaching on physical activity participation in people aged 60 years and over? A systematic review of randomised controlled trials. Br J Sports Med. 2017; 51(19):1425-1432. DOI: 10.1136/bjsports-2016-096943. View

10.

Cummings S, Studenski S, Ferrucci L . A diagnosis of dismobility--giving mobility clinical visibility: a Mobility Working Group recommendation. JAMA. 2014; 311(20):2061-2. PMC: 5012417. DOI: 10.1001/jama.2014.3033. View

11.

Hewitt J, Goodall S, Clemson L, Henwood T, Refshauge K . Progressive Resistance and Balance Training for Falls Prevention in Long-Term Residential Aged Care: A Cluster Randomized Trial of the Sunbeam Program. J Am Med Dir Assoc. 2018; 19(4):361-369. DOI: 10.1016/j.jamda.2017.12.014. View

12.

Bull F, Al-Ansari S, Biddle S, Borodulin K, Buman M, Cardon G . World Health Organization 2020 guidelines on physical activity and sedentary behaviour. Br J Sports Med. 2020; 54(24):1451-1462. PMC: 7719906. DOI: 10.1136/bjsports-2020-102955. View

13.

Makizako H, Shimada H, Doi T, Tsutsumimoto K, Nakakubo S, Hotta R . Predictive Cutoff Values of the Five-Times Sit-to-Stand Test and the Timed "Up & Go" Test for Disability Incidence in Older People Dwelling in the Community. Phys Ther. 2017; 97(4):417-424. DOI: 10.2522/ptj.20150665. View

14.

Fairhall N, Sherrington C, Cameron I, Kurrle S, Lord S, Lockwood K . A multifactorial intervention for frail older people is more than twice as effective among those who are compliant: complier average causal effect analysis of a randomised trial. J Physiother. 2016; 63(1):40-44. DOI: 10.1016/j.jphys.2016.11.007. View

15.

Greenhalgh T, Wherton J, Papoutsi C, Lynch J, Hughes G, ACourt C . Beyond Adoption: A New Framework for Theorizing and Evaluating Nonadoption, Abandonment, and Challenges to the Scale-Up, Spread, and Sustainability of Health and Care Technologies. J Med Internet Res. 2017; 19(11):e367. PMC: 5688245. DOI: 10.2196/jmir.8775. View

16.

Eagar K, Westera A, Kobel C . Australian residential aged care is understaffed. Med J Aust. 2020; 212(11):507-508.e1. DOI: 10.5694/mja2.50615. View

17.

Treacy D, Hassett L, Schurr K, Fairhall N, Cameron I, Sherrington C . Mobility training for increasing mobility and functioning in older people with frailty. Cochrane Database Syst Rev. 2022; 6:CD010494. PMC: 9245897. DOI: 10.1002/14651858.CD010494.pub2. View

18.

Batsis J, DiMilia P, Seo L, Fortuna K, Kennedy M, Blunt H . Effectiveness of Ambulatory Telemedicine Care in Older Adults: A Systematic Review. J Am Geriatr Soc. 2019; 67(8):1737-1749. PMC: 6684409. DOI: 10.1111/jgs.15959. View

19.

Delbaere K, Valenzuela T, Lord S, Clemson L, Zijlstra G, Close J . E-health StandingTall balance exercise for fall prevention in older people: results of a two year randomised controlled trial. BMJ. 2021; 373:n740. PMC: 8022322. DOI: 10.1136/bmj.n740. View

20.

Orgeta V, Tudor Edwards R, Hounsome B, Orrell M, Woods B . The use of the EQ-5D as a measure of health-related quality of life in people with dementia and their carers. Qual Life Res. 2014; 24(2):315-24. PMC: 4317511. DOI: 10.1007/s11136-014-0770-0. View