OTAGO Exercises for Preventing Falls

(ReabFalls Trial)

Overseen By Rubens da Silva, PhD

Age: 65+

Sex: Any

Trial Phase: Academic

Sponsor: Université du Québec à Chicoutimi

Disqualifiers: Cancer, Severe psychiatric disorders, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 2

Duration: 12 weeks

92 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores ways to prevent falls in older adults using a special exercise program called OTAGO. The program strengthens muscles and improves balance through exercises done at home or in group settings. Participants will divide into two groups: one trying the OTAGO exercises and the other receiving conventional therapy, such as physical or rehabilitation therapy, at the hospital. The trial seeks older adults with a neuro-musculoskeletal disorder who are at risk of falling. Participants may help shape better fall prevention strategies for others in the future. As an unphased trial, it offers a chance to contribute to innovative research that may lead to improved fall prevention strategies for older adults.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It is best to discuss this with the trial coordinators or your doctor.

What prior data suggests that the OTAGO exercises are safe for preventing falls in older adults?

Previous studies have shown that the OTAGO exercise program is safe for older adults. This program includes exercises to improve balance and strengthen muscles. Research shows it enhances mobility and reduces the risk of falls by 35-40%. The exercises are manageable, with no serious side effects reported. Participants can perform the routine at home, making it convenient and easy to follow. Overall, evidence suggests that OTAGO exercises are safe and effective for lowering the risk of falls in older adults. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the OTAGO exercises because they offer a fresh approach to preventing falls, especially in older adults. Unlike conventional physiotherapy, which is typically done in hospitals and focuses on general mobility exercises, OTAGO exercises are specifically designed to enhance balance, strength, and muscular endurance through a structured home-based program. This regimen includes targeted muscle strengthening and postural balance exercises, complemented by supervised group sessions in outdoor settings. By incorporating progressive resistance with free weights and encouraging regular walking, OTAGO exercises aim to provide a more comprehensive and engaging way to reduce fall risk compared to traditional methods.

What evidence suggests that this trial's treatments could be effective for preventing falls in older adults?

Research has shown that the Otago exercise program, which participants in this trial may receive, helps prevent falls in older adults. One study found that people who performed Otago exercises experienced 28% fewer injuries from falls. These exercises also improve balance and stability, which are crucial for reducing the risk of falling. Participants reported feeling less afraid of falling and enjoying a better quality of life. This evidence suggests that the Otago program can significantly help older adults stay safe and active. Meanwhile, another group in this trial will receive conventional physiotherapy at the hospital, the standard intervention in geriatric services. ^{1 2 6 7 8}

Who Is on the Research Team?

Sharlène Côté, MD

Principal Investigator

CIUSSS-SLSJ (La Baie Hospital)

Julie Bouchard, PhD

Principal Investigator

Université du Québec à Chicoutimi

Patrice Tremblay, PT

Principal Investigator

CIUSSS-SLSJ (La Baie Hospital)

Rubens da Silva

Principal Investigator

Université du Québec à Chicoutimi

Marie-Ève Langelier, MD

Principal Investigator

Université du Québec à Chicoutimi

Are You a Good Fit for This Trial?

This trial is for older adults with neuro-musculoskeletal disorders and a risk of falling, such as those with Parkinson's disease or chronic lower back pain. Participants should be experiencing issues that increase their chances of falls and may already be under geriatric care.

Inclusion Criteria

I can do exercises and tests to prevent falls on my own.

I am 65 years old or older.

I am admitted to La Baie Hospital for rehabilitation.

Exclusion Criteria

I was born with a spine deformity.

I had a stroke less than a week ago and am not yet stable.

I am receiving care to manage cancer symptoms.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Clinical Profile Creation

Create a clinical profile of patients in rehabilitation care from specialized geriatric services

4 weeks

Functional Deficit Diagnosis

Diagnose functional deficits using standardized tests and high-tech instruments

4 weeks

Treatment

Determine the effectiveness of the OTAGO exercise intervention program for falls prevention

12 weeks

2 visits per week (in-person)

Satisfaction and Long-term Impact Measurement

Measure client and professional team satisfaction as well as long-term impact of the new approach

6 months

Follow-up

Participants are monitored for safety and effectiveness after treatment

12 months

What Are the Treatments Tested in This Trial?

Interventions

• Conventional therapy
• OTAGO exercises

Trial Overview

The study tests a new exercise program called OTAGO against conventional therapy to manage fall risks in the elderly. It involves creating patient profiles, diagnosing functional deficits using high-tech tools, evaluating the effectiveness of OTAGO exercises, and assessing satisfaction.

How Is the Trial Designed?

Group I: Otago exercises Experimental Treatment 1 Intervention

OTAGO program - based on very specific exercises for balance, force, and muscular endurance as well as on education about the risk of falling. The program is considered as "home care" (exercises to be done at home) but will be done as a group and with supervision, at CIUSSS or from outdoor and nature intervention (recreactional parks). OTAGO session lasts for 30-40 minutes and will be done twice a week at sites with progression. The program is comprised of 5 muscle strengthening exercises and 12 postural balance exercises. Participants will also be invited to walk 2 times per week for 30 minutes (can be divided into shorter periods, for example 3 blocs of 10 minutes) from outdoor sites or recrative parks. According to each person's strength and mobility, exercises will be increased with the use of free weights (for example during squats) and/or by increasing the number of repetitions. Total duration of the program will be 3 months (i.e., a duration adapted to the site).

Group II: Conventional physiotherapy at Hospital Active Control 1 Intervention

This group will be for the conventional type of intervention already in place in geriatric services from La Baie Hospital. This therapy used for physiotherapists at site, including mobility exercices.

Conventional therapy is already approved in European Union, United States, Canada for the following indications:

Approved in European Union as Physical Therapy for:

• Fall Prevention
• Rehabilitation for Older Adults

Approved in United States as Exercise Programs for:

• Fall Prevention
• Balance Improvement
• Strength Training

Approved in Canada as Rehabilitation Therapy for:

• Fall Prevention
• Neuro-musculoskeletal Disorders

Who Is Running the Clinical Trial?

Université du Québec à Chicoutimi

Lead Sponsor

Trials

7

Recruited

320+

Agence de la Sante et des Services Sociaux du Saguenay-Lac-Saint-Jean

Collaborator

Trials

4

Recruited

1,600+

Published Research Related to This Trial

The Otago Exercise Program (OEP) was successfully adapted for American physical therapists (PTs), with modifications made to training materials to align with U.S. documentation and reimbursement practices, following feedback from 56 PTs during a pilot training.

Online training for the OEP was well-received by participants and effectively reached the target audience, although barriers such as lack of agency support and billing challenges were identified, indicating the need for further research on the program's implementation in practice.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Translation of the otago exercise program for adoption and implementation in the United States. Shubert, TE., Smith, ML., Ory, MG., et al.[2022]

The Otago exercise program (OEP) significantly improved physical performance and functional capacity in elderly participants, as evidenced by better scores in balance and mobility tests after six months of training.

OEP also led to a significant reduction in the incidence of falls among seniors with a history of falls, making it an effective home-based intervention for fall prevention in this population.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Randomized Control Trials on Otago Exercise Program (OEP) to Reduce Falls Among Elderly Community Dwellers in Shahroud, Iran. Dadgari, A., Aizan Hamid, T., Hakim, MN., et al.[2022]

The Otago Exercise Programme (OEP) is considered applicable and beneficial by physical therapists for older adults receiving formal home care, enhancing their physical function and mood.

Physical therapists believe that the OEP not only improves self-efficacy and social participation but also supports older adults in living independently for longer periods at home.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A qualitative study exploring physical therapists' views on the Otago Exercise Programme for fall prevention: a stepping stone to "age in place" and to give faith in the future. Cederbom, S., Bjerk, M., Bergland, A.[2022]

The Otago Exercise Program (OEP) significantly improves physical function and reduces fall risk among older adults, with a study involving 239 participants showing positive outcomes after 6 months.

Innovative delivery models using Certified Occupational Therapy Assistants and exercise physiologists, rather than solely physical therapists, can effectively implement the OEP, potentially making it more accessible and resource-efficient.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Otago Exercise Program: Innovative Delivery Models to Maximize Sustained Outcomes for High Risk, Homebound Older Adults. Shubert, TE., Goto, LS., Smith, ML., et al.[2022]

The Otago Exercise Program (OEP) can be effectively delivered through alternative models, such as the community OEP, which showed similar improvements in physical function compared to the traditional US OEP model, despite being implemented by non-physical therapists.

Participants in the community OEP experienced greater improvements in the Timed 'Up & Go' Test, suggesting that the exercise component is crucial for enhancing mobility and reducing fall risk, regardless of the delivery model.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Otago Exercise Program in the United States: Comparison of 2 Implementation Models. Shubert, TE., Smith, ML., Goto, L., et al.[2022]

The Otago Exercise Program (OEP) delivered via DVD is a useful tool for older adults to reduce falls, but participants found it too slow and low-energy for long-term engagement, indicating a need for more dynamic content.

While the program offers flexibility, personal health issues and daily life challenges hinder adherence, highlighting the importance of social support and motivation in maintaining an exercise routine.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Understanding the Experiences of Rural Community-Dwelling Older Adults in Using a New DVD-Delivered Otago Exercise Program: A Qualitative Study. Agha, A., Liu-Ambrose, TY., Backman, CL., et al.[2023]

The Otago exercise programme (OEP) significantly reduces the risk of death in older adults (aged 65+) living in the community, with a risk ratio of 0.45 over 12 months based on a review of seven trials involving 1503 participants.

The OEP also significantly lowers fall rates, with an incidence rate ratio of 0.68, indicating it is effective in preventing falls, although it does not significantly reduce the risk of serious injuries from falls.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Does the 'Otago exercise programme' reduce mortality and falls in older adults?: a systematic review and meta-analysis. Thomas, S., Mackintosh, S., Halbert, J.[2022]

Citations

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pmc.ncbi.nlm.nih.gov

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After one year, injuries due to falls were reduced by 28% in participants performing Otago exercises. The Otago exercise program was most effective at reducing ...

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The Otago Exercise Program's effect on fall prevention

The OEP intervention for osteoarthritis (OA) led to significant improvements in balance, stability, and fall efficacy over six months. However, it did not ...

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Efficacy of the Otago-Exercise-Programme to reduce falls in ...

The study found that the group and individual Otago Exercise Programme were equivalent in preventing falls over 12 months, though individual ...

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sciencedirect.com

sciencedirect.com/science/article/abs/pii/S2211034825001932

Efficacy of Otago exercise program on fear of falling and ...

The Otago exercise group demonstrated statistically significant improvements in balance, quality of life, reduced fear of falling and fatigue symptoms.

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Otago and Kitchen Sink Balance Exercises on Strength ...

The Otago Exercise Program is a fall prevention well designed program for older adults. It includes 17 strength and balance exercises and a ...

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ncoa.org/article/evidence-based-program-otago-exercise-program/

Evidence-Based Program: Otago Exercise Program

Studies demonstrate that OEP participants experience a 35 - 40% reduction in falls. The program is most effective for frail older adults. It is ...

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Tools to Implement the Otago Exercise Program

Otago began in New Zealand and was developed, tested, and demonstrated to be most effective for reducing falls and fall-related injuries among high risk ...