DR KATE SCRIVENER1,2, NICHOLAS YOUNG2, BRETT GREELY1, MATTHEW HEIDEMA1 AND KATHERINE ALAVA-BRAVO2

1. Macquarie University

2. Concentric Rehabilitation Centre

Exercise-based Physiotherapy in residential aged care: feasibility, outcomes and satisfaction

Ageing population

Increased population living in Residential Aged Care Facilities

Increased Care costs

Background

2

Role for Physiotherapy

Limited funding

Figure adapted from: https://stock.adobe.com/ee/images/medical-pills-and-money-health-care-cost-cost-of-medicine/65222473

• Declines attenuated• Improved strength and

balance• Lessen carer burden

• Exercise based physiotherapy interventions improve:

• Strength

• Balance

• Physical function and mobility

• Physiotherapy has the potential to:

• Attenuate functional decline

• Reduce care burden

• Slow increasing health care costs

Background: Exercise for aged care residents

3

1. Chou et al. (2012) Archives of physical medicine and rehabilitation. 93(2):237-244.

2. Valenzuela et al. (2012) Journal of the American Medical Directors Association. 13(5):418-

428. .

3. Forster (2010) Age and ageing. 39(2):169-175.

4. Hewitt et al. (2018) Journal of the American Medical Directors Association. 19(4):361-369.

• Centres that are co-located

within an aged care facility

• Low cost access to ongoing

rehabilitative programs

Concentric Rehabilitation Centre

FACULTY OF MEDICINE AND HEALTH SCIENCES

DEPARTMENT OF HEALTH PROFESSIONS | DISCIPLINE OF PHYSIOTHERAPY4

The specific research aims were to

document:

1. Acceptability of an on-site RACF

exercise-based physiotherapy

program

2. Physical ability and quality of life

before and after participating in an

on-site exercise-based

physiotherapy program

Aims

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- Residents of Opal Cardinal

Freeman Aged Care Facility

- Opted to participate in Opal

Rehabilitation Package

(Physiotherapist-led exercise

program)

- Able to safely participate in

exercise

Methods - Participants and recruitment

6

Initial assessment by physiotherapist - participants divided into one of three program types:

1. Orthopaedic

2. Functionality

3. Falls and Balance

Combination of weekly group and individual sessions with a physiotherapist depending on

resident function

Methods - Study Protocol

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Ongoing enrolment

(January 2018)

Initial Assessment & Outcome Measures

Ongoing physiotherapy

exercise sessions

Outcome measures re-assessed at 6

months

Final Data Collection

(March 2019)

Orthopaedic

* 3 sessions per fortnight

* Combination of groups and 1-1 training

Functionality

* Weekly 1-1 sessions

Falls and Balance

* 2 weekly group classes

Methods - Programs

FACULTY OF MEDICINE AND HEALTH SCIENCES

DEPARTMENT OF HEALTH PROFESSIONS | DISCIPLINE OF PHYSIOTHERAPY8

Walking Speed

Methods - Physical outcome measures

9

https://bit.ly/2DjKAC2

Timed Up and Go (TUG)

https://bit.ly/2OH21OM

5 Meter Walk Test

https://bit.ly/2FnpmpH

Ability to stand &

Walking Speed recorded in

metres per second (m/s)

Time recoded in seconds

Number of steps counted Recorded as a yes/no criterion

Ability to stand unsupported

http://bit.ly/2FvKuaJ

1. Kuys et al. (2014) J Am Med Dir Assoc.15(3):194-200.

2. Brooks et al. (2006) Archives of physical medicine and rehabilitation. 87(1):105-110.

3. Cruz-Jentoft et al. (2010). Age and ageing. 39(4):412-423.

4. Peters et al. (2013) Journal of geriatric physical therapy. 36(1):24-30.

Functional Mobility Balance

Methods – Satisfaction and quality of life measures

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• Purpose built satisfaction

survey

• Exercise Self-Efficacy Scale

• London Handicap Scale

• Community Integration Measure

39 participants

Average Age: 83 years (range 45 – 103)

Gender: 68% female

Moderate to Severe Cognitive Impairment: 63%

Assistance of 1 or more for mobilisation: 61%

Results

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PARTICIPANTS

Results

12

9792

0

10

20

30

40

50

60

70

80

90

100

Said the program was worth their time Would recommend the program to others

• Average number of exercise

sessions per week = 1.5 (SD 0.6)

• 94% compliance with session

attendance (SD 42%)

• No withdrawals from the program

• High satisfaction on survey results

Results

Social Atmosphere Improved Mobility Staff expertise“Social aspects, excellent

physios (great staff)”

“It has greatly helped with

my severe pain. It has also

greatly improved my mobility

both in and out of the

residence”

“The caring and respectful

approach of staff. The leader

treats the whole person, the

cheerful atmosphere and

gentle supervision”

“Worth it to come, you can

meet people there”

“I would advise other

residents to participate in

rehab. It can have many

great benefits. I with physio,

was able to walk again after

months of being immobile

and having lost my

confidence”

“Variety of exercises,

awareness of my limitations,

pleasant staff”

FACULTY OF MEDICINE AND HEALTH SCIENCES

DEPARTMENT OF HEALTH PROFESSIONS | DISCIPLINE OF PHYSIOTHERAPY13

Key themes from participant feedback:

• Majority of participants improved their walking speed (55%)

• Mean change in walking speed was an improvement of 0.04

metres per second (SD 0.22)

• No overall difference in walking speed from initial to final

assessment (MD -0.2, 95% CI -0.1 to 0.07, p = 0.7)

Results

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WALKING SPEED

https://bit.ly/2OH21OM

• No difference in participants ability

to stand up from a chair or stand

unsupported for 10 seconds between

initial and final assessments

• No difference in timed up and go

(TUG) test times from initial to final

assessment (MD 4.5, 95% CI -3.1 to

12, p = 0.2)

Results

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https://bit.ly/2DjKAC2

https://bit.ly/2FnpmpH http://bit.ly/2FvKuaJ

Timed Up and Go (TUG)

Ability to stand & Ability to stand unsupported

Results – Quality of life measures

• No change from baseline scores

• Presence of chronic pain associated

with a higher final LHS score (p=0.03)

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Initial

score

Mean

(SD)

Final

Score

Mean

(SD)

Mean difference

p-value

Community

Integration

Measure (/50)

38 (6) 39 (7) +1

p=0.46

Exercise Self

Efficacy Scale

(/40)

London Handicap

Scale (/1)

25 (7)

0.6

(0.1)

25 (8)

0.6 (0.1)

0

p=0.95

0

p=0.71

Note: SD = Standard deviation

• More sessions per week

associated with greater change in

walking speed (R2 = 24%, p<0.01)

• More sessions per week

associated with a better final London

Handicap Scale score (p=0.01)

Results

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• The mean change in walking speed was an

improvement of 0.04m/s (SD 0.22)

• This is despite the evidenced expected decline in gait

speed of 0.03 – 0.05 m/s per year1,2

• More sessions per week associated with better walking

and quality of life

Discussion

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1. Auyeung et al. (2014) Geriatrics & gerontology international. 14:76-84.

2. Onder et al. (2002) The Journals of Gerontology Series A: Biological Sciences and Medical

Sciences. 57(5):M289-M293.

• Physiotherapist-led exercise programs

are acceptable and feasible for

residents of aged care facilities

• Exercise can maintain or improve the

physical outcomes of aged care

residents reversing the expected

decline in physical function

Conclusion

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