RESEARCH ARTICLE
The Otago Exercise Program Performed as Group Training Versus Home Training in Fall-prone Older People: A Randomized Controlled Trial Ingebjørg L. Kyrdalen1*, Kjersti Moen1, Anne Sofie Røysland1 & Jorunn L. Helbostad2,3 1
Vestfold Regional Hospital, Geriatric Ward, Tønsberg, Norway
2
Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
3
Clinic for Clinical Services, St. Olavs University Hospital, Trondheim, Norway
Abstract Background and Purpose. Exercise programs targeting muscle strength and balance can reduce falls. The study aimed to compare the Otago Exercise Program (OEP), originally designed as supervised home training (HT), with the same programme performed as GT, on functional balance and muscle strength, mobility, fall efficacy and self-reported health. Methods. A single-blind randomized controlled trial with assessments at baseline (T1), following the 12-week intervention (T2), and 3 months following intervention (T3), was performed. 125 people, mean age 82.5 (SD = 5.7) years, 73% women, referred to a Falls Outpatient Clinic, participated. 74% had fallen, and 37% had a fall-related hospital stay during the previous year. OEP supervised by physiotherapists was performed as GT twice weekly or as HT three times a week, for 12 weeks. Total exercise time was comparable between groups. The primary outcome was the Berg Balance Scale assessed at T2. Results. From T1–T2, Berg Balance Scale improved significantly more in the GT group than in the HT group (mean group difference in change of 3.2 points, 95%CI = 0.7–5.8, p = 0.014). Of the secondary outcomes, the 30second sit-to-stand test (p = 0.004), and physical health measured by the Short Form-36 (p = 0.004), improved significantly more for the GT group. Change in mobility measured by the Timed Up and Go test, mental health by the Short Form-36, and fall efficacy by the Fall Efficacy Scale International did not differ between groups. The 30-second sit-tostand test and the Timed Up and Go, but not the Berg Balance Scale, was still better in the GT group at T3. Discussion. In fall-prone home-dwelling older people, the OEP performed as GT is more effective for improving functional balance, muscle strength and physical health, but not fall efficacy and mental health than when performed as HT. The OEP provided as GT should be considered in this population. Copyright © 2013 John Wiley & Sons, Ltd. Received 16 July 2013; Revised 17 October 2013; Accepted 4 November 2013 Keywords accidental falls; exercise; frail elderly; motor performance *Correspondence Ingebjørg L. Kyrdalen, PT, BSc, Service of physiotherapy and occupational therapy, Sande Community, Vestfold, PO box 300, N-3071 Sande, Vestfold, Norway. E-mail: [email protected] TRIAL REGISTRATION: ClinicalTrial.govRecord 6.2008.1352. Published online 11 December 2013 in Wiley Online Library (wileyonlinelibrary.com) DOI: 10.1002/pri.1571
Introduction Home and group exercises targeting muscle strengthening and balance retraining have been found to be 108
effective in reducing falls when compared with no or sham intervention (Sherrington et al., 2008; Gillespie et al., 2012). The Otago Exercise Program (OEP), a Physiother. Res. Int. 19 (2014) 108–116 © 2013 John Wiley & Sons, Ltd.
I. L. Kyrdalen et al.
home-based supervised, progressive balance and muscle strengthening program run for 12 months, is one of the best documented falls prevention exercise programs (Campbell et al., 1997, 1999; Robertson et al., 2001). Other benefits of the OEP include improved mobility and executive function (Liu-Ambrose et al., 2008). Studies on older people with increased risk of falling show conflicting results on whether group training (GT) is more effective than home training (HT) (Helbostad et al., 2004a, 2004b; Cyarto et al., 2008). Older homedwelling people with functional impairments have difficulties in getting out on their own and are thereby at risk of inactivity, functional decline, falling and social isolation. In order to improve outcomes in these people, it may be more appropriate to run exercise programs in a group setting. To our knowledge, OEP performed as group-training has not been evaluated. However, in a study by Skelton et al., 2005, a once-a-week group program used the OEP as additional HT. The study demonstrated reduced falls and improved motor performance compared with sham home exercise. The present study aimed to compare the effect of the OEP run for 12 weeks as supervised GT with HT in home-dwelling older people at high risk of falling. The original OEP protocol was used apart from the shortened duration. The primary outcome was functional balance. Secondary outcomes included functional muscle strength, mobility, fall efficacy and self-reported health. We hypothesized that GT would improve functional balance more than the same exercises performed as HT. An additional aim was to assess sustainability of effect of the intervention 3 months after cessation of training.
Methods Study design The study was a single-blind randomized clinical trial with parallel groups. Assessors were blinded to participants’ group assignment. The study was performed and reported in concordance with the CONSORT statement (Moher et al., 2010), it adhered to the principles of the Declaration of Helsinki, and was approved by the Regional Committee for Medical and Health Research and the Norwegian Social Science Data Service. Written informed consent was collected from all participants. A Web-based block randomization procedure with varying group size, developed by the Applied Clinical Research Unit at the Norwegian University of Science and Technology, was used. Physiother. Res. Int. 19 (2014) 108–116 © 2013 John Wiley & Sons, Ltd.
Otago Exercise Program as Group or Home Training
Sample Older people referred to a Falls Outpatient Clinic were eligible for inclusion if they were home-dwelling in 11 communities in the southeast of Norway and living a maximum distance of 45 km from the hospital. During the visit to a Falls Outpatient Clinic, patients underwent an interdisciplinary geriatric assessment and were screened for fall-risk by a geriatrician and a physiotherapist using the following criteria: 1) had fallen at least once during the previous 12 months; 2) had self-reported balance or gait problems; 3) had Parkinson’s disease or had suffered a stroke; 4) had four or more concomitant diseases; 5) needed a handrail or support while rising from a chair; 6) used four or more prescribed medications; 7) had reduced cognitive function as assessed by a geriatrician; 8) had body mass index
The Otago Exercise Program Performed as Group Training Versus Home Training in Fall-prone Older People: A Randomized Controlled Trial Ingebjørg L. Kyrdalen1*, Kjersti Moen1, Anne Sofie Røysland1 & Jorunn L. Helbostad2,3 1
Vestfold Regional Hospital, Geriatric Ward, Tønsberg, Norway
2
Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
3
Clinic for Clinical Services, St. Olavs University Hospital, Trondheim, Norway
Abstract Background and Purpose. Exercise programs targeting muscle strength and balance can reduce falls. The study aimed to compare the Otago Exercise Program (OEP), originally designed as supervised home training (HT), with the same programme performed as GT, on functional balance and muscle strength, mobility, fall efficacy and self-reported health. Methods. A single-blind randomized controlled trial with assessments at baseline (T1), following the 12-week intervention (T2), and 3 months following intervention (T3), was performed. 125 people, mean age 82.5 (SD = 5.7) years, 73% women, referred to a Falls Outpatient Clinic, participated. 74% had fallen, and 37% had a fall-related hospital stay during the previous year. OEP supervised by physiotherapists was performed as GT twice weekly or as HT three times a week, for 12 weeks. Total exercise time was comparable between groups. The primary outcome was the Berg Balance Scale assessed at T2. Results. From T1–T2, Berg Balance Scale improved significantly more in the GT group than in the HT group (mean group difference in change of 3.2 points, 95%CI = 0.7–5.8, p = 0.014). Of the secondary outcomes, the 30second sit-to-stand test (p = 0.004), and physical health measured by the Short Form-36 (p = 0.004), improved significantly more for the GT group. Change in mobility measured by the Timed Up and Go test, mental health by the Short Form-36, and fall efficacy by the Fall Efficacy Scale International did not differ between groups. The 30-second sit-tostand test and the Timed Up and Go, but not the Berg Balance Scale, was still better in the GT group at T3. Discussion. In fall-prone home-dwelling older people, the OEP performed as GT is more effective for improving functional balance, muscle strength and physical health, but not fall efficacy and mental health than when performed as HT. The OEP provided as GT should be considered in this population. Copyright © 2013 John Wiley & Sons, Ltd. Received 16 July 2013; Revised 17 October 2013; Accepted 4 November 2013 Keywords accidental falls; exercise; frail elderly; motor performance *Correspondence Ingebjørg L. Kyrdalen, PT, BSc, Service of physiotherapy and occupational therapy, Sande Community, Vestfold, PO box 300, N-3071 Sande, Vestfold, Norway. E-mail: [email protected] TRIAL REGISTRATION: ClinicalTrial.govRecord 6.2008.1352. Published online 11 December 2013 in Wiley Online Library (wileyonlinelibrary.com) DOI: 10.1002/pri.1571
Introduction Home and group exercises targeting muscle strengthening and balance retraining have been found to be 108
effective in reducing falls when compared with no or sham intervention (Sherrington et al., 2008; Gillespie et al., 2012). The Otago Exercise Program (OEP), a Physiother. Res. Int. 19 (2014) 108–116 © 2013 John Wiley & Sons, Ltd.
I. L. Kyrdalen et al.
home-based supervised, progressive balance and muscle strengthening program run for 12 months, is one of the best documented falls prevention exercise programs (Campbell et al., 1997, 1999; Robertson et al., 2001). Other benefits of the OEP include improved mobility and executive function (Liu-Ambrose et al., 2008). Studies on older people with increased risk of falling show conflicting results on whether group training (GT) is more effective than home training (HT) (Helbostad et al., 2004a, 2004b; Cyarto et al., 2008). Older homedwelling people with functional impairments have difficulties in getting out on their own and are thereby at risk of inactivity, functional decline, falling and social isolation. In order to improve outcomes in these people, it may be more appropriate to run exercise programs in a group setting. To our knowledge, OEP performed as group-training has not been evaluated. However, in a study by Skelton et al., 2005, a once-a-week group program used the OEP as additional HT. The study demonstrated reduced falls and improved motor performance compared with sham home exercise. The present study aimed to compare the effect of the OEP run for 12 weeks as supervised GT with HT in home-dwelling older people at high risk of falling. The original OEP protocol was used apart from the shortened duration. The primary outcome was functional balance. Secondary outcomes included functional muscle strength, mobility, fall efficacy and self-reported health. We hypothesized that GT would improve functional balance more than the same exercises performed as HT. An additional aim was to assess sustainability of effect of the intervention 3 months after cessation of training.
Methods Study design The study was a single-blind randomized clinical trial with parallel groups. Assessors were blinded to participants’ group assignment. The study was performed and reported in concordance with the CONSORT statement (Moher et al., 2010), it adhered to the principles of the Declaration of Helsinki, and was approved by the Regional Committee for Medical and Health Research and the Norwegian Social Science Data Service. Written informed consent was collected from all participants. A Web-based block randomization procedure with varying group size, developed by the Applied Clinical Research Unit at the Norwegian University of Science and Technology, was used. Physiother. Res. Int. 19 (2014) 108–116 © 2013 John Wiley & Sons, Ltd.
Otago Exercise Program as Group or Home Training
Sample Older people referred to a Falls Outpatient Clinic were eligible for inclusion if they were home-dwelling in 11 communities in the southeast of Norway and living a maximum distance of 45 km from the hospital. During the visit to a Falls Outpatient Clinic, patients underwent an interdisciplinary geriatric assessment and were screened for fall-risk by a geriatrician and a physiotherapist using the following criteria: 1) had fallen at least once during the previous 12 months; 2) had self-reported balance or gait problems; 3) had Parkinson’s disease or had suffered a stroke; 4) had four or more concomitant diseases; 5) needed a handrail or support while rising from a chair; 6) used four or more prescribed medications; 7) had reduced cognitive function as assessed by a geriatrician; 8) had body mass index
