Training Physical Therapists
in Evidence-Based
Outcome Measures
The
Otago Exercise Program
Training Webinar
April 17, 2013
Tiffany E. Shubert, PhD, MPT
Carolina Geriatric Education Center
1
Acknowledgements
• Carolina Geriatric Education Consortium
– Content
– Webinar Platform
• Eastern Area Health Education Center
– Contact Hours
– Archived webinar
2
What we want to understand about
the Otago Exercise Program
• The research & rollout in
the US
• How to implement
• Discuss evidence-based
protocols for outcome
measures
• How to use the database
to track patient outcomes
3
US Implementation
1. CDC identifies Otago as an
evidence-based fall prevention program
1. CDC Pilots in CO, NY, OR
2. Online training program
3. CDC Partners, Policies, and Programs for Fall
Prevention
4. Evaluation of implementation
4
Otago – True or False?
• You must start Otago on Day 1
• You have to prescribe all 17 exercises on Day 1
• You need to modify the exercises for your
patient
• Your patient will not succeed if you see them
so infrequently
• But my exercises are better than Otago…
5
Myths of Standardization & Variation
6
Otago – In a nutshell
• Evidence-based fall prevention program from
New Zealand
• 6 – 8 visits over a year
• Standard set of balance and strength exercises
• Best for community-dwelling but frail
• Patient does exercises INDEPENDENTLY
• Progressed by physical therapist
• 30-40% reduction in falls in high risk fallers
• Can it work in the United States?
7
Before You Start
• Is the patient ready?
• Is the patient compliant?
• Do we start on day 1???
8
Before You Start
• Is the therapist ready?
• Is the therapist
compliant?
• Is the therapist proficient
in the outcome measures?
• Has the therapist
registered with the
database?
• Has the therapist
registered the patient
with the database?
9
Quick Review –
Outcome Measures
•
•
•
•
Timed Up and Go
30-second Chair Rise
Standing balance sequence
Walking speed*
– Walking speed is optional, only input if your
agency already collects the data
http://www.cdc.gov/homeandrecreationalsafety/Fal
ls/steadi/videos.html#TUG
10
Let’s go!
• Register your patient
(anytime before start)
• Enter baseline info
(Otago Day 1)
• Follow up info
@ 8 weeks & 6 months
• Discharge when
appropriate
11
Otago Visit 1
• What info is
collected?
• What happens?
• When is next visit?
12
Otago Visits
PT Management Phase
Month
Week
1
1
2
Initial Visit
Self- Management Phase
2
3
3
4
6
8
Visit
Visit*
Visit
7
8
9
5
6
Visit
Call
Month
4
10
Call
Call
11
12
Week
Visit
Visit
Call
Call
Call
13
Visit 4 and After
•
•
•
•
Visit 4 – Outcome measures
Phone calls
Visits 5, 6, 7 (Months 6, 9 , 12)
Final Otago Visit/Discharge:
– Discharge at 12-Month point or
WHEN APPROPRIATE
– When to discharge:
• Patient no longer challenged
by Otago OR
• Patient mastered exercises
and independently exercising
6 days per week OR
• Patient met goals
• Resources and Reminders
14
Reminders and Resources
•
•
•
•
Phone calls
Email reminders
Where to go if you have questions
www.Phconnect.org
15
How am I doing?
• You (or your agency) can request
– Average number of visits
– Improvements in outcome measures
– Fall history
16
Summary
• Provide your email to access the database
• You will receive an email inviting you to join
• For each patient
– Enter into the database
– Complete Patient Information and Baseline Survey
tabs within 5 days of starting Otago
– Receive e-mail reminders for 3-Month 6-Month
Follow-Up visits
– Complete Discharge Survey when patient is
discharged from Otago (can be done at ANY time)
17
Questions?
• otago@unc.edu
• Phconnect.org
• 919-360-1970 if
you get really
stuck!
18
Appendix
• Screen shots to demonstrate database use
19
OTAGO EXERCISE PROGRAM:
Outcome Measures Database
Form Completion
• Navigation
• Instructions to Therapist
20
21
22
23
24