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The long-term goal of this project is to effectively bridge the research-clinic-community gap and to foster partnerships that support the implementation, utilization, and advocacy of evidence-based fall prevention programs in the older adult community. The Otago Exercise Program (OEP) is an evidence-based fall prevention program that has been shown to reduce falls and fall-related injuries among older adults. Traditionally, OEP is delivered in the home by a physical therapist and focuses on muscle strengthening and balance training. Despite its proven effectiveness, adherence and compliance rates have been low. The personnel and resource demands of program delivery, along with challenges in monitoring participant adherence, represent significant barriers to broader implementation. Alternative delivery systems using remote and community-based platforms may help address these limitations.
Specific Aim 1: To compare the effectiveness of two delivery modes of the Otago Exercise Program: a remotely delivered, home-based smartphone program and an in-person, community-based program.
Specific Aim 2: To examine the feasibility, acceptability, and usability of the Otago Exercise Program delivered through both smartphone-based and in-person formats.
Thirty eligible participants will provide written informed consent prior to enrollment. In accordance with the World Guidelines for Falls Prevention, participants will be stratified into low-, intermediate-, and high-risk groups. Following the first visit assessment, older adults classified as intermediate or high risk will be randomly assigned to one of two intervention groups: (1) a remotely delivered, smartphone- based Otago Exercise Program, or (2) an in-person, community-based Otago Exercise Program.
Participants in both groups will receive individualized 60-minute training sessions, two times per week for eight weeks. Across the sixteen training sessions, participants will receive a progressive balance, mobility, and strengthening program following the structure of the Otago Exercise Program.
Prior to and immediately following the exercise program, participants are asked to complete several surveys and evaluations, including: demographics, STEADI-12, SF-36, Geriatric Depression Scale (GDS), Falls Efficacy Scale-International (FES-I), Four-Square Stepping Test, Timed Up and Go Test (TUG), Ten-meter Walk Test, Four-Stage Balance Test, 30-second chair stand, and the Physiological Profile Assessment (PPA). All outcome measures will be collected at baseline and at the end of the intervention, with testers blinded to participant group allocation, and trainers blinded to baseline outcomes. In addition, gait speed will be assessed weekly using smartphone-based measurements.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Smartphone In-home Delivery | Experimental | In-home 8-week OTAGO program |
|
| Group In-Person Delivery | Active Comparator | In-Person 8-week Group OTAGO Program |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Smartphone-Based Intervention | Behavioral | Participants in the smartphone-based group will receive Otago Exercise Program instructions delivered through Improve, an investigator-developed application. This application, installed on each participant's iOS or Android smartphone, will allow participants to track their exercises and review workout instructions. Participants in the smartphone-based group will be contacted weekly by phone to ensure safety and adherence and to assist with troubleshooting any technology-related issues. All participants will be instructed to maintain their usual activity patterns and to refrain from initiating any new structured physical activity programs during the 8-week study period. Participants will be directed by Doctor of Physical Therapy students under the supervision of a licensed Physical Therapist, with weekly phone check-ins. |
| Measure | Description | Time Frame |
|---|---|---|
| Gait Velocity | Self-selected walking speed (m/s) over level surface | Baseline (Day 0) and 1 week post-training (9 weeks later) |
| Measure | Description | Time Frame |
|---|---|---|
| Injurious Falls | Self-reported falls that lead to injury requiring clinical evaluation | Up to 1-year post intervention |
| PPA-Short Form: Postural Sway | Sway Area (units: mm^2) while standing quietly for 30 seconds |
| Measure | Description | Time Frame |
|---|---|---|
| Four square step test | Time to complete a clockwise and counterclockwise stepping into four quadrants | Baseline (Day 0) and 1 week post-training (9 weeks later) |
| Frailty | Physical Frailty Phenotype, reported on a scale of 0-5. A higher score indicates increased frailty. |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Vipul Lugade, PhD | Contact | 16077774700 | vlugade@binghamton.edu | |
| Patima Silsupadol, PT, PhD | Contact | patimas@binghamton.edu |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Binghamton University | Recruiting | Binghamton | New York | 13902 | United States |
No identifying information will be shared.
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| ID | Term |
|---|---|
| D020233 | Gait Disorders, Neurologic |
| ID | Term |
|---|---|
| D009461 | Neurologic Manifestations |
| D009422 | Nervous System Diseases |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
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| Group-Based Intervention | Behavioral | Participants in the in-person, community-based group will complete the individualized Otago Exercise Program in a group setting at the Johnson City Senior Center, under the guidance of Doctor of Physical Therapy students (4) and supervision of licensed Physical Therapists. |
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| Baseline (Day 0) and 1 week post-training (9 weeks later) |
| PPA-Short Form: Finger Reaction Time | Simple reaction time (units: msec) | Baseline (Day 0) and 1 week post-training (9 weeks later) |
| PPA-Short Form: Knee Extensor Strength | Maximum isometric knee extensor force (kg) | Baseline (Day 0) and 1 week post-training (9 weeks later) |
| PPA-Short Form: Visual Contrast Sensitivity | Melbourne Contrast Sensitivity (db), on a scale of 0-24 | Baseline (Day 0) and 1 week post-training (9 weeks later) |
| PPA-Short Form: Proprioception | Degrees offset in foot positioning | Baseline (Day 0) and 1 week post-training (9 weeks later) |
| 30-second Chair Stand | Number of chair rises in 30-seconds | Baseline (Day 0) and 1 week post-training (9 weeks later) |
| TUG | Timed up and go test. Rise from a chair, walk 3-meters, turn, and return walk, and sit back down at self-selected speed | Baseline (Day 0) and 1 week post-training (9 weeks later) |
| Four-Stage Balance | Total time to stand in side-to-side, semi-tandem, tandem, one-leg stance. | Baseline (Day 0) and 1 week post-training (9 weeks later) |
| Smartphone-based assessments | Self-evaluated walking speed as performed by participants at home | Weekly during 8-week training program |
| Baseline (Day 0) and 1 week post-training (9 weeks later) |
| Self-reported Assessment: Enjoyment | Participant report of enjoyment, usability, and feasibility of the exercise program (1-5 scale), where higher scores indicate increased self-report. | At study completion, or on average 1 week post-training |
| SF-36 | Short-form health survey to evaluate participant self-reported health quality of life. | Baseline (Day 0) and 1 week post-training (9 weeks later) |
| STEADI | Self-report (0 to 14-point scale), where increased scores indicate increased fall risk. | Baseline (Day 0) and 1 week post-training (9 weeks later) |