Effectiveness of a Group Exercise Class vs. Home Exercise Program as a Follow-up to Physical Therapy for Older Adults with High Fall Risk

Martha Hinman (School of Physical Therapy, Anderson University, Greenville, SC, USA)
Patrice Hazen (GroupHab Physical Therapy and Wellness, Simpsonville, SC, USA)

Abstract


This quasi-experimental study compared the results of a traditional model of physical therapy (PT) care to a PT wellness model known as GroupHab. The traditional model included discharge from PT with a home exercise program (HEP) to be self-administered with or without the addition of a community-based exercise program. The wellness model included participation in a PT-designed and supervised group exercise program (GroupHab class) in an outpatient clinical setting following discharge from PT. Independent t-tests were used to compare the number of falls, exercise frequency, and exercise duration between the two groups. A repeated measures, analysis of variance (RM-ANOVA) compared changes in balance confidence scores both within and between groups, and a multivariate analysis of variance (MANOVA) analyzed group differences across multiple quality of life ratings using the SF-20. All data were analyzed at the 0.05 alpha level using SPSS 24 statistical software. Our results showed a significantly greater reduction in recurrent falls among the GroupHab wellness group compared to the HEP group (t=2.811, p=0.009). The resulting odds ratio for subsequent falls was 2.2 among HEP participants and 0.2 among GroupHab participants. Exercise adherence was also greater for those who participated in the GroupHab class They documented greater exercise frequency (t= -3.253, p=0.002) and more exercise minutes (t= -7.188, p<0.001) than those who participated in the HEP. When comparing changes in the participants’ balance confidence, we found an average increase of 5% among GroupHab participants compared to a 6% decrease among HEP participants (F=16.877, p<0.001, power=0.981). Although our multivariate analysis of the SF-20 scores revealed no significant difference overall (F=0.768, p=0.73), the univariate analyses showed significantly greater improvements among GroupHab participants in selected areas of physical function. These results suggest that at-risk older adults who are discharged into a functionally-based group exercise class are less likely to experience recurrent falls more likely to have more confidence in their balance than those who are discharged with a standard HEP and/or use of community-based exercise classes.  


Keywords


Fall prevention, Balance confidence, Exercise adherence, Quality of life, Physical therapy, Physiotherapy

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References


United States Census Bureau (2018 March 13). Older people projected to outnumber children for the first time in history [R]. Census Bureau Website. https://www.census.gov/newsroom/press-releases/2018/cb18-41-population-projections.html. Retrieved August 21, 2020.

National Institute of Aging. (2017 May 17) Supporting patients with chronic conditions [R]. U.S. Department of Health and Human Resources

https://www.nia.nih.gov/health/supporting-older-patients-chronic-conditions Retrieved August 21, 2020.

National Council of Aging. Fall prevention facts [R]. https://ncoa.org/news/resources-for-reporters/get-the-facts/falls-prevention-facts. Retrieved August 21, 2020.

Vellas BJ, Wayne SJ, et al. Fear of falling and restriction of mobility in elderly fallers [J]. Age Ageing. 1997; 26:189-193. DOI: 10.1093/ageing/26.3.189

Dipietro L, Campbell WW, Buchner DM, et al. Physical activity, injurious falls, and physical function in again: an umbrella review [J]. Med Sci Sports Exerc. 2019; 51(6):1303-1313. DOI: 10.1249/MSS.0000000000001942

Kaiser Family foundation (2019, August 20). Facts on Medicare Spending and Financing [R]. https://www.kff.org/medicare/issue-brief/the-facts-on-medicare-spending-and-financing/. Retrieved August 21, 2020.

Wolf B, Feys H, De Weerdt, et al. Effect of a physical therapeutic intervention for balance problems in the elderly: a single-blind, randomized, controlled multicenter trial [J]. Clin Rehabil. 2001;15(6):624–636. DOI: 10.1191/0269215501cr456oa

Hauer K, Specht N, Schuler M, Bartsch P, Oster P. Intensive physical training in geriatric patients after severe falls and hip surgery [J]. Age Ageing. 2002;31(1):49–57. DOI:10.1093/ageing/31.1.49

Timonen L, Rantanen T, Ryynanen OP, et al. A randomized controlled trial of rehabilitation after hospitalization in frail older women: effects on strength, balance and mobility [J]. Scand J Med Sci Sport. 2002;12(3):186–192. DOI:10.1034/j.1600-0838.2002.120310.x

Forkan R, Pumper B, et al. Exercise adherence following physical therapy intervention in older adults with impaired balance [J]. Phys Ther. 2006;86(3):401-410. DOI: 10.1093/ptj/86.3.401

Landry MD, Hack LM, Coulson E, et al. Workforce projections 2010-2020: annual supply and demand forecasting models for physical therapists across the United States [J]. Phys Ther. 2016;96(1):71-80. DOI: 10.2522/ptj.20150010

Zimbelman JL, Juraschek SP, Zhang X, Lin VW. Physical therapy workforce in the United States: forecasting nationwide shortages [J]. Phys Med Rehabil. 2010;2:1021-1029. DOI: 10.1016/j.pmrj.2010.06.015

Aguirre LE, Villareal DT. Physical exercise as therapy for frailty [J]. Nestle Nutr Inst Workshop Ser. 2015;83:83-92. DOI: 10.1159/000382065

Mitros M. Evaluation of the stay in balance wellness program: An interdisciplinary, multi-component falls prevention program. [M] [Order No. 3425794]. Arizona State University; 2010.

Toto PE, Raina KD, et al. Impact of a multi-component exercise and physical activity program for sedentary, community-dwelling, older adults [J]. J Aging Phys Act. 2012;20(3):363-378. DOI: 10.1123/japa.20.3.363

Fougère B, Morley JE, et al. Interventions against disability in frail older adults: Lessons learned from clinical trials [J]. J Nutr Health Aging. 2018;22(6):676-688.

Gallagher KM, PhD. Helping older adults sustain their physical therapy gains: A theory-based intervention to promote adherence to home exercise following rehabilitation. J Geriatr Phys Ther. 2016;39(1):20. DOI: 10.1007/s12603-017-0987-z

Powell L, Myers A. The Activities-specific Balance Confidence (ABC) Scale [J]. J Gerontol Med Sci. 1995:M28–M34. DOI: 10.1093/gerona/50a.1.m28

Myers A, Powell L, et al. Psychological indicators of balance confidence: relationship to actual and perceived abilities [J]. J Gerontol Med Sci. 1996;51A:M37–M43. DOI: 10.1093/gerona/51a.1.m37

Carver, D.J., C.A. Chapman, V.S. Thomas, K.J. Stadnyk and K. Rockwood. Validity and reliability of the Medical Outcomes Study Short Form-20 questionnaire as a measure of quality of life in elderly people living at home [J]. Age Ageing. 1999; 28: 169-17. DOI: 10.1093/ageing/28.2.169

American Physical Therapy Association Section on Geriatrics. June 2010, Exercise and Physical Activity and Aging Conference (ExPAAC) [C]. Indianapolis, IN.

Crandall S, Howlett S, Keysor JJ. Exercise adherence interventions for adults with chronic musculoskeletal pain [J]. Phys Ther. 2013; 93(1):17–21. DOI: 10.2522/ptj.20110140

Boutaugh ML. Arthritis Foundation community-based physical activity programs: effectiveness and implementation issues [J]. Arthritis Care Res. 2003;49:463–470. DOI: 10.1002/art.11050

Centers for Disease Control and Prevention. Increasing physical activity: a report on recommendations of the Task Force on Community Preventive Services [R]. MMWR: Morb Mortal Wkly Rep. 2001;50(RR-18):1–14.



DOI: https://doi.org/10.30564/jgm.v2i2.2310

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