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Rehabilitation, reablement and restorative care
Technology in aged care
Workforce training
Grant Funding Round 2
POSTED 17 Jul 2023

Improving mobility in aged care with telehealth physiotherapy: an effectiveness and implementation randomised controlled trial (The TOP UP Study)

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The University of Sydney in partnership with The Frank Whiddon Masonic Homes of NSW and Uniting Agewell Ltd has been awarded an ARIIA grant for their ‘Improving mobility in aged care with telehealth physiotherapy: an effectiveness and implementation randomised controlled trial (The TOP UP Study)’ project. 

Over 1 million Australians live in residential care or receive aged care services at home.

  1. Most of these people are frail, have walking problems, and many have dementia.
  2. Physiotherapists can help older people improve their physical function and independence by coaching them to undertake regular balance and strengthening exercise.
  3. This is a challenge to deliver in the Australian aged care context as there are not enough physiotherapists to assist older people to exercise safely.
  4. COVID-19 has exacerbated the situation by restricting physiotherapist’s ability to visit people.   

Telehealth is emerging as a new way to allow older people to ‘see’ their physiotherapist online and exercise with a device such as an iPad and support from care workers. The TOP UP Study has collaborated with older people and service providers to co-design a research project to explore telehealth physiotherapy.  

Our intervention has training of care staff at its core. We aim to evaluate the effectiveness and acceptability of our telehealth physiotherapy programs on mobility and falls in older people receiving aged care services. We want to understand how to engage technology to improve the quality of life for this vulnerable population and seek to directly inform ongoing service delivery and staff training.

 

Background and Aims 

Mobility issues and falls often decrease independence and quality of life among older people, particularly those in aged care settings. There is increasing evidence that telehealth can support older people in the community, but its feasibility and acceptability in aged care are unknown. The TOP UP Study is a telehealth physiotherapy program that aims to investigate the impact of telephysiotherapy on the mobility and quality of life of older individuals receiving aged care services.

What We Did 

The study recruited 242 participants aged 65 years and above, who were receiving aged care services either in their own homes in the community or residential settings. The TOP UP Program consisted of a 6-month intervention, during which participants received 10 physiotherapy sessions conducted via video call using Zoom. Additionally, participants had access to online exercise videos and were supported by trained local aged care workers once a week. The physiotherapist’s used motivational coaching techniques to encourage participants to engage in balance and strength exercises for two hours per week.

Outcomes

The outcomes of the TOP UP project were promising. The exercise group showed a significant improvement in mobility, and there was a 40% reduction in the number of falls. Most participants (77%) completed the trial, engaging in an average of two 40-minute exercise sessions per week. The intervention proved safe, with only one person experiencing a fall during exercise. Participant feedback was overwhelmingly positive, with many expressing a willingness to recommend telephysiotherapy to others.

Key findings from the study highlight the significant impact of the TOP UP telehealth physiotherapy program on aged care recipients. The program provided convenient access to physiotherapy services, addressing a crucial community need. Tailored physiotherapy sessions, supported by local aged care workers, positively influenced participants' motivation to engage in exercises. Additionally, the use of senior-friendly online and printed resources, which featured large text, clear sound, and engaging content, enhanced program adherence.

Impact on Aged Care and Workforce

The TOP UP Study highlights the potential of telehealth physiotherapy programs in addressing mobility issues and reducing falls among older individuals in aged care settings, presenting an opportunity for aged care services to leverage telehealth technologies to enhance client care quality, especially in areas where it is hard to access physiotherapy services. Additionally, positive participant feedback underscores the importance of skilled and supportive caregiving in facilitating exercise adherence and promoting overall well-being, suggesting the need for aged care workers to receive training in supporting older adults with telephysiotherapy and exercise routines.

Resources Developed 

A website is planned to be released to the public in 2025.

Next Steps

The University of Sydney is planning to trial a version of the TOP UP study in hospital and in the general community to increase the access of evidence-based fall prevention exercise.

 

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