Center for Healthy Aging The Otago Exercise Program ... · Delivered by a PT or a Physical Therapy...

Improving the lives of 10 million older adults by 2020

Center for Healthy Aging

The Otago Exercise Program:

Implementation Journeys

May 16, 2018

Tiffany Shubert, PhD, MPT

Mary Lisa Siegel, MPT

Janet Hetherington, RN, BSN

Marissa Whitehouse, MEd

Improving the lives of 10 million older adults by 2020 | © 2017 National Council on Aging 2

Objectives

▪ Introduce the Otago Exercise Program

▪ Review the OEP Resources

▪ Discuss implementation and marketing strategies


Polling Question #1

▪ Who is joining us today?

▪ Community Providers (Area Agency on Aging/Senior

Centers)

▪ Physical Therapists/Rehab Agencies

▪ Other Health Care Professionals

▪ Personal Trainers/Exercise Instructors


Polling Question #2

▪ What is your experience with the Otago Exercise Program?

▪ Brand new to the program

▪ Have read about it, but never implemented

▪ Experienced implementation


Where did this all come from?

• Selected by CDC as an evidence-based fall prevention program in 2010– https://www.cdc.gov/homeandrecreationalsafety/falls/co

mpendium.html

• Implementation Guide published in 2012

• Online training launched March 2013; Updated March 2016– Online training, videos, tools for your practice and

patients

– http://www.med.unc.edu/aging/cgec/exercise-programOnline

training

$35

6000+

Providers

Trained

18

Countries

Represented

https://www.cdc.gov/homeandrecreationalsafety/falls/compendium.html


The Otago Exercise Program

▪ Evidence-based fall prevention program from New Zealand

▪ Implemented in the home

▪ 5 visits over 8 weeks

▪ Monthly phone calls when there is no face to face interaction

▪ Follow up visits at 6 months and 1 year

▪ Exercises

▪ A series of warm up exercises

▪ Up to 17 strength and balance exercises for up to 30

minutes/day, three times/week

▪ Three exercises use ankle weights to provide added

progressive resistance

▪ A walking program done for up to 30 minutes/day, three

times/week


The OEP Experience

7

Month 1 2 3 4 5 6

Week 1 2 4 6 8

Initial Visit Visit Visit Visit Visit

Call Call Call

Month 7 8 9 10 11 12

Week

Visit/DC

Call Call Call Call Call

Clinical/Supervised Phase Self- Management Phase


Most Appropriate For:

▪ Older adults who have experienced at least one fall

▪ Older adults who have significant balance impairments

▪ Older adults who would have challenges participating in a

community-based program


Progressive Strength Exercises


Progressive Balance/Strength Exercises


Progressive Static Balance Exercises


Progressive Balance Exercises

Supported

Unsupported

Knee bends

Supported Unsupported

Backward Walking


Progressive Balance Exercises

Sideways WalkingWalking and

Turning Around

Supported Unsupported

Heel – Toe Walking


Progressive Dynamic Balance Exercises

15

Supported

Unsupported

Toe Walking

Backward

walking

Stair

Walking


Translation Challenges!

▪ Developed and implemented in a small country with

nationalized healthcare

▪ OEP in-home visits and phone calls not aligned with

Medicare documentation and reimbursement policies and

procedures

▪ Program is still relatively unknown


US Modifications

The OEP works when the older adults do the exercises!

▪ Implement in the home, outpatient clinic, or community

setting

▪ Participants can exercise on their own, in a class, or using

online applications, videos, or virtual programs

▪ Participants can use a variety of tools to track participation

rates and progress


US Modifications

▪ Delivered by a PT or a Physical Therapy Assistant (PTA)

and reimbursed by Medicare as long as the participant

meets the requirements for physical therapy under

Medicare Part A, B, or C

▪ Required 8 week participation with a recommendation of a

minimum of 6 months

▪ Delivered by a community-based organization (by an

individual with an exercise background and experience

working with older adults)


Guidance Statementhttps://www.ncoa.org/wp-content/uploads/2017-OEP-Guidance-Statement.pdf


Fidelity Mantra

The OEP works when the older adults do the exercises!

▪ DO THE EXERCISES

▪ DO NOT MODIFY THE EXERCISES


Fidelity

▪ PT or PTA meeting with the participant five times over the

first eight weeks of the program, in either one-on-one or

group sessions

▪ Insuring the participant is challenged throughout the

program

▪ Insuring the participant has access to ankle weights

▪ Supporting participant adherence and compliance


Relevant Publications

▪ Shubert, T.E, Smith, M.L., Goto, L, Jiang, L., Ory, M.G. (2017). "Otago Exercise Program

in the United States: Comparison of Two Implementation Models." Phys Ther 97.

▪ Shubert TE, Goto LS, Smith ML, Jiang L, Rudman H, Ory MG.(2017). The Otago

Exercise Program: Innovative Delivery Models to Maximize Sustained Outcomes for High

Risk, Homebound Older Adults. Front Public Health. 2017 Mar 23;5:54. doi:

10.3389/fpubh.2017.00054.

▪ Shubert TE, Smith ML, Jiang L, Ory MG. Disseminating the Otago Exercise Program in

the United States: Perceived and Actual Physical Performance Improvements From

Participants. J Appl Gerontol. 2018 Jan;37(1):79-98. doi: 10.1177/0733464816675422.

▪ Shubert TE, Smith ML, Ory MG, Clarke CB, Bomberger SA, Roberts E, Busby-

Whitehead J. Translation of the otago exercise program for adoption and implementation

in the United States. Front Public Health. 2015 Apr 27;2:152. doi:

10.3389/fpubh.2014.00152

Otago Implementation

Experience: Effective

Physician Marketing

Strategies & Lesson's

LearnedLandmark Home Health Care Services

Mary Lisa Siegel, MPT

&

Janet Hetherington, RN, BSN

Effective Physician Marketing

Strategies

Getting to the right person in the Physician

office

Providing Otago Education

Providing our fall rate for those enrolled

Following back up with patient progress

Lessons Learned

Physical Therapist Buy In to program

Implemented Weekly Conference Calls to

Discuss Patients Referred

ALF/PCH were difficulty when transitioned to

Self-Management Phase

Selective in enrolling ALF/PCH patients into

Otago

Some of Marketers had difficulty presenting

Otago to Referral Sources

Added a Physical Therapist to the Marketing

Team

Lessons Learned

Weights

Cost issue for patients

Finding at a reasonable cost

Finding the weights that worked for patients

Insurance

Medicare Advantage Contracts

Authorizations


Contact Information

▪ Tiffany E. Shubert, PT, PhD

Clinical Architect, Shubert Consulting,

[email protected]

▪ Marissa Whitehouse, MEd

Senior Program Specialist, Center for Healthy Aging, National

Council on Aging;

[email protected]

▪ Janet Hetherington, RN, BSN

Administrator, Landmark Home Health Care Services

[email protected]

▪ Marylisa Siegel, MPT

Business Development Coordinator, Landmark Home Health

Care Services

[email protected]

mailto:[email protected]





Resources

▪ OEP implementors are required to complete the Otago

Exercise Program Online Training at

http://www.med.unc.edu/aging/cgec/exercise-program

(cost $35).

▪ Other information about training, resources, and marketing

materials is available at

http://www.med.unc.edu/aging/cgec/exercise-program.

▪ OEP Database

▪ https://apps.hpdp.unc.edu/ACL/security/login



https://apps.hpdp.unc.edu/ACL/security/login

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