Online physio program brings fall prevention into the home

The national TOP UP clinical trial, a partnership between University of Sydney researchers and aged care providers, found participants could walk and get out of a chair more easily, were less likely to fall, and experienced less pain.

The results of the trial, recently published in the Medical Journal of Australia, showcase the potential for telehealth physical therapy programs assisted by local aged care workers, especially in regional and rural settings with less access to physical therapists, said the study’s first author Dr. Rik Dawson.

“As a physical therapist, I see a lot of older patients who’ve gradually lost strength and mobility over time who are scared to get back into regular exercise in case they fall and hurt themselves. But over six months, this program helped people to walk better and fall less,” said Dr. Dawson, Postdoctoral Researcher in the Sydney School of Public Health and Institute for Musculoskeletal Health.

Trial participants saw significant improvements in their health, including:

• TOP UP participants moved better and more easily after completing the program. On average, their mobility (ability to stand up and walk) improved by more than 2 points on a standard 12-point test used by physical therapists.
• They were less likely to fall. About 1 in 3 had a fall compared to nearly 1 in 2 in the control group who received standard physical therapy care. Participants in the control group received usual care, which included seated group exercise, general mobility activities, or massage and heat therapy, but not tailored physical therapy or structured strength and balance training.
• Participants reported less pain—1 point lower on the 10-point pain scale used as standard in health care (with 1 being no pain and 10 being the worst pain imaginable).
• Their overall quality of life improved by standard measures (up 6 points out of a 100-point scale), including things like daily comfort, confidence, and ability to stay active.
• Nearly everyone who took part (94%) said they would recommend the program to others.
• Importantly, the telehealth-delivered exercise sessions themselves were safe. Only one fall occurred during an exercise session, and it did not result in any injury.

More than one-third of people over 70, and most people over 85, live with a mobility-related disability.

Professor Cathie Sherrington, senior author of the study, said, “One of the great things shown in the data from the TOP UP trial was that this combination of expert advice from physical therapists over video consultations such as Zoom and in-person support from care workers or family meant we could provide a safe, accessible environment for people to exercise more, improve mobility and regain some of their independence.

“We saw remarkable improvements across multiple measures of health and quality of life from people who undertook the TOP UP program, and 94% of participants would recommend it to others,” said Professor Sherrington, a Senior Principal Research Fellow at the Sydney School of Public Health, Charles Perkins Center member, and Deputy Director of the Institute for Musculoskeletal Health at the Sydney Local Health District.

The randomized controlled clinical trial was conducted over two years with 242 individuals aged 65+, across 27 sites in Australia. The average age of participants was 82 years and 47% had mild-to-moderate cognitive impairments, including dementia. Some lived in the community with aged care support, while others resided in aged care facilities.

Care workers provided iPads and equipment for remote physical therapy sessions. The sessions used focused exercise to improve balance, strength, and stamina. Exercises built up from standing and balance practices to squats, stairs and stepping through obstacle courses.

“The exercises were challenging but realistic,” said Dr. Dawson. “Research shows that this helps build up balance, strength and confidence quickly, but it can understandably be a bit intimidating if someone with mobility issues were to think about taking it up at home unsupervised.

“When you’ve had limited mobility and pain for years, this kind of strength training really increases your confidence, quality of life and overall health,” added Dr. Dawson. “So much so that one of our early participants, Rita, has kept using the program for the last two years and recommends it to everyone.

Rita, who is 95 and lives in Sydney’s Inner West, said, “Because of my health, there’s no way I can go out to see a physical therapist. One, I’ve got to get someone, like a relative, to take me, or pay someone to take me. It’s not practical.

“Two, it’s hard to park anywhere near the physical therapist, so you’ve usually got to walk. By the time you get to the physical therapist you’re exhausted,” said Rita.

“I think TOP UP is fabulous. I wouldn’t have imagined that I would be given the opportunity to get physical therapy. Physically, I can walk further. My breathing is better. I’m stronger, and it gives you more independence.”

Following the initial success of the TOP UP research trial, Dr. Dawson is now in the process of commercializing his research.

The researchers will continue working with industry partners including Whiddon, Uniting AgeWell, Ashfield Baptist Homes and Maranatha House, to scale up the TOP UP program so more aged care residents can benefit from easy access to bespoke physical therapy advice.

Professor Sherrington added, “Australia is in desperate need of more qualified health care professionals who can help our aging population, particularly in rural and regional towns, access the care they need to live life comfortably, confidently and independently. TOP UP helps bridge that gap and we’re excited to continue building on these strong results.”