Implementation of a digital exercise programme in health services to prevent falls in older people

Morag E Taylor; Meghan Ambrens; Helen Hawley-Hague; Christopher Todd; Jacqueline C T Close; Stephen R Lord; Lindy Clemson; Thomas Lung; David Berlowitz; Jannette Blennerhassett; Julia Dayhew; Ashley Gluchowski; Wendy Hodge; Pamela Johnson; Reena Lasrado; Marita Merlene; Lillian Miles; Sandra O'Rourke; Catherine M Said; Leanne White; Nicola Wilson; Avigdor Zask; Kim Delbaere

doi:10.1093/ageing/afae173

Implementation of a digital exercise programme in health services to prevent falls in older people

Age Ageing. 2024 Aug 6;53(8):afae173. doi: 10.1093/ageing/afae173.

Authors

Morag E Taylor^{1

2

3}, Meghan Ambrens^{1

2}, Helen Hawley-Hague^{4

5

6}, Christopher Todd^{4

5

6

7}, Jacqueline C T Close^{1

8}, Stephen R Lord^{1

2}, Lindy Clemson^{9

10}, Thomas Lung^{11

12}, David Berlowitz^{13

14}, Jannette Blennerhassett¹³, Julia Dayhew¹⁵, Ashley Gluchowski^{5

16}, Wendy Hodge¹⁷, Pamela Johnson¹⁸, Reena Lasrado^{4

5

6}, Marita Merlene¹⁷, Lillian Miles¹, Sandra O'Rourke¹, Catherine M Said^{14

19

20}, Leanne White^{1

15}, Nicola Wilson²¹, Avigdor Zask^{15

22}, Kim Delbaere^{1

2}

Affiliations

¹ Neuroscience Research Australia, Falls, Balance and Injury Research Centre, Sydney, New South Wales, Australia.
² Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia.
³ School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia.
⁴ School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.
⁵ National Institute for Health and Care Research, Applied Research Collaboration-Greater Manchester, The University of Manchester, Manchester, UK.
⁶ Manchester Academic Health Science Centre, Manchester, UK.
⁷ Manchester University NHS Foundation Trust, Manchester, UK.
⁸ School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia.
⁹ Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
¹⁰ Centre of Excellence for Population Ageing Research, The University of Sydney, Sydney, New South Wales, Australia.
¹¹ Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
¹² The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia.
¹³ Austin Health, Heidelberg, Victoria, Australia.
¹⁴ Physiotherapy, University of Melbourne, Parkville, Australia.
¹⁵ Health Promotion, Northern NSW Local Health District, Lismore, New South Wales, Australia.
¹⁶ School of Health & Society, University of Salford, Salford, UK.
¹⁷ ARTD Consultants, Sydney, New South Wales, Australia.
¹⁸ Mid North Coast Local Health District, New South Wales, Australia.
¹⁹ Physiotherapy, Western Health, St Albans, Victoria, Australia.
²⁰ Australian Institute of Musculoskeletal Science, St Albans, Victoria, Australia.
²¹ Research & Innovation Service, Mersey Care NHS Foundation Trust, Liverpool, UK.
²² University Centre for Rural Health, School of Public Health, University of Sydney, Lismore New South Wales, Australia.

Abstract

Background: StandingTall uses eHealth to deliver evidence-based balance and functional strength exercises. Clinical trials have demonstrated improved balance, reduced falls and fall-related injuries and high adherence. This study aimed to evaluate the implementation of StandingTall into health services in Australia and the UK.

Methods: Two hundred and forty-six participants (Australia, n = 184; UK, n = 62) were recruited and encouraged to use StandingTall for 2 h/week for 6-months. A mixed-methods process evaluation assessed uptake and acceptability of StandingTall. Adherence, measured as % of prescribed dose completed, was the primary outcome.

Results: The study, conducted October 2019 to September 2021 in Australia and November 2020 to April 2022 in the UK, was affected by COVID-19. Participants' mean age was 73 ± 7 years, and 196 (81%) were female. Of 129 implementation partners (e.g. private practice clinicians, community exercise providers, community service agencies) approached, 34% (n = 44) agreed to be implementation partners. Of 41 implementation partners who referred participants, 15 (37%) referred ≥5. Participant uptake was 42% (198/469) with mean adherence over 6 months being 41 ± 39% of the prescribed dose (i.e. 39 ± 41 min/week) of exercise. At 6 months, 120 (76%) participants indicated they liked using StandingTall, 89 (56%) reported their balance improved (moderately to a great deal better) and 125 (80%) rated StandingTall as good to excellent. For ongoing sustainability, health service managers highlighted the need for additional resources.

Conclusions: StandingTall faced challenges in uptake, adoption and sustainability due to COVID-19 and a lack of ongoing funding. Adherence levels were lower than the effectiveness trial, but were higher than other exercise studies. Acceptance was high, indicating promise for future implementation, provided sufficient resources and support are made available.

Trial registration: Australian and New Zealand Clinical Trials Registry ACTRN12619001329156.

Keywords: adherence; aged; exercise; health behaviour; implementation science; older people; postural balance; qualitative research; telemedicine.

MeSH terms

Accidental Falls* / prevention & control
Aged
Aged, 80 and over
Australia
COVID-19* / epidemiology
COVID-19* / prevention & control
Exercise Therapy* / methods
Female
Humans
Male
Patient Compliance / statistics & numerical data
Postural Balance*
SARS-CoV-2
Telemedicine
United Kingdom