Acknowledgements

1. Training Physical Therapistsin Evidence-BasedOutcome MeasuresTheOtago Exercise ProgramTraining WebinarApril 17, 2013Tiffany E. Shubert, PhD, MPTCarolina Geriatric Education Center

2. Acknowledgements • Carolina Geriatric Education Consortium • Content • Webinar Platform • Eastern Area Health Education Center • Contact Hours • Archived webinar

3. What we want to understand about the Otago Exercise Program • The research & rollout in the US • How to implement • Discuss evidence-based protocols for outcome measures • How to use the database to track patient outcomes

4. US Implementation • CDC identifies Otago as an evidence-based fall prevention program • CDC Pilots in CO, NY, OR • Online training program • CDC Partners, Policies, and Programs for Fall Prevention • Evaluation of implementation

5. Otago – True or False? • You must start Otago on Day 1 • You have to prescribe all 17 exercises on Day 1 • You need to modify the exercises for your patient • Your patient will not succeed if you see them so infrequently • But my exercises are better than Otago…

6. Myths of Standardization & Variation

7. Otago – In a nutshell • Evidence-based fall prevention program from New Zealand • 6 – 8 visits over a year • Standard set of balance and strength exercises • Best for community-dwelling but frail • Patient does exercises INDEPENDENTLY • Progressed by physical therapist • 30-40% reduction in falls in high risk fallers • Can it work in the United States?

8. Before You Start • Is the patient ready? • Is the patient compliant? • Do we start on day 1???

9. Before You Start • Is the therapist ready? • Is the therapist compliant? • Is the therapist proficient in the outcome measures? • Has the therapist registered with the database? • Has the therapist registered the patient with the database?

10. Quick Review – Outcome Measures • Timed Up and Go • 30-second Chair Rise • Standing balance sequence • Walking speed* • Walking speed is optional, only input if your agency already collects the data http://www.cdc.gov/homeandrecreationalsafety/Falls/steadi/videos.html#TUG

11. Let’s go! • Register your patient (anytime before start) • Enter baseline info (Otago Day 1) • Follow up info @ 8 weeks & 6 months • Discharge when appropriate

12. Otago Visit 1 • What info is collected? • What happens? • When is next visit?

13. Otago Visits PT Management Phase Self- Management Phase

14. Visit 4 and After • Visit 4 – Outcome measures • Phone calls • Visits 5, 6, 7 (Months 6, 9 , 12) • Final Otago Visit/Discharge: • Discharge at 12-Month point or WHEN APPROPRIATE • When to discharge: • Patient no longer challenged by Otago OR • Patient mastered exercises and independently exercising 6 days per week OR • Patient met goals • Resources and Reminders

15. Reminders and Resources • Phone calls • Email reminders • Where to go if you have questions • www.Phconnect.org

16. How am I doing? • You (or your agency) can request • Average number of visits • Improvements in outcome measures • Fall history

17. Summary • Provide your email to access the database • You will receive an email inviting you to join • For each patient • Enter into the database • Complete Patient Information and Baseline Survey tabs within 5 days of starting Otago • Receive e-mail reminders for 3-Month 6-Month Follow-Up visits • Complete Discharge Survey when patient is discharged from Otago (can be done at ANY time)

18. Questions? • otago@unc.edu • Phconnect.org • 919-360-1970 if you get really stuck!

19. Appendix • Screen shots to demonstrate database use

20. OTAGO EXERCISE PROGRAM:Outcome Measures Database Form Completion • Navigation • Instructions to Therapist