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Training Physical Therapistsin Evidence-BasedOutcome Measures

TheOtago Exercise ProgramTraining WebinarApril 17, 2013

Tiffany E. Shubert, PhD, MPTCarolina Geriatric Education Center

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AcknowledgementsCarolina Geriatric Education ConsortiumContentWebinar Platform

Eastern Area Health Education CenterContact HoursArchived webinar 2

You could just put the logos2What we want to understand about the Otago Exercise ProgramThe research & rollout in the USHow to implement Discuss evidence-based protocols for outcome measuresHow to use the database to track patient outcomes

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US ImplementationCDC identifies Otago as an evidence-based fall prevention programCDC Pilots in CO, NY, OROnline training programCDC Partners, Policies, and Programs for Fall Prevention Evaluation of implementation 4

Please add in state icons4Otago True or False?You must start Otago on Day 1You have to prescribe all 17 exercises on Day 1You need to modify the exercises for your patientYour patient will not succeed if you see them so infrequentlyBut my exercises are better than Otago

5Cris, we could potentially do a poll here? I cut it down to the top 5. Might be fuYes definitely polls I will load5Myths of Standardization & Variation

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Ask audience about benefits of standardization of practice

Minimize variation in practice to maximize outcomesProvide a set of exercises which can be selected and progressed for each individual patient regardless of therapistLeverages motor learning greater repetition facilitates learning

6Otago In a nutshellEvidence-based fall prevention program from New Zealand6 8 visits over a yearStandard set of balance and strength exercisesBest for community-dwelling but frailPatient does exercises INDEPENDENTLYProgressed by physical therapist30-40% reduction in falls in high risk fallersCan it work in the United States?7This is not really the research. Ask them what they know about otago. Have them describe the program in the chat. Someone gives us one piece then the next and so on. We can prompt with questions. Eg. Where did otago start. And this page could be just pictures. 7Before You StartIs the patient ready?Is the patient compliant?Do we start on day 1???

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Do you want these as yes no questions? Or how do you know the patient is ready, compliant etcI would just have the pics and ask the questions verbally or do it like I have here with one slide for patietn and 1 for PT8Before You StartIs 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?9

Quick Review Outcome MeasuresTimed Up and Go30-second Chair RiseStanding balance sequenceWalking speed*Walking speed is optional, only input if your agency already collects the datahttp://www.cdc.gov/homeandrecreationalsafety/Falls/steadi/videos.html#TUG10

Call on people to describe protocols for each measures10Lets go!Register your patient (anytime before start)Enter baseline info (Otago Day 1)Follow up info @ 8 weeks & 6 monthsDischarge when appropriate11

Add pictures of older people

11Otago Visit 1 What info is collected?What happens?When is next visit?

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Complete Baseline SurveyIncludes Functional Outcome MeasuresIf not first day of PT, no need to do a full evaluationPrescribe exercises Review exercisesRepeat the patient MUST DO the exercisesReview exercisesSee in 1 week

After this slide go to database and demonstrate patient enrollment and baseline information12Otago Visits13Month123456Week123468InitialVisitVisitVisit*VisitVisitCallCallCallMonth789101112WeekVisitVisitCallCallCall

PT Management PhaseSelf- Management PhaseMake sure the patient is READY and Compliant!! Does Otago need to start on day 1? No!!13Visit 4 and AfterVisit 4 Outcome measuresPhone callsVisits 5, 6, 7 (Months 6, 9 , 12)Final Otago Visit/Discharge:Discharge at 12-Month point or WHEN APPROPRIATEWhen to discharge: Patient no longer challenged by Otago ORPatient mastered exercises and independently exercising 6 days per week ORPatient met goals Resources and Reminders

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Picture of older adultCut away to database14Reminders and ResourcesPhone callsEmail remindersWhere to go if you have questionswww.Phconnect.org15

15How am I doing?You (or your agency) can requestAverage number of visitsImprovements in outcome measuresFall history

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SummaryProvide your email to access the databaseYou will receive an email inviting you to joinFor each patientEnter into the databaseComplete Patient Information and Baseline Survey tabs within 5 days of starting OtagoReceive e-mail reminders for 3-Month 6-Month Follow-Up visitsComplete Discharge Survey when patient is discharged from Otago (can be done at ANY time)17Questions?otago@unc.eduPhconnect.org919-360-1970 if you get really stuck!18

AppendixScreen shots to demonstrate database use19OTAGO EXERCISE PROGRAM:Outcome Measures DatabaseForm CompletionNavigationInstructions to Therapist

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