Let’s make a SMART

referral: a comparison of

SMART and Enhanced

SMART

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Jennifer McLellan & Andrea Cameron

Original SMART

Overview:

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The SMART Program

SMART (Seniors Maintaining Active Roles Together) ® is an exercise program for community members 55+ who wish to improve their strength, balance and flexibility, regardless of their current physical ability.

The Original SMART Program

Evidence-based and accredited by Accreditation Canada

Fully funded by NSM LHIN- no cost to the participant

Community exercise classes, in-home exercises and healthy aging education classes

Specialized classes for Stroke, Parkinson Disease, Osteoporosis, Multiple Sclerosis and community members who are deaf

Across NSM LHIN there are over 300 classes running at 126 sites each week!

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Inclusion Criteria

Community members 55+

Reside in NSM LHIN

Reside in Community/ Retirement Home (not LTC)

Must be able to participate and follow instructions to complete exercises

Referral Sources: anyone can refer & self referrals accepted – please contact the SMART coordinator in your area

Program Components

In Home: 1 session per week with a fitness leader/volunteer Client to complete the 15 exercises an additional 2 x

per week on their own for 12 weeks Significant waitlist - attend classes where possible

Exercise Classes: Retirement homes and community locations Classes run continuously through the year 45 minutes- 1 hour in duration

Program Components

Healthy Aging Education:

12 standardized education modules developed and delivered by regulated health professionals from the IRFP, VON and Osteoporosis Canada

12 2-hour sessions delivered across NSM LHIN in various locations

Contact Information

Barrie and area: 705-737-5044 ext. 221

Muskoka: 705-787-1996

Orillia and area: 705-326-7021

Collingwood, Wasaga Beach & Midland areas: 705-355-2200

Enhanced SMART

Overview

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Enhanced SMART Pilot Project 10

An initiative of the Assess and Restore program & Rehab Care Alliance

Current gap in community-based rehabilitation programs for the frail elderly

The interdisciplinary team works with seniors at high risk for hospitalization or admission to LTC

Fully funded by NSM LHIN until March 2017- no cost to the participant

Inclusion Criteria

Aged 55+ & live in the Barrie or Orillia area

4 to 6 on the Clinical Frailty Scale

Restorative potential and a recent decline in functional ability

Designated Referral sources:

RVH, OSMH, IOOF Convalescent Care Program (CCP), Woods Park CCP, Muskoka Shores CCP, IRFP, CCAC Rapid Response Nurses, VON SMART, Aging Well Clinic and Dr. Young’s Geriatric Outreach Clinic

Program Components

Team: Kinesiologist, Physiotherapist, Occupational Therapist & fitness leaders (OTA/PTA designated)

Comprehensive intake and discharge assessments

Individualized client-centered care plans

Group or in-home exercises, falls prevention/healthy aging education & cognitive stimulation activities

Ongoing support and monitoring by the RHPs

30 day follow-up calls

Goal: progress clients to Original SMART or other community exercise programs

Class Structure

Builds on the Original SMART model to include progressive, evidence-based exercises with client-centered care plans

Two class locations in Barrie & two classes in Orillia running twice weekly for a maximum of 12 weeks

In-home: 1:1 with an exercise leader [1 hour of exercises]

Class: 1:6 ratio -Maximum of 12 participants with 1 exercise leader and 1 regulated health professional (RHP) [2 hours of exercise, education & cognitive stimulation]

Successes - Outcome Measures

Average Pre Average Post Average Gain

Barthel (/20) 16.9 18.2 1.29

Knowledge confidence

(/55)

36.6 48.4 11.8

QOL (/65) 49.5 55.8 6.3

CFS (1-7) 5 (Mildly Frail) 4 (Vulnerable) -1 (Less Frail by 1

category)

Tinetti (/28) 18 (High risk of falls) 21.5 (Moderate risk of falls) 3.5

Grip Strength Right (kg) 20.7 21.3 0.6

Grip Strength Left (kg) 19.4 20.2 0.8

30s STS Test (# reps) 2.5 3.6 1.1

Gait Speed Test (m/s) 0.42 (red flag) 0.67 (yellow flag) 0.25** (a Δ of 0.1m/s is

clinically significant)

COPM Performance (/10) 2.5 6.1 3.6** (a Δ of 2 is clinically

significant)

COPM Satisfaction (/10) 2.7 7.2 4.5** (a Δ of 2 is clinically

significant)

Contact Info:

Andrea CameronKinesiologist & Enhanced SMART Program ContactVON Canada Simcoe County Branch

Tel: 705-737-5044 ext. 248

Central IntakeFax: 705-330-3201Email: enhancedsmart@osmh.on.ca

So, what is the

difference?

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In-home Comparison

SMART Enhanced SMART

1 hour of exercises 1 hour of exercises, informal education and cognitive stimulation

1 x per week 2 x per week

Led by a FitnessLeader/Volunteer

Led by an OTA/PTA

12 weeks in duration Maximum of 12 weeks

Community Class Comparison

SMART Enhanced SMART45min. to 1 hour of exercises 1 hour of exercises

Classes run throughout the week at a variety of locations and times

Each class runs twice a week at the 3 locations: North Barrie, South Barrie and Orillia.

Led by a Fitness Leader/Volunteer/RKin

Led by an OTA/PTA and RHP (RKin, PTor OT)

No set ratio of leader : participant 1:6 max ratio of leader : participant

Classes run continuously Maximum of 12 weeks

Program consists of exercises Program consists of exercises, cognitive stimulation and education

Exercise Comparison

SMART Enhanced SMARTProgressive and Maintenance exercises for strength, balance and mobility

Rehabilitative and Progressive exercises for strength, balance and mobility

Evidence-based and accredited

Individualized client-centered care plans determined by PT/RKin

General Comparisons

SMART Enhanced SMARTReferrals:

Any referral source, including self referrals

Referrals: Designated sources

Inclusion Criteria:Community members 55+ in the NSM

LHIN

Inclusion Criteria: High-risk frail seniors with restorative

potential in Barrie/Orillia areas

Cost:Funded by LHIN – no cost for

participant

Cost:Funded by LHIN – no cost for

participant

Ongoing Program- base funding Pilot Project- funded until March 2017

Questions?

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