The Telephysiotherapy for Older People (TOP-UP) program for improving mobility in people receiving aged care: a hybrid type 1 effectiveness–implementation randomised controlled trial

IF 8.5 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

Medical Journal of Australia Pub Date : 2025-07-20 DOI:10.5694/mja2.70004

Rik Dawson, Marina Pinheiro, Juliana Oliveira, Abby Haynes, Vasikaran Naganathan, Morag E Taylor, Nina Bowes, Karn Nelson, Jenny Rayner, Catherine Sherrington

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Abstract

Objectives

To assess the effectiveness and implementation of a telephysiotherapy program for improving mobility, mobility goal attainment, and quality of life of people receiving at-home or residential aged care.

Study design

Hybrid type 1 effectiveness–implementation randomised controlled trial.

Setting, participants

People aged 65 years or older who were receiving community or residential aged care services in Australia, 1 September 2021 – 30 November 2023.

Intervention

Telephysiotherapy for Older People (TOP-UP): six-month program of ten telephysiotherapy (Zoom) sessions for assessment and tailored exercise prescription, supported by trained aged care workers and exercise videos.

Main outcome measures

Primary outcome: mobility (Short Physical Performance Battery [SPPB] score at baseline and six months). Secondary outcomes: fall rate (per person), proportion of people with falls, SPPB components (sit-to-stand performance, balance, gait speed), pain (visual analogue scale), mobility goal attainment, physical activity (Incidental and Planned Exercise Questionnaire), quality of life (EQ-5D-5L visual analogue scale).

Results

A total of 1348 people were screened at 27 sites, and 242 eligible people were recruited for the trial (mean age, 83 years [standard deviation, 8 years]; 158 women [65%]); 92 of 120 intervention group participants and 100 of 122 control group participants completed the six-month. After adjusting for baseline mobility scores, the mean difference in mobility score at six months (intervention v control group) was 2.1 (95% confidence interval [CI], 1.4–2.7) points. Sit-to-stand performance was more likely to improve in intervention than control participants (adjusted odds ratio, 2.7; 95% CI, 1.3–4.3); intervention participants reported greater quality of life (EQ-5D-5L visual analogue scale: adjusted mean difference, 6.2 [95% CI, 1.8–10.7] points) and less pain (visual analogue scale: adjusted mean difference, –1.1 [95% CI, –1.8 to –0.3] points), and a smaller proportion experienced falls (29, 32% v 44, 44%; risk ratio, 0.62; 95% CI, 0.42–0.92). Of 1348 screened people, 242 enrolled in the trial (18.0%), of whom 186 (77%) completed the trial, and 62 of 66 surveyed participants (94%) endorsed the intervention. No serious adverse events were recorded.

Conclusion

The TOP-UP program safely improved mobility, reduced fall risk and pain, and improved quality of life for people receiving aged care. Telephysiotherapy could be incorporated into aged care to improve the lives of older Australians.

Trial registration

Australian New Zealand Clinical Trials Registry, ACTRN 12621000734864 (prospective).

Abstract Image

查看原文本刊更多论文

老年人远程物理治疗（TOP-UP）项目用于改善接受老年护理的人的行动能力：一项混合1型有效性实施随机对照试验。

目的：评估远程物理治疗方案的有效性和实施，以改善接受居家或居家老年护理的人的活动能力、活动目标的实现和生活质量。研究设计：混合1型有效性-实施随机对照试验。环境，参与者：在2021年9月1日至2023年11月30日期间，在澳大利亚接受社区或住宅老年护理服务的65岁或以上的老年人。干预：老年人远程物理治疗（充值）：为期六个月的10次远程物理治疗（Zoom）课程，用于评估和量身定制的运动处方，由训练有素的老年护理人员和运动视频提供支持。主要结局指标：活动能力（基线和6个月时SPBB评分）。次要结局：跌倒率（人均）、跌倒人群比例、SPBB成分（坐立表现、平衡、步态速度）、疼痛（视觉模拟量表）、活动目标实现、身体活动（附带和计划运动问卷）、生活质量（EQ-5D-5L视觉模拟量表）。结果：在27个站点共筛选了1348人，招募了242名符合条件的受试者(平均年龄83岁[标准差8岁]；158名妇女[65%])；120名干预组参与者中有92人完成了六个月的训练，122名对照组参与者中有100人完成了六个月的训练。调整基线活动能力评分后，6个月时（干预组和对照组）活动能力评分的平均差异为2.1分（95%可信区间[CI]， 1.4-2.7）。与对照组相比，干预组的坐立表现更有可能得到改善(校正优势比，2.7；95% ci, 1.3-4.3)；干预参与者报告了更高的生活质量（EQ-5D-5L视觉模拟量表：调整后的平均差值，6.2 [95% CI, 1.8-10.7]分）和更少的疼痛（视觉模拟量表：调整后的平均差值，-1.1 [95% CI, -1.8至-0.3]分），更小的比例经历跌倒(29.32% v 44.44%；风险比0.62；95% ci, 0.42-0.92)。在1348名被筛选者中，242人参加了试验（18.0%），其中186人（77%）完成了试验，66名被调查参与者中有62人（94%）赞同干预措施。无严重不良事件记录。结论：补足项目安全改善了老年人的活动能力，减少了跌倒风险和疼痛，并改善了老年人的生活质量。远程物理治疗可以纳入老年护理，以改善澳大利亚老年人的生活。试验注册：澳大利亚新西兰临床试验注册中心，ACTRN 12621000734864（前瞻性）。

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来源期刊

Medical Journal of Australia 医学-医学：内科

CiteScore

9.40

自引率

5.30%

发文量

410

审稿时长

3-8 weeks

期刊介绍： The Medical Journal of Australia (MJA) stands as Australia's foremost general medical journal, leading the dissemination of high-quality research and commentary to shape health policy and influence medical practices within the country. Under the leadership of Professor Virginia Barbour, the expert editorial team at MJA is dedicated to providing authors with a constructive and collaborative peer-review and publication process. Established in 1914, the MJA has evolved into a modern journal that upholds its founding values, maintaining a commitment to supporting the medical profession by delivering high-quality and pertinent information essential to medical practice.